Cost-effectiveness Of Screening Program Research Articles

Genetic landscape of recessive diseases in the Vietnamese population from large-scale clinical exome sequencing.

Accurate profiling of population-specific recessive diseases is essential for the design of cost-effective carrier screening programs. However, minority populations and ethnic groups, including Vietnamese, are still underrepresented in existing genetic studies. Here, we reported the first comprehensive study of recessive diseases in the Vietnamese population. Clinical exome sequencing data of 4503 disease-associated genes obtained from a cohort of 985 Vietnamese individuals was analyzed to identify pathogenic variants, associated diseases and their carrier frequencies in the population. A total of 118 recessive diseases associated with 164 pathogenic or likely pathogenic variants were identified, among which 28 diseases had carrier frequencies of at least 1% (1 in 100 individuals). Three diseases were prevalent in the Vietnamese population with carrier frequencies of 2-12 times higher than in the world populations, including beta-thalassemia (1 in 23), citrin deficiency (1 in 31), and phenylketonuria (1 in 40). Seven novel pathogenic and two likely pathogenic variants associated with nine recessive diseases were discovered. The comprehensive profile of recessive diseases identified in this study enables the design of cost-effective carrier screening programs specific to the Vietnamese population.

The Costs and Benefits of Risk Stratification for Colorectal Cancer Screening Based On Phenotypic and Genetic Risk: A Health Economic Analysis.

Population-based screening for colorectal cancer is an effective and cost-effective way of reducing colorectal cancer incidence and mortality. Many genetic and phenotypic risk factors for colorectal cancer have been identified, leading to development of colorectal cancer risk scores with varying discrimination. However, these are not currently used by population screening programs. We performed an economic analysis to assess the cost-effectiveness, clinical outcomes, and resource impact of using risk-stratification based on phenotypic and genetic risk, taking a UK National Health Service perspective. Biennial fecal immunochemical test (FIT), starting at an age determined through risk-assessment at age 40, was compared with FIT screening starting at a fixed age for all individuals. Compared with inviting everyone from age 60, using a risk score with area under the receiver operating characteristic curve of 0.721 to determine FIT screening start age, produces 418 QALYs, costs £247,000, and results in 218 fewer colorectal cancer cases and 156 fewer colorectal cancer deaths per 100,000 people, with similar FIT screening invites. There is 96% probability that risk-stratification is cost-effective, with net monetary benefit (based on £20,000 per QALY threshold) estimated at £8.1 million per 100,000 people. The maximum that could be spent on risk-assessment and still be cost-effective is £114 per person. Lower benefits are produced with lower discrimination risk scores, lower mean screening start age, or higher FIT thresholds. Risk-stratified screening benefits men more than women. Using risk to determine FIT screening start age could improve the clinical outcomes and cost effectiveness of colorectal cancer screening without using significant additional screening resources. PREVENTION RELEVANCE: Colorectal cancer screening is essential for early detection and prevention of colorectal cancer, but implementation is often limited by resource constraints. This work shows that risk-stratification using genetic and phenotypic risk could improve the effectiveness and cost-effectiveness of screening programs, without using substantially more screening resources than are currently available.

Cost-effectiveness of a population-based AAA screening program for men over 65 years old in Iran

BackgroundScreening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran.MethodsA Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients’ medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer’s perspective. Costs and effects were discounted at an annual rate of 3%. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses.ResultsThe mean incremental cost of the AAA screening strategy compared with the no-screening strategy was $140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of $5566 ($14,656 PPP) per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita ($5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50%. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95% probability for the AAA screening program to be cost-effective in Iran.ConclusionsThe results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained.

Impact of artificial intelligence support on accuracy and reading time in breast tomosynthesis image interpretation: a multi-reader multi-case study

ObjectivesDigital breast tomosynthesis (DBT) increases sensitivity of mammography and is increasingly implemented in breast cancer screening. However, the large volume of images increases the risk of reading errors and reading time. This study aims to investigate whether the accuracy of breast radiologists reading wide-angle DBT increases with the aid of an artificial intelligence (AI) support system. Also, the impact on reading time was assessed and the stand-alone performance of the AI system in the detection of malignancies was compared to the average radiologist.MethodsA multi-reader multi-case study was performed with 240 bilateral DBT exams (71 breasts with cancer lesions, 70 breasts with benign findings, 339 normal breasts). Exams were interpreted by 18 radiologists, with and without AI support, providing cancer suspicion scores per breast. Using AI support, radiologists were shown examination-based and region-based cancer likelihood scores. Area under the receiver operating characteristic curve (AUC) and reading time per exam were compared between reading conditions using mixed-models analysis of variance.ResultsOn average, the AUC was higher using AI support (0.863 vs 0.833; p = 0.0025). Using AI support, reading time per DBT exam was reduced (p < 0.001) from 41 (95% CI = 39–42 s) to 36 s (95% CI = 35– 37 s). The AUC of the stand-alone AI system was non-inferior to the AUC of the average radiologist (+0.007, p = 0.8115).ConclusionsRadiologists improved their cancer detection and reduced reading time when evaluating DBT examinations using an AI reading support system.Key Points• Radiologists improved their cancer detection accuracy in digital breast tomosynthesis (DBT) when using an AI system for support, while simultaneously reducing reading time.• The stand-alone breast cancer detection performance of an AI system is non-inferior to the average performance of radiologists for reading digital breast tomosynthesis exams.• The use of an AI support system could make advanced and more reliable imaging techniques more accessible and could allow for more cost-effective breast screening programs with DBT.

SCREENING FOR CONGENITAL HYPOTHYROIDISM WITH UMBILCAL CORD BLOOD TSH LEVEL ‘AN EXPERIENCE FROM A TERTIARY CARE CENTER'

BACKGROUND:- Congenital hypothyroidism (CH) is the most common preventable cause of mental retardation. Screening for congenital hypothyroidism can be helpful in preventing mental retardation among general population. Umbilical cord blood TSH (CBTSH) estimation has been universally accepted and is one of the most cost effective screening programs in the field of preventive medicine and public health. AIMS AND OBJECTIVES:- This study was aimed to find the effectiveness of cord blood TSH as a screening tool for congenital hypothyroidism. MATERIALS AND METHODS:- This hospital based cross sectional study was conducted at GCS Medical College Hospital &amp; Research Centre, Ahmedabad, over a period of one year in 1687 neonates. All newborns delivered at the institute were subjected to cord blood TSH level estimation and a repeat Serum TSH estimation was done at or after 72 hours of life. Diagnosis of congenital hypothyroidism is confirmed postnatally by standard Serum TSH value cut offs as per age. Data collected and statistically analysed. RESULTS:- Out of 1687 neonates born during the study period, 1548 formed the study group. 805 (52%) were males and 743(48%) were females. The birth weight of babies ranged from 850 gms to 4300 gms. The value of CBTSH varied from 1.3mIU/L to 101.4mIU/L with mean CBTSH of 7.21mIU/L. 28(1.8%) babies had CBTSH levels &gt;20mIU/L. Out of which four were later diagnosed to have congenital hypothyroidism. All four had CBTSH levels &gt;20mIU/L. All other neonates with CBTSH levels less than 20mIU/L were found to have normal screening later postnatally. CONCLUSION:- The current study concludes that cord blood TSH is a sensitive marker to screen for congenital hypothyroidism in neonates. A cut off value of cord blood TSH &gt;20mIU/ml can be used for screening purpose.

Diagnostic patterns in keratoconus

PurposeTo investigate the current patterns of diagnosis and referral in keratoconus. MethodsA retrospective chart review was performed of patients who had recently been diagnosed with keratoconus and attended dedicated clinics at Antwerp University Hospital, Belgium and Maria Middelares General Hospital, Ghent, Belgium between June 2013 and February 2018. Exclusion criteria included longstanding keratoconus diagnosis, reduced cognitive capabilities and prior surgical procedures (corneal crosslinking, penetrating keratoplasty or any type of refractive surgery). ResultsThree-hundred and ninety-nine patients (722 eyes) were included in this study. The mean age was 24.7 ± 6.5 years and the average maximal keratometry was 51 ± 5.2 D for the better eye and 58.4 ± 9.6 D for the worse eye. Upon diagnosis, 233 eyes (32.2 %) and 51 eyes (7.1 %) had a thinnest pachymetry <450 and <400 μm, respectively. At 6-month follow-up, 58 % of patients had been fitted with specialty contact lenses. During follow-up, 199 eyes (27.6 %) underwent corneal crosslinking. One patient underwent corneal graft surgery of his worse eye due to contact lens intolerance and insufficient visual acuity. ConclusionDespite advances in diagnostic tools, keratoconus is often diagnosed at a relatively late stage. Earlier detection of keratoconus would increase the overall clinical benefit of corneal crosslinking. Further research into screening strategies is required to develop cost-effective screening programs.

Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline on the prevalence of hypertension in young Saudi women.

The diagnostic criteria for hypertension have recently been redefined by the American College of Cardiology/ American Heart Association (ACC/AHA). Data on the new prevalence of hypertension in different countries are emerging, but none, to date, from Saudi Arabia. This study aimed to determine the impact of the 2017 ACC/AHA hypertension guideline on the prevalence and determinants of hypertension in young Saudi women. 518 female college students, 17-29 years of age were prospectively enrolled in a survey during the period from January 1, 2016, to April 15, 2016 at Princess Nourah University. The participants completed a previously validated questionnaire, that assessed their risk factors for hypertension, and their blood pressure, weight and height were measured. Application of the 2017 ACC/AHA diagnostic criteria resulted in approximately 7-fold increase in the prevalence of hypertension, from 4.1% to 27.1% (P < 0.001). At a cut-off value of ≥140/90, hypertension was significantly associated with increased age, increased body mass index (BMI), increased heart rate, history of chronic illnesses, prior diagnosis with diabetes mellitus and family history of hypertension. Whereas, with the ≥130/80 cut-off value, only increased BMI and heart rate were significant predictors (P < 0.001). The prevalence of hypertension markedly increased among young adult Saudi women with the 2017 ACC/AHA classification for hypertension, and the main predictors were increased BMI and heart rate. Further studies on the new prevalence and predictors of hypertension in the Saudi population are warranted. This information is important for healthcare authorities to plan cost effective screening, prevention and control programmes.

Cost-Effectiveness of National Breast Cancer Screening Programs in Developing Countries, with Reference to the Recent Egyptian Initiative

Breast cancer was the second most common cancer in the world and the most common cancer in women both in developed and less developed world. It ranked the fifth cause of death from all cancers and caused the greatest number of cancer related deaths among women in 2018. A variety of factors have been shown to impact an individual’s risk of developing breast cancer and its ultimate prognosis. Screening for breast cancer will help to reduce mortality, to confer lifetime protection, and to protect those with high risk factors. Cost-effectiveness analysis refers to the economic evaluation in which the costs and consequences of alternative interventions are expressed in cost per unit of health outcome. Studies on cost-effectiveness of screening programs in developing countries used different methods and calculated different outcome measures. They studied different tools used for screening. Some studied the cost-effectiveness of clinical breast examination and others studied that of mammography. The outcome measures varied, some studies calculated the cost-effectiveness ratio, while others calculated the incremental cost-effectiveness ratio, the disability adjusted life years and the quality adjusted life years. It is concluded that although population-based mammography has been widely adopted in high-income countries, it is less cost–effective in low- and middle-income countries which face some challenges such as the problem of investment in screenings. In developing countries, further research to study the cost-effectiveness of breast cancer screening, covering a comprehensive set of interventions and resulting in clear policy recommendations, is required.

Congenital hypothyroidism screening by umbilical cord blood: thyroid stimulating hormone

Background: Congenital hypothyroidism (CH) is one of the common preventable cause of intellectual disability. Most cases of CH result from thyroid dysgenesis. CH is often asymptomatic in early infancy, and any delay in treatment can affect the child in terms of delayed cognitive milestones. NSCH (newborn screening for congenital hypothyroidism) has been universally accepted and it is one of the most cost effective screening programs in the field of preventive medicine and public health.Methods: A cross sectional study was conducted in Sri Venkata Sai Medical College and Hospital from 28th August to 28th February 2019 (1.5 years), this study was done on 73 newborns (70 deliveries, three mothers gave birth to twins). All data was collected prospectively. Mothers with known thyroid disease or on thyroid medication were excluded from the study. Under sterile aseptic conditions blood sample is collected from the umbilical cord soon after delivery.Results: In the present study Cord blood TSH level of &gt;20 mIU/L was present in 10% (7) of neonates. When the blood TSH levels were repeated (on day 3) among those with high cord blood TSH levels (&gt;20), the blood TSH levels was also high (&gt;20) in 6 (85.7%) neonates and low (&lt;20) in 1 (14.2%). In Neonates with cord blood TSH &gt;20, 6 neonates also had Low T4 (T4&lt;7) levels (85.7%) and 1 neonate (14.2%) had T4 &gt;7. In the present study 6 neonates (85.7%) had Congenital Hypothyroidism. The present study finds that Cord blood TSH as a diagnostic tool has Sensitivity of 100% and specificity of 98.5% in diagnosing congenital hypothyroidism.Conclusions: The current study concludes that Cord blood TSH is a sensitive and specific marker to predict the presence of congenital hypothyroidism in neonates.

Perspectives of primary healthcare providers on implementing cancer screening services in tribal block of Maharashtra, India

Background:Breast, cervical, and oral cancers contribute to majority of cancer deaths among women in India. However, there is poor implementation of screening programs at primary health care (PHC). There is a need to understand the perspectives of healthcare providers at PHC level for feasibility of implementation of a cost-effective cancer screening program, particularly in the rural and tribal areas that are under served by cancer services.Materials and Methods:A continuous medical education (CME) program on “Prevention and early detection of common cancers” was held for all Medical Officers of Palghar District, Maharashtra. A self-administered questionnaire was used to assess the knowledge, attitude, practices, perspectives regarding common cancers, screening methods, and human papilloma virus (HPV) vaccination. A pre- and post-assessment was carried out before the commencement and on completion of the CME among 76 participants.Results:Knowledge about etiology of common cancers was high; however, awareness of risk factors was low. There were knowledge gaps about HPV vaccination. There was overall improvement about the available screening methods and knowledge of HPV vaccine and dosages after the CME (pretest 65% to posttest 95%). Providers had no experience in performing cervical cancer screening on a routine basis. While the majority of the providers (97%) indicated that screening for cancer was essential and feasible at PHC level; however, training (52%) and resources (53%) would be needed.Conclusion:Healthcare providers though from the underserved tribal areas, were optimistic to implement screening for common cancers and were willing to take training for the same. This emphasizes the need for educating and training the healthcare providers with simple techniques for effective implementation of cancer screening programs in underserved areas.

Human leukocyte antigen-associated severe cutaneous adverse drug reactions: from bedside to bench and beyond.

Despite their being uncommon, severe cutaneous adverse drug reactions (SCARs) result in a very great burden of disease. These reactions not only carry with them a high mortality (10%–50%) and high morbidity (60%) with severe ocular complications, alopecia, oral and dental complications and development of autoimmune diseases, but also create a substantial economic burden for patients' families and society. SCARs are, therefore, an important medical problem needing a solution in many countries, especially in Asia. The clinical spectrum of SCARs comprises Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS (drug rash with eosinophilia and systemic symptoms) (also known as drug hypersensitivity syndrome or drug-induced hypersensitivity syndrome) and acute generalised exanthematous pustulosis. Recent crucial advances in determining genetic susceptibility and understanding how T cells recognise certain medications or their metabolites via the major histocompatibility complex and the effects of cofactors, have led to the implementation of cost-effective screening programs enabling prevention in a number of countries, and to further understanding of the patho-mechanisms involved in SCARs and their significance. In this review, we document comprehensively the journey of SCARs from bedside to bench and outline future perspectives in SCARs research.

REMOVED: Artificial intelligence for diabetes case management: The intersection of physical and mental health

Diabetes is a major public health problem in the United States, affecting roughly 30 million people. Diabetes complications, along with the mental health comorbidities that often co-occur with them, are major drivers of high healthcare costs, poor outcomes, and reduced treatment adherence in diabetes. Here, we evaluate in a large state-wide population whether we can use artificial intelligence (AI) techniques to identify clusters of patient trajectories within the broader diabetes population in order to create cost-effective, narrowly-focused case management intervention strategies to reduce development of complications. This approach combined data from: 1) claims, 2) case management notes, and 3) social determinants of health from ~300,000 real patients between 2014 and 2016. We categorized complications as five types: Cardiovascular, Neuropathy, Opthalmic, Renal, and Other. Modeling was performed combining a variety of machine learning algorithms, including supervised classification, unsupervised clustering, natural language processing of unstructured care notes, and feature engineering. The results showed that we can predict development of diabetes complications roughly 83.5% of the time using claims data or social determinants of health data. They also showed we can reveal meaningful clusters in the patient population related to complications and mental health that can be used to cost-effective screening program, reducing the number of patients to be screened down by 85%. This study outlines creation of an AI framework to develop protocols to better address mental health comorbidities that lead to complications development in the diabetes population. Future work is described that outlines potential lines of research and the need for better addressing the 'people side' of the equation.

CN8 - COST-EFFECTIVENESS ANALYSIS OF ORAL CANCER SCREENING IN TAIWAN: A REAL WORLD DATA ANALYSIS

To determine the cost-effectiveness of oral cancer screening program of Taiwan, or, how many dollars spent per life-year saved. We interlinked National Cancer Registry (1998-2012), Mortality Registry (1998-2014), and reimbursement database of National Health Insurance (1998-2013) of Taiwan. A total of 40,092 pathologically verified oral cancer were identified and followed to the end of 2014. After stratification by 0-4 stages, survival analyses were conducted and extrapolated to lifetime by a semiparametric method to estimate life expectancy (LE), expected years of life lost (EYLL), and lifetime costs. National data of oral cancer screening during 2010-3 were abstracted to determine the stage shifting, including oral potential malignant disorder (PMD) and their outcomes. The nominal cost charged for screening was also collected for final analysis. The LE for stages 1-4 were 19.5, 14.0, 11.9, and 7.7 life-years, respectively, while those of EYLL were 7.3, 12.2, 15.4, and 18.7 life-years, respectively. The lifetime costs for stages 1-4 were 65,752, 60,086, 53,675, and 47,570 US dollars, respectively. There is no life loss for stage 0, and the one-year total spending was 5,380 US dollars. During 2010-3, there seems no obvious shift of staging when we compare the frequency distributions for oral cancer detected by screening versus not by screening. However, the screening program detected a total of 28,018 cases with PMD, of which 967 were found to develop oral cancer during 2010-3. The overall cost-effectiveness of screening program was 28,516 USD per life-year saved. It would be improved to less than 5,579 USD per life-year if all the PMD cases could be detected before stage 1. Current oral cancer screening program in Taiwan exceeded 1 GDP per capita per life-year. It could be improved if oral PMD could be regularly followed under an intensive surveillance program and detected oral cancer before stage 1.

Benefits and Harms of Gastric Cancer Screening and Prevention in Japan: A Microsimulation Modeling Analysis

Background: In 2016, gastric cancer is the second leading cause of cancer mortality worldwide. Globally, Japan and Korea are the only two countries implementing national screening program for gastric cancer. South Korea launched a biennial national -endoscopic screening program in 1999, which demonstrated a 47% reduction in gastric cancer mortality compared with no screening. In 2015, endoscopic screening was recommended by the Japanese Guideline for Gastric Cancer Screening. Currently, Japan's screening policy recommends endoscopic screening every 2 to 3 years for individuals aged 50 or above. Aim: This study aims to quantify the potential impacts of Japan's current national endoscopic screening policy and other alternative endoscopic screening options, and to identify a set of efficient endoscopic screening strategies for the current population of Japan. Methods: A microsimulation model of intestinal-type noncardia gastric adenocarcinoma was developed to simulate a virtual population with similar risk profile and life expectancy to the actual population of Japan. The model was calibrated and validated to the nationally-representative data from vital statistics and population-based cancer registries. The baseline scenario was modeled to project the current trend of gastric cancer. Variations among age of initiation (40, 45, 50, and 55), age of termination (75, 80, and 85), and screening interval (2, 5, 10, and 15 years) resulted in 39 unique endoscopic screening strategies for evaluation. In addition, the following three existing screening scenarios were included for analysis: the current screening program in Japan (screening every two or three years from age 50 years, with no termination) and Korea (biennial screening from age 40 years, with no termination). In total, 42 unique endoscopic screening strategies were simulated. Full adherence for all screening scenarios were assumed. Results: In comparison with baseline scenario, endoscopic screening strategies provided 43 to 203 life-years gained per 1000 individuals. The number of lifetime endoscopies per 1000 individuals ranged from 2281 to 28,635. The complications caused by screening were from 6 to 77 per 1000 individuals. The lifetime number of false-positive results ranged from 381 to 4941 per 1000 individuals. Scenarios simulating the current national endoscopic screening program in Japan and Korea fell below the efficient frontier. Under full adherence assumption, the most advantageous endoscopic screening strategy among evaluated scenarios is screening from age 40 to 80 years every 5 year. Conclusion: In this microsimulation modeling study with full adherence assumption, the findings suggest that the current national endoscopic screening program for gastric cancer in Japan might not be the most efficient screening option under benefit-to-harm consideration. The finding underpins the need for further investigation to bring up an efficient and cost-effective endoscopic screening program in Japan.

Knowledge of ovarian cancer in Ibadan: Community-based assessment of women aged 15 years and above

Background: Noncommunicable diseases are increasing in proportion in developing countries. Ovarian cancer has the highest case fatality rate among gynecological cancers but forms only 3%. Its etiology is unknown, and no cost-effective screening program exists due to the absence of well-defined precursor lesions. Early symptoms are vague but can be used to detect Stages I and II diseases. Documented knowledge or awareness of ovarian cancer varies between 4.4% and 15%. However, this is the first community-based survey in Africa to determine knowledge of ovarian cancer by females.Materials and Methods: The questionnaire was semi-structured and interviewer administered. Females aged 15 years and above were selected through a four-stage process involving urban/semi-urban settings, local government areas, wards, and units. We randomly selected 424 participants, equally distributed between urban and semi-urban areas. Bivariate and linear regression analyses were done.Results: Most (83.5%) of the respondents were <40 years, married (56.1%), had secondary education (52.4%), Yoruba (92.5%), and Christian (56.1%). With good knowledge score taken as having at least 70% of required information, about 2.8% of respondents had good knowledge of ovarian cancer. Only level of education and occupation significantly affected knowledge of ovarian cancer.Conclusion: There is very poor knowledge about ovarian cancer, its risk factors, symptoms, treatment, and prognosis among females in Ibadan, strongly affected by education and occupation.

Feasibility and effectiveness of a health examination center-based opportunistic eye diseases screening

Background Blindness and low vision represent significant public health issues in China.Late diagnosis is the major reason for the irreversible vision impairment.A feasible, cost-effective screening and referral program is very important for the eye health care, prevention and treatment of blindness in China. Objective This study was to evaluate the feasibility and effectiveness of a health examination center-based opportunistic eye disease screening program. Methods This was a cross-sectional study.Subjects undergoing a routine physical examination at the health examination center of the Fourth People's Hospital of Shenyang were invited to attend this program.Presenting visual acuity, intraocular pressure, and nonmydriatic fundus photography were obtained.Optic disc photographs were evaluated independently by two ophthalmologists.Blindness and moderate to severe vision impairment were defined based on the criteria of World Health Organization Visual Impairment Classification in 2009.Glaucoma, diabetic retinopathy(DR) and other suspected eye diseases were diagnosed according to the fundus photography and intraocular pressure.This study was approved by Ethic Committe of the Fourth People's Hospital of Shenyang, the informed consent of each subject was obtained. Results Totally, 15 303 subjects were enrolled and 15 197 of them finished the exanimations, giving a response rate of 99.3%.The overall percentage of blindness and moderate to severe visual impairment was 0.08% (12/15 197) and 2.34% (355/15 197). Two hundred and twenty-eight (1.50%) subjects were defined as glaucoma suspects and 80 individuals (0.53%) were diagnosed as epimacular membrane.Other suspected eye diseases included DR (0.41%), branchial retinal vessel occlusion (0.24%), macular degeneration (0.09%), and macular hole (0.06%). More than 95% of the eye disease suspects have never been previously diagnosed or treated.A total of 358 subjects (2.36%) were defined as ocular hypertension suspects. Conclusions This health examination center-based opportunistic eye disease screening shows a good efficiency and feasibility.It may become an optional program in the national eye health care project, as well as the work of prevention and treatment of blindness. Key words: Opportunistic eye disease screening; Prevention and treatment of blindness; Eye health care

Abstract 4544: Computational modeling to suggest patient-specific screening schedules for early detection of gastric cancer

Abstract Gastric cancer (GC) is often diagnosed at an advanced stage and consequently remains the third most common cause of cancer-related death worldwide. Early detection and surgical intervention has been found to reduce GC-associated mortality, yet an efficient and cost-effective screening program still does not exist. Several proteins including Lgr5, CD44 and CD133 have been found to be upregulated during the H. pylori-associated Correa pathway of carcinogenesis, and have the potential to act as biomarkers for early detection. The tools of mathematical oncology facilitate the development of models capable of both reproducing and predicting the increase in expression of these markers, and thus the patient-specific progression of disease. These predictions can allow the identification of optimal screening times to minimize the risk of undetected malignant transformation. Here, we present a combined mathematical-statistical approach to identifying such optimal screening times in a manner which is both biomarker-independent and H.pylori status-independent, thus allowing improved generalizability and the potential for broader application in the clinical setting. Logistic regression models are developed for each biomarker of interest (Lgr5, CD133, CD44) to determine the likelihood of a patient being either early in the Correa pathway (gastritis or metaplasia) or late in the pathway (dysplasia or carcinoma) based on current age, sex and biomarker-positive cell fraction obtained from immunohistochemical staining of biopsy tissue samples. Calibrated models for all three biomarkers were able to accurately classify disease stage as determined by pathology report in more than 85% of an initial cohort of 59 patients. Mathematical models describing the temporal evolution of the expression of each marker of interest are then defined based on clinical data. Coupled with the statistical tool for identifying the likelihood of being at each stage of disease for all combination of input parameters, this framework can forecast time to a clinically-significant endpoint such as the development of dysplasia or adenocarcinoma for future patients, allowing the suggestion of screening times at which the likelihood of progression reaches a certain threshold. The results suggest that for 13 out of 16 patients in our initial test cohort (81%), models independently developed using three different markers all recommend similar follow-up screening times, showing promise for the general applicability and robustness of such a tool. Citation Format: Heiko Enderling, Rachel Walker, Jose Pimiento, Jaime Mejia, Domenico Coppola. Computational modeling to suggest patient-specific screening schedules for early detection of gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4544. doi:10.1158/1538-7445.AM2017-4544

Screening score for early detection of cardio-metabolic risk in Indian adults.

To develop and to evaluate efficacy of screening score for early detection of cardio-metabolic risk (CMR) in adults. Cross-sectional data on anthropometry, lipids, sugar levels, diet, and physical activity were collected on 720 adults (361 men, 35-50year) using standardized techniques. Screening score was developed using regression analysis-cluster of risk conditions (blood pressure, lipids, and sugar levels) was dependent variable against age, sex, waist, diet, and physical activity as independent variables. Odd ratios were added to obtain final score and receiver-operating characteristic (ROC) curves were constructed to identify cut-off value of CMR score. Mean age and BMI were 42.7±9.4years and 25.7±5.0kg/m2. Analysis showed age, male sex, waist, lack of fruits, green leafy vegetables, and lack of physical activity were independent predictors for increased CMR (p<0.05). Total score ranged from 0 to 20. Area under the curve for ROC was 0.728 [95% (CI) 0.67-0.78]. Criterion value >8 had sensitivity (76%) and specificity (56%) for screening cases with CMR. Screening score is a pragmatic way of identifying individuals with CMR without performing biochemical tests. Cost-effective community screening programs may be planned.

Looking back and to the future: Are we improving ‘cure’ in non-small cell lung cancer?

In surgical series, cancer-free survival at 5 years is often referred to as a cure. In recent years, attempts to improve cure rates in non-small cell lung cancer (NSCLC) have focussed on earlier diagnosis through cost-effective screening programs. Systemic therapies have historically added only a small benefit to overall survival in both the adjuvant and palliative setting. However, in the last two decades, the development of new treatment options has added incremental improvements in NSCLC survival rates. Patients with a targetable sensitising mutation including epidermal growth factor receptor gene mutations and anaplastic lymphoma kinase rearrangements have significantly better prognosis, and many will survive beyond 5 years. Immunotherapy is an effective treatment in selected patients with NSCLC and is set to cause another leap in 5 year survival rates. Although these patients are not free from disease, survival at 5 years may become the more important end-point as NSCLC becomes seen as a chronic oncological disease.

Improving the antenatal and post-partum management of women presenting to Sexual Health Services with positive syphilis serology through audit.

The incidence of congenital syphilis remains low in the UK, but the morbidity and mortality to babies born to women who are untreated for the condition make testing for the disease antenatally one of the most cost-effective screening programmes. Women attending North Middlesex Hospital, UK with a positive syphilis test at their antenatal booking visit are referred to St Ann's Sexual Health Clinic, London, for management and contact tracing. We were concerned that our initial audit revealed that a large proportion of women referred to our service never attended and recorded partner notification was poor. Following the implementation of recommendations, specifically the introduction of an electronic referral system, re-audit showed an improvement in attendance, contact tracing, documentation and communication.