Health Costs Research Articles

Cost-effectiveness of a machine learning risk prediction model (LungFlagTM) in the selection of high-risk individuals for non-small cell lung cancer screening in Spain.

The LungFlagTM risk prediction model uses individualized clinical variables to identify individuals at high-risk of non-small cell lung cancer (NSCLC) for screening with low-dose computed tomography (LDCT). This study evaluates the cost-effectiveness of LungFlagTM implementation in the Spanish setting for the identification of individuals at high-risk of NSCLC. A model combining a decision-tree with a Markov model was adapted to the Spanish setting to calculate health outcomes and costs over a lifetime horizon, comparing two hypothetical scenarios: screening with LungFlagTM versus non-screening, and screening with LungFlagTM versus screening the entire population meeting 2013 US Preventive Services Task Force (USPSTF) criteria. Model inputs were obtained from the literature and the clinical practice of a multidisciplinary expert panel. Only direct costs (€of 2023), obtained from local sources, were considered. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results. A cohort of 3,835,128 individuals meeting 2013 USPSTF criteria would require 2,147,672 LDCTs scans. However, using LungFlagTM would only require 232,120 LDCTs scans. Cost-effectiveness results showed that LungFlagTM was dominant versus non-screening scenario, and outperformed the scenario where the entire population were screened since the observed loss of effectiveness (-224,031 life years [LYs] and -97,612 quality-adjusted life years [QALYs]) was largely offset by the significant cost savings provided (€7,053 million). The resulting incremental cost-effectiveness ratio (ICER) for this strategy of screening the whole population versus using LungFlagTM was €72,000/QALY, showing that LungFlagTM is cost-effective. Various were described, such as the source of the efficacy or adherence rates, and other limitations inherent to cost-effectiveness analyses. Using LungFlagTM for the selection of high-risk individuals for NSCLC screening in Spain would be a cost-effective strategy over screening the entire population meeting USPSTF 2013 criteria and is dominant over non-screening.

Hospital-Acquired Complications in Critically Ill Children and PICU Length of Stay, Duration of Respiratory Support, and Economics: Propensity Score Matching in a Single-Center Cohort, 2015-2020.

To identify the health and economic costs of hospital-acquired complications (HACs) in children who require PICU admission. Propensity score matched cohort study analyzing routinely collected medical and costing data collected by the health service over 6 years (2015-2020). Tertiary referral PICU in Queensland, Australia. All children admitted to the PICU were included. None. We assessed ventilator- and respiratory support-free days at 30 days post-PICU admission, length of PICU stay, prevalence of individual HACs, and attributable healthcare costs. A total of 8437 admissions, representing 6054 unique patients were included in the analysis. Median (interquartile range) for cohort age was 2.1 years (0.4-7.7 yr), 56% were male. Healthcare-associated infections contributed the largest proportion of HACs (incidence rate per 100 bed days, 46.5; 95% CI, 29.5-47.9). In the propensity score matched analyses (total 3852; 1306 HAC and 1371 no HAC), HAC events were associated with reduced ventilator- (adjusted subhazard ratio [aSHR], 0.88 [95% CI, 0.82-0.94]) and respiratory support-free days (aSHR, 0.74 [95% CI, 0.69-0.79]) and increased PICU length of stay (aSHR, 0.63 [95% CI, 0.58-0.68]). Healthcare costs for children who developed a HAC were higher compared with children with no HAC, with mean additional cost ranging from Australian dollar (A$) 77,825 (one HAC [95% CI, $57,501-98,150]) to $310,877 (≥ 4 HACs [95% CI, $214,572-407,181]; in 2022, the average conversion of A$ to U.S. dollar was 0.74). In our PICU (2015-2020), the burden of HAC for critically ill children was highest for healthcare-associated infections. Further high-quality evidence regarding HAC prevention and prospective risk assessment could lead to improved patient outcomes and reduced costs.

Assessing the need for a doctor of philosophy (Ph.D.) degree in Endodontics: perspective and implication for advancing dental education and research in Saudi Arabia

AimThis study aims to evaluate the necessity and feasibility of integrating a Doctor of Philosophy (Ph.D.) degree into Endodontic programs at the Faculty of Dentistry King Abdulaziz University, (KAUFD), Jeddah, Saudi Arabia, and to gather insights from key stakeholders regarding the value and necessity of a Ph.D. in enhancing the field of Endodontics.Materials and MethodsAn online questionnaire link was distributed among potential Ph.D. candidates and key decision-makers in Endodontics in Saudi Arabia through social media and emails to members of the Saudi Endodontic Society and the Saudi Endodontic Journal. The questionnaire assessed demographics, professional background, interest in Ph.D. programs, program preferences, perceived need for Ph.D. programs in various sectors, and university selection criteria. Data were analyzed using IBM SPSS Statistics (Version 23).Results141 responses were received. Most respondents were aged 31–40, with an almost equal gender distribution. In terms of current position, a significant number were Endodontic consultants (35.7%) and Endodontic residents/Master students (28.6%) (P = 0.006). Additionally, a considerable proportion of probable prospective students had less than 5 years of expertise (45.7%) (p = 0.013), and the highest degree held by many was a bachelor’s degree (35.7%) (P = 0.007). Key considerations for prospective students were program duration, Saudi Commission for Health Specialists (SCFHS) recognition, part-time options, and cost. The importance of acquiring research skills, such as learning new research technologies and gaining publication experience, was also highlighted.ConclusionThe findings strongly suggest a need for a Ph.D. program in Endodontics in Saudi Arabia. The results provide valuable insights for developing a program that aligns with potential candidates’ and key stakeholders’ needs and preferences, thereby advancing Endodontic research and education within the country.

Stumbles, Gait, and Cognition: Risk Factors Associated with Falls in Older Adults with Subjective Memory Complaints

Falls are a public health problem, impacting quality of life, independence, and health costs. Subjective memory complaints (SMCs) and mild cognitive impairment (MCI) increase with age and may coexist. The risk of falls coinciding with SMCs is less understood. This study explored the risk factors associated with falls in adults with SMCs or MCI. A case–control study in adults over 50 was conducted. All participants underwent a neuropsychological assessment and a Timed Up and Go (TUG) test for gait analysis. Logistic regression calculated OR and p values, adjusting for demographic, clinical, cognitive, and gait variables. There was a total of 64 patients (47.06%) and 72 controls (52.94%). Fallers were older (70.76 ± 7.31) and had hypertension (29.63%), a history of stumbling (13.97%), slow TUG test performance (19.12%), and an asymmetric arm swing (19.85%). Fallers had lower verbal fluency (p = 0.043) and impairment on the Rey–Osterrieth figure copy (p = 0.047). Highest risk factors included female sex (OR 3.55, p = 0.006), older age (OR= 1.08, p = 0.006), hypertension (OR 3.33, p = 0.005), and stumbles (OR 5.65, p = 0.002). This study reconsiders clinical fall risk assessments in older adults with SMCs. Visuo-constructional abilities and executive dysfunction should be followed over time. Female sex, hypertension, and stumbles are risk factors. Integrated cognitive and motor assessments are crucial for detecting and proposing interventions for fall prevention in this population.

Spatial Distribution and Mechanisms of Groundwater Hardness in the Plain Area of Tangshan City, China

Groundwater resources play a critical role in meeting the agricultural, industrial, and domestic water demands of Tangshan, a key industrial city in China. However, with the acceleration of urbanization and the overextraction of groundwater, issues related to groundwater quality have become increasingly apparent. Notably, groundwater hardness has steadily increased over the years, posing risks to human health and elevating industrial water treatment costs. This study analyzed the spatial distribution characteristics and causes of groundwater hardness using 214 groundwater quality samples collected in 2022 from the plain area of Tangshan City, employing inverse distance weighting (IDW), Gibbs diagrams, ion ratios, mineral saturation indices, and Pearson correlation analysis. The results indicate that, in horizontal distribution, high-hardness groundwater is predominantly concentrated in the southern coastal plain area, with hardness gradually decreasing from south to north. Vertically, shallow groundwater in the coastal plain exhibits significantly higher hardness than deep groundwater, with a non-compliance rate of 94.12%, while deep groundwater hardness remains markedly lower. Mid-depth groundwater (60–300 m) in the alluvial plain exhibits elevated hardness, primarily attributed to mineral dissolution and agricultural irrigation return flow. The spatial distribution pattern of groundwater hardness across the study area is predominantly governed by hydrogeochemical processes and hydrochemical environmental factors, with cation exchange adsorption and evaporation–concentration processes identified as the dominant influences. The analysis of ion sources indicates that Ca2+ and Mg2+, the primary contributors to groundwater hardness in the area, are mainly derived from the weathering and dissolution of carbonate minerals, sulfate minerals, and cation exchange processes. Therefore, an in-depth investigation into the spatial distribution and driving factors of groundwater hardness in Tangshan can provide a scientific basis for regional water resource management, pollution control, and water quality optimization. Such research also supports the development of sustainable groundwater management and optimization strategies.

Healthcare debts in USA: a silent fight

Healthcare debt in the United States is a significant problem, affecting millions of Americans. Many people struggle to pay for healthcare, and approximately 9% owe over $250 due to health costs. Nearly half of US adults find it difficult to afford healthcare, with uninsured individuals and those with lower incomes facing the most significant challenges. Healthcare debt in the United States is a problem with profound consequences. This debt encompasses expenses incurred for various medical services, from hospital stays and surgeries to doctor visits and medications. Healthcare debt casts a long shadow, adversely affecting physical and mental well-being and increasing stress, anxiety, and depression. Unpaid bills lead to the avoidance of necessary care, perpetuating health issues and straining the healthcare system. Beyond health implications, it affects credit history, limits access to credit facilities, and hampers employment opportunities. So, comprehensive healthcare reform emerges as a potential remedy, by expanding access to affordable health insurance, regulating healthcare costs, and addressing coverage gaps could alleviate the impact of healthcare debts. Therefore, exploring the feasibility of transitioning towards a universal healthcare system becomes crucial, offering equitable access to essential medical services and mitigating financial burdens on individuals. As healthcare debts continue to profoundly influence health, economic stability, and social well-being, a holistic approach is imperative for a healthier and economically sound future for all Americans.

Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review.

Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally. Scoping review. A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist. PubMed, CINHAL and Embase for articles between 2016 and 2023. Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management. Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care. Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care. Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration. No patient or public contribution is required for this study.

Cost-utility analysis of newborn screening for spinal muscular atrophy in Japan

ABSTRACT Aims Spinal muscular atrophy (SMA) is a rare genetic disorder characterized by progressive muscle weakness, atrophy, respiratory failure, and in severe cases, infantile death. Early detection and treatment before symptom onset may substantially improve outcomes, allowing patients to achieve age-appropriate motor milestones and longer survival. We assessed the cost-utility of newborn screening (NBS) for SMA in Japan. Materials and Methods A cost-utility model (decision tree and Markov model) compared lifetime health effects and costs between “NBS” for SMA (presymptomatic treatment) or “no NBS” (treatment initiated at symptom onset). Model inputs were sourced from literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess model robustness and data validity. Results Based on the 1:10,000 SMA incidence, it was estimated that 43 newborns/year would have SMA, and a total of 39 patients with SMA would initiate presymptomatic treatment after NBS. An estimated 736 quality-adjusted life-years were gained per annual birth cohort with NBS. NBS for SMA was dominant compared with no NBS (i.e., less costly and more effective), with ¥8,856,960,096 reduced total costs with NBS versus no NBS (base-case). Sensitivity and scenario analyses supported cost effectiveness of NBS for SMA versus no NBS. A greater percentage of patients was estimated to enjoy longer survival and be without permanent assisted ventilation with NBS versus no NBS. Limitations Real-world observations may differ from single-arm clinical trial outcomes. It was assumed that patients with SMA identified via NBS were asymptomatic and would receive treatment prior to symptoms. Best supportive care was not considered, and Japan-specific variations in gene replacement therapy protocol were not fully reflected. Conclusion NBS for SMA allows for early identification of patients with SMA and treatment initiation before symptom onset, improving health outcomes and reducing total costs than without NBS.

Building a community of practice to address alcohol harms in Canada: Experience from the Canadian Alcohol Policy Evaluation project.

Alcohol is a major cause of health and social costs and harms in Canada. While research and awareness of harms caused by alcohol are on the rise, few transdisciplinary platforms exist that are committed to facilitating bold alcohol policy change to reduce health inequities and improve lives. In response to feedback heard during engagement for the Canadian Alcohol Policy Evaluation project, an alcohol policy-focused community of practice (CoP) was launched in January 2022. Webinars, roundtable discussions, working group meetings, networking events, and a digital platform allow practitioners from various sectors (e.g. public health, alcohol regulation and distribution, public safety, justice, non-governmental organizations), researchers, and people with lived/living experience (PWLLE) to connect, share experiences and resources, and build capacity. More than 500 members have joined the CoP from all Canadian provinces and territories, and international jurisdictions. CoP members engage in learning opportunities, contribute to letter-writing campaigns in support of alcohol policy initiatives, and lead a working group focused on alcohol warning labels. Through the CoP, members report gaining and applying new knowledge in their work, while also establishing valuable connections and collaborations that have supported positive change. This cross-jurisdictional, intersectoral alcohol policy CoP facilitates knowledge sharing, networking, and collaboration among practitioners, policymakers, advocates, and PWLLE, while contributing to public health efforts to prevent alcohol harms. Furthermore, as transdisciplinary approaches continue to be prioritized in research and practice, this CoP offers an example that could be applied to other public health initiatives.

Cost-effectiveness of human papillomavirus (HPV) vaccination in Tunisia: a modelling study

ObjectivesThe objective of this study is to assess the cost utility of the implementation of the human papillomavirus (HPV) vaccination programme in Tunisia in addition to the current cytology screening...

Predictors of dropout in cognitive behavior and interpersonal online brief psychotherapies for essential professionals during the COVID-19 pandemic

Premature dropout from psychotherapy can harm patients and increase mental health costs. This study identified predictors of dropout in brief online psychotherapy for essential workers during the COVID-19 pandemic. This was a secondary analysis of a randomized trial on 4-week CBT or IPT protocols. Participants provided sociodemographic data and completed the Patient-Reported Outcomes Measurement Information System and Burnout Assessment Tool Short-Form. Predictors were analyzed in three blocks: sociodemographic, clinical, and therapist characteristics using bivariable and multivariable analyses. The sample included 804 individuals who attended at least the first session of either CBT (n = 403) or IPT (n = 401). A total of 17.2% (n = 138) of the participants dropped out during the protocol. Significant predictors of dropout included having children (IRR = 1.48; 95% CI: 1.07–2.05; p = 0.016), residing in specific regions of Brazil (Northeast IRR = 1.44; 95% CI:1.04–2.00; p = 0.02 and Midwest IRR = 1.73; 95%CI: 1.13–2.64; p = 0.01), therapist male sex (IRR = 2.04; 95% CI: 1.47–2.83; p = < 0.001), second wave of Covid-19 (IRR = 1.54; 95% CI: 1.01–2.34; p = 0.04) and low life satisfaction (IRR = 1.63; 95% CI: 1.06–2.50; p = 0.02). Our findings underscore the necessity for culturally tailored strategies, support for those with children, and targeted therapy for individuals with low life satisfaction. Implementation of these strategies may reduce dropout rates and improve treatment outcomes for essential workers in crisis.

Non-communicable diseases related multimorbidity, catastrophic health expenditure, and associated factors in Ernakulam district.

Multimorbidity, the coexistence of two or more chronic conditions in an individual, has emerged as a significant public health challenge with profound economic implications, exerting substantial strain on healthcare systems and economies worldwide. This study aimed to estimate the prevalence of non-communicable diseases (NCD) related multimorbidity, catastrophic health expenditure (CHE), and associated factors among adults aged ≥40 years in Ernakulam district. A community-based cross-sectional study was conducted among 420 individuals aged ≥40 years using population probability sampling. The tools used were the Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC), the WHO STEPS Questionnaire, and the Patient Health Questionnaire-9 (PHQ-9), which assessed non-communicable diseases, diet, physical activity, smoking, alcohol consumption, and depression. A pretested semi-structured questionnaire collected data on health and household expenditures. Multimorbidity was defined as having two or more self-reported NCDs, and CHE was identified when health costs exceeded 10% of a household's expenditure in the past month. Multivariable logistic regression was performed to find independent predictors of multimorbidity and CHE. The mean age of participants was 60.02 ± 10 years. The prevalence of NCD multimorbidity was 42.6% (95% CI: 37.9-47.3%). The most common dyad was diabetes and hypertension (24.5, 95% CI: 20.4-28.6%). Higher odds of multimorbidity were observed in those aged ≥60 years (aOR = 3.03, 95% CI: 1.95-4.73), unmarried/widowed/divorced (aOR = 2.15, 95% CI: 1.28-3.63), unemployed (aOR = 1.81, 95% CI: 1.14-2.87), and tobacco users (aOR = 3.72, 95% CI: 1.85-7.48). Approximately 32.4% (95% CI: 25.5-39.3%) of households incurred catastrophic health expenditure (CHE) by treating adults with multimorbidity. Age ≥ 60 (aOR = 2.39, 95% CI: 1.99-5.77) and use of outpatient services (aOR = 4.09, 95% CI: 2.01-8.32) were independently associated with higher odds of CHE. IP services and each additional morbidity add ₹22,082.37 (β = 0.557, p < 0.001, 95% CI: ₹17,139.88- ₹27,024.86) and ₹1,278.75 (β = 0.128, p = 0.044, 95%CI: ₹35.58-₹2,521.92) to healthcare costs, respectively. The high prevalence of multimorbidity and associated CHE among individuals over 60 years highlights the urgent need for the National Programme for the Prevention and Control of Non-Communicable Diseases to prioritise multimorbidity and its management, especially above 60 years within this age group.

Development of a Conceptual Model to Identify and Rank Environmental and Health Costs of Work-Related Diseases Using Delphi Study and Analytic Network Process

Introduction: Improving health and the environment is one of the components of development, social welfare, and economic growth. Another influential factor in increasing health costs and reducing social welfare is work-related accidents and diseases, which impose high costs on individuals, industries, and the national economies of countries. Therefore, using multi-criteria decision-making methods, the present study provided a conceptual model to identify and rank work-related diseases’ environmental and health costs. Material and Methods: The present study was conducted in 2023. A classification model for the economic evaluation of environmental and health costs of occupational diseases was developed to achieve the study’s aim. In the current research, the Delphi method was used to identify health and environmental criteria, and the Analytic Network Process (ANP) was used to weight the sub-criteria. Finally, the cost of health and the environment was estimated based on the available information. Naft Tehran Hospital (NSHT) was also selected as a case study site. Results: The results showed that the drug and medical equipment cost factor, with a weight of 0.312 in the treatment sector, and the particular and infectious waste cost factor, with a weight of 0.085, were the most critical factors in the economic evaluation. Also, the parametric model results showed that 99.84% of the total costs are related to health costs, and 0.16% are related to environmental costs. In general, the results of this research showed that 61.3% of the costs of the health sector are related to the two sectors of medicine and medical equipment and the cost of service personnel, and 91.7% of the costs of the environmental sector are related to wastewater treatment and the cost of electricity consumption. Conclusion: This study presented a semi-quantitative model to estimate health and environmental costs caused by occupational diseases. The results can create a novel scientific insight into implementing control measures using the optimal point of cost-benefit parameters. Implementing this integrated model can be a practical and effective step in allocating resources and prioritizing interventions.

Steady existence of Escherichia coli co-resistant to carbapenem and colistin in an animal breeding area even after the colistin forbidden

Carbapenem- and colistin-resistant Escherichia coli (CCREC) cause high mortality rates and health costs, and have become serious health concerns. Total 1764 samples were collected from 60 animal farms in 2019 and 2021, including worker and animal faeces, wastewater, well water, air, vegetables, human hands, object surfaces, throat swabs, soil, and flies to investigate the prevalence and potential transmission pathways of CCREC. Eleven CCREC were detected: 9 (5 in 2019 and 4 in 2021) from 5 worker faeces, 3 animal faeces, 1 wastewater, and 2 from 1 flies sample. Chicken farms had the highest number of CCREC (n = 9). The detection rate was low (<1.1%) overall, and there was no significant difference in both years, indicating that CCREC existed stably after 4 years of colistin ban. The combinations of chromosomes and plasmids harbouring blaNDM and mcr-1.1 were divided into 4 patterns: IncX3 plasmid-blaNDM & chromosome-mcr.1.1 (n = 5); IncX3 plasmid-blaNDM & IncHI2 plasmid-mcr.1.1 (n = 3); IncFII plasmid-blaNDM & IncI2 plasmid-mcr.1.1 (n = 2); both chromosome (n = 1). The blaNDM located on plasmids was surrounded by similar genetic structures: Tn3-IS-blaNDM-bleMBL-TrpF-DsbD-IS. The genetic contexts of mcr-1.1 were highly similar, with ‘ISApl1-mcr-1.1-PAP2’ and ‘mcr-1.1-PAP2’. All plasmids can be successfully transferred into E. coli J53, except for the IncHI2 plasmids with the transfer rate of 33.3%. The IncFII and IncI2 plasmids from same strain of flies could be co-transferred. The clonal spread of CCREC from humans to humans occurred on the same pig farm (P4) or different chicken farms (BC9 and LH7). This study suggested that flies, chromosomes, and plasmids jointly contribute to the steady existence of CCREC.

Leveraging AI in Traffic Engineering to Enhance Bicycle Mobility in Urban Areas

More With the rise of AI-driven technologies, urban cycling is becoming more accessible and appealing to many due to benefits such as health improvement and cost efficiency. Governments worldwide are promoting cycling as a sustainable transportation option to address environmental challenges. Ensuring seamless bicycle mobility in cities is essential to incentivize cycling. AI-powered Traffic Engineering can significantly enhance the flow of bicycle traffic in urban areas by optimizing infrastructure and safety. This article explores the benefits of cycling and the rationale for investing in AI-integrated cycling infrastructure. It provides examples of smart solutions such as AI-based vehicle-cycle segregation (including London's Cycle Superhighways), protected intersections enhanced by machine learning algorithms, and Intelligent Transport Systems (ITS) that incorporate AI for dynamic traffic management. Their implementation and impact on cyclists and overall traffic flow are analyzed, demonstrating that these advanced systems reduce accidents, boost road efficiency, and make cycling more enjoyable. Quantitative data on these improvements is also presented. In conclusion, AI-enabled Traffic Engineering solutions play a vital role in enhancing bicycle mobility and safety in urban environments.

Breastfeeding Support for All: Narrowing Inequalities for Nurturing a Future That Is Fair and Sustainable

Early initiation of breastfeeding, duration, and exclusivity are internationally recommended practices to maximize impact in preventing and reducing the double burden of malnutrition, reducing child mortality and other morbidities, improving child development, and reducing health costs. The protection, promotion, and support of breastfeeding are also central to countries' commitments to the 2030 Agenda for Sustainable Development. Global progress in breastfeeding rates has been reported in past years. However, many children are still left behind and are not receiving the numerous benefits of breastfeeding. There are also relevant inequities in breastfeeding rates across global regions and countries and between groups from different socioeconomic statuses and cultural backgrounds within countries. These inequities are also extended to the frequency and availability of comparable standardized indicators worldwide. In 2023, globally, only 39% of the countries provided information on exclusive breastfeeding rates to the age of six months, and 7% assessed their overall breastfeeding support programs in the past five years. The increase in the coverage and frequency of monitoring globally agreed breastfeeding targets and the assessment of the impact of breastfeeding programs are imperative to providing breastfeeding support for all and increasing breastfeeding prevalence equitably. Breastfeeding can be an equalizer in society; no one should be left behind. Only this way can breastfeeding mums be celebrated in all their diversity and journeys, attending the 2024 World Breastfeeding Week call.

Economics of first-line treatment with tislelizumab in patients with nonsquamous non-small cell lung cancer.

This study evaluates the cost-effectiveness of tislelizumab plus chemotherapy as a first-line treatment for locally advanced or metastatic (IIIB/IV) nonsquamous non-small cell lung cancer (nsq-NSCLC) in China. A Markov model projected health outcomes and costs over a lifetime, with health states including progression-free survival, progressive disease, terminal progressive disease (TPD) and death. Data came from a Chinese phase III trial. The primary outcome was quality-adjusted life years (QALYs), with incremental cost-effectiveness ratios (ICERs) calculated. Using sensitivity analysis to confirm the robustness of the results. The base-case analysis showed that tislelizumab combined chemotherapy group had 1.06 more QALYs (3.967 QALYs VS 2.909 QALYs) than the chemotherapy-alone group at an incremental cost of U.S. dollars ($) 19594.75 ($43390.52 VS $23795.77), resulting in an ICER of $18,512.47/QALY. This ICER is below the willingness-to-pay (WTP) threshold of three times China's 2023 per capita GDP ($36,672.23/QALY), indicating tislelizumab is economically favorable. The conclusion is that tislelizumab combination therapy is a cost-effective first-line treatment option for nsq-NSCLC patients in China.

Design and Framework of a Technology-Based Closed-Loop Referral Project for Care Coordination of Social Determinants of Health.

Screening for social determinants of health (SDOH) has been mandated by health systems nationwide. However, a gap exists in closed-loop referral for care coordination between health care and social services. This article presents the framework of a technology-based project to facilitate closed-loop referral between health care and social service agencies in Greater Houston by leveraging and connecting the existing care coordination technology infrastructure. Ten health care and social service organizations in Greater Houston participated in the demonstration project initiated in January 2023. The authors leveraged and linked regional health information exchange (HIE) technology with a master patient index of >18 million, and sector-specific care coordination platforms to build closed-loop referral capacity between HIE-participating health care organizations and social service organizations to meet patient SDOH needs. Evaluation efforts will assess the reach, adoption, implementation, and the effectiveness of the closed-loop framework in improving social and health outcomes. The framework comprised the following 4 components: (1) establishment of collaborative governance for shared decision-making processes, fostering trust, alignment, and transparency among organizations; (2) development of technology linkages between existing platforms to facilitate seamless referrals between organizations and ensure visibility of referral outcomes; (3) integration of regional resource directories into technology infrastructure to ensure resource accessibility/quality; and (4) evaluation of the system's impact on health equity, efficiency, and cost reduction. This project aimed to close the loop for care coordination between health care and social service agencies, enable data evaluation to determine care coordination effectiveness, and lay the foundation for SDOH-related research/practice equitably.

Dietary supplementation use for outpatient treatment in children: A cross-sectional study

Dietary supplements (DSs) are commonly used supplements among children to support disease treatment, however, overuse and inappropriate prescription of outpatient DS can negatively affect health and treatment costs. This study aimed to evaluate DS use in outpatient treatment in children. The present study used a cross-sectional descriptive retrospective method based on data from 188,579 outpatient prescriptions of children for 1 year. DSs were commonly prescribed in pediatric patients ≤5 years old (63.48%) with diagnosing respiratory, infectious, and gastrointestinal diseases (>50%). DS costs account for a high proportion (24.86%) of total outpatient prescription costs. In addition, pediatric prescriptions containing one DS product (88.16%) showed a higher rate than prescriptions containing two DS products (11.84%) with the main ingredients being vitamin D3 (80.55%), vitamin B6 (63.01%), vitamin B1 (60.22%), and vitamin B2 (59.04%), and calcium (51.0%). The majority of DS products contained multivitamins (69.52%) with DS containing ≥5 vitamins of 59.04% and DS containing 2-4 vitamins of 10.48%. Besides, non-compliance with DS prescribing guidelines for age (21.38%), dose (14.13%), and both age and dose (5.54%) was found primarily in highly prescribed DSs (vitamin-amino acid-mineral ingredients), pediatric patients <2 years old, prescriptions containing one DS product or multivitamins, and respiratory disease group (J and R04-09 ICD). The univariate and multivariate regression analyses showed that vitamin-mineral products and groups <2 years old were significantly associated with guideline-adherent DS prescribing for age and/or dose. Meanwhile, foreign DSs and vitamin-mineral ingredients of prescription showed significant associations with guideline-adherent DS prescribing for age or dose. Instructions for DS use regarding recommended age and maximum dosage may not be carefully considered by doctors due to belonging to an over-the-counter medicine group. Therefore, there is a strong need for a national public policy to prevent and control overprescribing and inappropriate prescribing of DS.

Measurement-Based Care as a Tool to Detect and Prevent Harm in Youth Psychotherapy.

Measurement-based care (MBC), the use of routine assessment to guide clinical decision-making, has the potential to significantly enhance the quality of mental health services for youth by improving the detection and prevention of harm. Concerns exist, however, that widespread efforts to implement MBC may have a negative impact on youth mental health care. We explore both perspectives by describing how MBC can be leveraged as a tool to detect and prevent harmful treatment in youth and how misapplication of MBC also has the potential to cause harm. This discussion focuses on how MBC can help therapists identify harm caused by ineffective practices (i.e., deterioration or no symptoms changes), poor client engagement (e.g., early drop-out, poor alliance), and adverse events (e.g., injury caused by treatment). We also discuss multi-level applications of aggregated MBC data to prevent harm through workforce development and organizational and health systems quality and cost of care improvement initiatives. Misapplication of MBC by failing to adhere to MBC best practices, overreliance on data above clinical judgement, providing insufficient organizational support, and using MBC data to justify cost containment are all discussed as possible sources of harm. We conclude with a discussion of future directions for research needed to advance the application of MBC to the prevention of harm in youth psychotherapy.