Program Costs Research Articles

Economic evaluation of the “paramedics and palliative care: bringing vital services to Canadians” program compared to the status quo

ObjectiveBased on programs implemented in 2011–2013 in three Canadian provinces to improve the support paramedics provide to people receiving palliative care, the Canadian Partnership Against Cancer and Healthcare Excellence Canada provided support and funding from 2018 to 2022 to spread this approach in Canada. The study objectives were to conduct an economic evaluation of “the Program” compared to the status quo.MethodsA probabilistic decision analytic model was used to compare the expected costs, the quality-adjusted life years (QALYs) and the return on investment associated with the Program compared to the status quo from a publicly funded healthcare payer perspective. Effectiveness data and Program costs, expressed in 2022 Canadian dollars, from each jurisdiction were supplemented with literature data. Probabilistic sensitivity analyses varying key model assumptions were conducted.ResultsAnalyses of 5416 9-1-1 calls from five jurisdictions where paramedics provided support to people with palliative care needs between April 1, 2020 and March 31, 2022 indicated that 60% of the 9-1-1 calls under the Program enabled people to avoid transport to the emergency department and receive palliative care at home. Treating people at home saved paramedics an average of 31 min (range from 15 to 67). The Program was associated with cost savings of $2773 (95% confidence interval [CI] $1539–$4352) and an additional 0.00069 QALYs (95% CI 0.00024–0.00137) per 9-1-1 palliative care call. The Program return on investment was $4.6 for every $1 invested. Threshold analyses indicated that in order to be cost saving, 33% of 9-1-1 calls should be treated at home under the Program, the Program should generate a minimum of 97 calls per year with each call costing no more than $2773.ConclusionThe Program was cost-effective in the majority of the scenarios examined. These results support the implementation of paramedic-based palliative care at home programs in Canada.

Determinants of costs of human papillomavirus vaccine delivery in six low- and middle-income countries

Evidence on determinants of vaccine delivery costs can inform program design and planning. Given the dearth of this evidence for human papillomavirus (HPV) vaccine, we conducted an analysis to identify programmatic and operational factors that are statistically associated with variations in economic costs for HPV vaccine delivery, within and across six low- and middle-income countries.HPV vaccine program operations and cost data were collected from Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda. An ordinary least square regression analysis was done using data from 279 health facilities in these six countries. We ran country-specific and pooled multivariate linear regressions. A conditional regression including 228 facilities was also run. The dependent variable was the estimated total economic costs for HPV vaccine delivery per facility, excluding vaccine procurement costs. Explanatory variables included number of HPV vaccine doses delivered; numbers of vaccination sessions conducted, and schools served; distance traveled by health workers for vaccine delivery; intensity of conducting program activities; human resource (health workers, school staff, etc.) utilization rates; and categorical variables indicating whether per diems were paid, and for country-specific dummies;Explanatory variables such as the number of program activities or meetings held, receipt of per diems, and utilization rates of health workers, were all positively and statistically significantly associated with economic costs in the pooled sample, for both the unconditional and conditional regressions. Variables such as the doses delivered, and number of sessions conducted were statistically significant in the unconditional regression. The within-country regression found that only variations in utilization rates of health workers were statistically significant in all countries.Our analysis provides evidence to HPV vaccination program stakeholders on which program context variables impact costs, which can inform program adjustment to improve cost efficiency, especially as programs managers work to revitalize and rebuild HPV vaccine coverage after the COVID-19 pandemic.

Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis.

To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth. We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI, defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities. Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of -11,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796. Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth.

Optimising species detection probability and sampling effort in lake fish eDNA surveys

Environmental DNA (eDNA) metabarcoding is transforming biodiversity monitoring in aquatic environments. Such an approach has been developed and deployed for monitoring lake fish communities in Great Britain, where the method has repeatedly shown a comparable or better performance than conventional approaches. Previous analyses indicated that 20 water samples per lake are sufficient to reliably estimate fish species richness, but it is unclear how reduced eDNA sampling effort affects richness, or other biodiversity estimates and metrics. As the number of samples strongly influences the cost of monitoring programmes, it is essential that sampling effort is optimised for a specific monitoring objective. The aim of this project was to explore the effect of reduced eDNA sampling effort on biodiversity metrics (namely species richness and community composition) using algorithmic and statistical resampling techniques of a data set from 101 lakes, covering a wide spectrum of lake types and ecological quality. The results showed that reliable estimation of lake fish species richness could, in fact, usually be achieved with a much lower number of samples. For example, in almost 90% of lakes, 95% of complete fish richness could be detected with only 10 water samples, regardless of lake area. Similarly, other measures of alpha and beta-diversity were not greatly affected by a reduction in sample size from 20 to 10 samples. We also found that there is no significant difference in detected species richness between shoreline and offshore sampling transects, allowing for simplified field logistics. This could potentially allow the effective sampling of a larger number of lakes within a given monitoring budget. However, rare species were more often missed with fewer samples, with potential implications for monitoring of invasive or endangered species. These results should inform the design of eDNA sampling strategies, so that these can be optimised to achieve specific monitoring goals.

A retrospective audit with subsequent cost and environmental analysis of a denosumab self-injection program.

The Metabolic Bone Health Department, Cardiff and Vale University Health Board, serves a local population of approximately 445 000 people. A retrospective audit of attendance data regarding the denosumab treatment clinic (the traditional treatment pathway) and the denosumab Self-Injection Program (SIP) was conducted to determine whether the SIP is both cost-effective and environmentally beneficial, compared to the traditional treatment pathway. Cost analysis was then conducted by the Finance Department. The audit was conducted over 3years following the implementation of the service development; 233 patients had enrolled in the program at the time of the audit and 69 had completed 3years of self-injected treatment. A control group of 497 patients were identified by the service. This group remained on the historical pathway and had consistent attendance activity over the 3-yr period from 2017 to 2019. Pre- and post-period activity of all patients on the program was compared, together with the activity for the independent control group. The SIP resulted in a reduction in clinical contacts, with financial analysis showing a total opportunity cost saving per patient of £420 per annum. There were obvious benefits to the patient of a reduced number of visits to a clinical site, which also resulted in an estimated carbon footprint reduction of 59 kg CO2 per patient per annum. The cost analysis is based on our organization's 2022 charges. The SIP demonstrates that by focusing on care "closer to home", it is possible to maximize resources, improve the patient experience through reduced travel, and reduce the environmental impact of healthcare.

Decoding the puzzle: exploring the factors influencing homeownership in Togo

Purpose This study aims to analyze the factors influencing households housing tenure choices in Togo. Design/methodology/approach The authors applied a rigorous econometric approach, using Harmonized Household Living Conditions Survey (EHCVM) data from 2018 and 2021 to construct a longitudinal panel, and Unified Basic Welfare Indicators Questionnaire (QUIBB) data from 2006, 2011 and 2015 to construct a pseudo-panel. Findings The study reveals that a household’s life-cycle variables like age of the household head, marital status, household size and place of residence, have a significant influence on homeownership. In addition, households in the highest wealth quartiles and used heads of household are more likely to own their home. Research limitations/implications Housing policies focused on improving the financial sustainability of low-income households and reducing the transaction costs associated with property acquisition are essential to promoting homeownership. Practical implications As part of the implementation of the Government Roadmap 2020–2025, the government has committed to providing 20,000 affordable social housing units, aiming to significantly boost the supply of decent housing. However, the findings of this study highlight the need for targeted subsidy programs for low-income households, particularly for female-headed households and those living in urban areas. These subsidies could cover part of the cost of purchasing homes. For middle-income households, it is crucial to develop suitable financing mechanisms, such as low-interest mortgages and loan guarantees. Given demographic pressures and the high cost of public housing programs, promoting self-build remains essential. This support should be accompanied by the provision of low-cost building materials and technical training in innovative, sustainable construction methods. Additionally, improved access to employment and land regularization are essential prerequisites for the success of these initiatives. Originality/value Research on the determinants of tenure choice is relatively limited in sub-Saharan Africa due to the unavailability of housing survey data. This paper proposes a case study of Togo, whose housing market characteristics correspond to most sub-Saharan African countries. Furthermore, this study applied two methodological approaches commonly used in dynamic analyses, thereby enhancing the robustness of the findings.

Local Government Initiatives: A Comprehensive Analysis of Infertility Diagnostic and Treatment Programs in Poland (2009-2020).

BACKGROUND Infertility is an increasingly significant public health problem. However, thanks to the achievements of modern medicine, it is possible to take steps to treat it. The objective of this study was to present data about programs for the diagnosis and treatment of infertility that were developed, implemented, and financed by local governments at all levels in Poland in 2009-2020. MATERIAL AND METHODS The study was conducted based on the analysis of existing data from the Minister of Health. We present data on infertility diagnostics and treatment programs, the number of programs in particular years, the number of programs implemented by individual levels of local governments, the number of people participating in the programs, and the total cost of the programs in EUR. RESULTS Programs aimed at diagnosing/treating infertility began to be implemented in 2012 (most were implemented in 2019 and 2020, 18 each). Twenty-three local governments of various levels, including 5 communes, 13 cities with poviat rights, 1 poviat, and 4 voivodeships, participated in the implementation of these programs. A total of 22 379 people were covered by infertility diagnosis and treatment programs in the years 2012-2020. The cost of all implemented programs was over EUR 10.7 million. CONCLUSIONS The legal situation in Poland caused the vast majority of infertile couples who wanted to have children to have to self-finance in vitro fertilization procedures. A small number of local governments undertook actions aimed at co-financing in vitro fertilization procedures.

The Role of Women to Program Agribusiness Driving in Air Talas Tourism Village (ANGGREK DEWATA)

This research method takes the form of a qualitative field study or field research. The data collection techniques were carried out using observation with active participation, in-depth interviews, documentation and focus group discussions. The research results show: In the Agribusiness Program Driving Talas Air Tourism Villages (ANGGREK DEWATA) there are 3 (three) programs carried out by PT Pertamina EP Limau Field, namely: BU JUSI (Organic Cultivation of Siamese Oranges), BUDE ARTA MAJU (Women of Air Talas Village Managing Oranges) and PUTERI JELITA (Liquid Fertilizer from Air Talas Orange Waste. The economic impact of this program for women is an increase in family income by IDR 2,500,000/person/month or 20% from the previous year from product sales. This program also has a positive social and environmental impact. This is in line with the fifth SDG goal, namely gender equality Talas (DEWATA ORGANGREK) from the Social Return on Investment (SROI) Report shows that the calculated SROI value of the program is 1.66, indicating that every rupiah of program costs produces a positive change worth IDR 1.66. Meanwhile, from the results of the Community Satisfaction Index assessment, the Anggrek Dewata Program obtained Community Satisfaction Index (IKM) results with the predicate "Very Good", with an index value of 3.44 with a conversion value of 86.07%. The Commitment aspect received an average SME score of 3.80 and is included in the Very Good category. And the community has optimism to continue the program after the intervention is carried out.

A peer mentoring program for eating disorders: improved symptomatology and reduced hospital admissions, three years and a pandemic on

BackgroundPeer support involves people (mentors) using their own experiences to assist others (mentees). The impetus to include peer support in eating disorder recovery is high, however research on implementation of peer roles in eating disorder management is limited. A previous pilot study found positive but preliminary results for a Peer Mentor Program (PMP) for eating disorders. The PMP has since developed over time, including broadening its eligibility criteria and shifting to predominantly online delivery during COVID-19. This study aimed to evaluate the updated version of the PMP, on a larger and more diverse group of mentees.MethodsPreviously collected PMP service data from July 2020 to April 2022 (during COVID-19 lockdowns) was evaluated for fifty-one mentees using mixed methods. Data from program start (baseline), mid-point (3-months) and end (6-months) for measures of eating disorder symptoms as measured by the Eating Disorder Examination Questionnaire (EDE-Q) and psychological wellbeing as measured by the Depression, Anxiety and Stress Scale (DASS) was evaluated. Frequency of eating disorder-related hospital admissions during PMP participation versus the 6 months prior, direct program costs and qualitative mentee feedback were also analysed. One way ANOVA’s with post hoc tests were used to evaluate symptom change and thematic analysis was conducted on qualitative data.ResultsProgram attendance averaged 12.12 (SD ± 1.57) of a possible 13 sessions. Statistically significant and clinically meaningful improvements were demonstrated across all subscales of the eating disorder and psychological wellbeing symptom measures. EDE-Q Global score and DASS scores decreased significantly by program end. Fewer eating disorder-related hospital admissions were reported during PMP than the 6-months prior. Qualitative findings were positive and themed around the unique benefits of lived experience connection, a new kind of space for recovery, hope and motivation for change. Challenges with the time limited nature of the mentee-mentor relationship were expressed.ConclusionsThe important benefits of a PMP for individuals with eating disorders are further supported. There is a pressing need for high quality, co-produced research, utilising a mixture of designs and fidelity to core peer work principles, to inform further implementation of peer work into eating disorder policy and practice.

Evaluation of Infectivity and Immunogenicity of Sugar Stabilized Nairobi Sheep Disease Vaccine

This work presents a cost-effective approach that can tremendously reduce the financial and logistical burden for vaccine delivery. Strict requirement of a cold chain account about 80% of the total cost of vaccination program. This research paper detail the use of inexpensive FDA approved biocompatible sugars for stabilizing inactivated Nairobi sheep disease virus vaccine. We evaluated sugar additives that improve the storage and maintain the antigenic properties of inactivated vaccine. Low concentrations of trehalose and sucrose maintain the residual infectivity of the virus. Nairobi sheep disease virus vaccine was lyophilized in trehalose and sucrose and subjected to accelerated stability test at temperatures; 25 0C, 37 0C and 40 0C. Results of this study showed the sugar stabilizers can retain residual infectivity for 14 days at 400C. Stabilization effect of trehalose and sucrose preserve the efficacy of inactivated vaccine stored at 40 0C for despite loss of infectivity.

Educational Debt and Income Among Pharmacists and Other Health Professionals

ObjectiveGiven the substantial increases in student educational loan debt in recent years, the objective was to assess trends in educational debt-to-income ratios for graduates of pharmacy, medicine, dentistry, optometry, and veterinary medicine programs in the United States in the 2017–2022 period. MethodsA retrospective analysis of 2017–2022 data for educational debt and income for select health professions was conducted. Annual income data were collected from the American Community Survey, and educational debt data were collected from health professions organizations. Educational debt-to-income ratios for each health profession were calculated, as was the mean change per year in debt-to-income ratio. ResultsWith the exception of medicine, educational debt consistently exceeded income across the selected health professions in the 2017–2022 period. Debt-to-income ratios of pharmacists and the remaining health professionals decreased on average per year between 2017 and 2022. Physicians had the lowest debt-to-income ratios and dentists had the highest debt-to-income ratios in the study period. ConclusionDebt-to-income ratios fell below the 2017 levels for the health professions of interest, suggesting that average growth in income outpaced that of debt for the study period. Regardless, debt remains high and may influence health care professionals’ postgraduate training and career decisions, and in turn affect access to health care. Therefore, a call to action is proposed to address educational debt burden. Several strategies are suggested, including federal policy changes, implementing tuition reductions or minimal increases, facilitating financial aid options, and reducing underlying costs of health professions programs.

Cost-Effectiveness of Addressing Retinopathy of Prematurity in Rwanda

ABSTRACT Purpose With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo. Methods Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model. Results Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity. Conclusion The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

The Impact of Benefit Generosity on Workers’ Compensation Claims: Evidence and Implications

Leveraging unique administrative data and a sharp increase in benefit generosity in a difference-in-differences research design, we estimate the impact of workers’ compensation wage replacement benefits on individual behavior and program costs. We find that increased benefit generosity leads to longer income benefit durations and increased medical spending. Responses along these two margins are equally important drivers of increased program costs, collectively increasing program costs 1.4 times the mechanical increase in costs. Using these estimates and an estimate of the consumption drop among injured workers, our welfare calibrations suggest that a marginal increase in benefit generosity would not improve welfare. (JEL D91, I11, J28, J31)

Modeled impacts of bouillon fortification with micronutrients on child mortality in Senegal, Burkina Faso, and Nigeria.

Micronutrient interventions can reduce child mortality. By applying Micronutrient Intervention Modeling methods in Senegal, Burkina Faso, and Nigeria, we estimated the impacts of bouillon fortification on apparent dietary adequacy of vitamin A and zinc among children and folate among women. We then used the Lives Saved Tool to predict the impacts of bouillon fortification with ranges of vitamin A, zinc, and folic acid concentrations on lives saved among children 6-59 months of age. Fortification at 250µg vitamin A/g and 120µg folic acid/g was predicted to substantially reduce vitamin A- and folate-attributable deaths: 65% for vitamin A and 92% for folate (Senegal), 36% for vitamin A and 74% for folate (Burkina Faso), and >95% for both (Nigeria). Zinc fortification at 5mg/g would avert 48% (Senegal), 31% (Burkina Faso), and 63% (Nigeria) of zinc-attributable deaths. The addition of all three nutrients at 30% of Codex nutrient reference values in 2.5g bouillon was predicted to save an annual average of 293 child lives in Senegal (3.5% of deaths from all causes among children 6-59 months of age), 933 (2.1%) in Burkina Faso, and 18,362 (3.7%) in Nigeria. These results, along with evidence on program feasibility and costs, can help inform fortification program design discussions.

Michael Scriven and “The Missing Half of Quantitative Evaluation”

Although Michael Scriven is one of the most recognized parents of program evaluation in general, it may be surprising to learn that he also was a founder of cost-inclusive evaluation (CIE) in particular. CIE incorporates into evaluations information on the amounts, types, and monetary values of resources used by programs to achieve outcomes, and, increasingly, the monetary value of those outcomes (Herman et al., 2009; Persaud & Yates, 2023; Yates, 1996). Michael Scriven blazed a trail toward routine use of cost, cost-effectiveness, and cost-benefit analyses by emphasizing that evaluations should measure costs as well as nonmonetary and monetary outcomes, and should compare costs and outcomes for alternative programs in cost-effectiveness and cost-benefit analyses. Scriven also was emphatic that CIE be recognized as a core evaluator competency. Noting that “cost analysis” in evaluation was “the missing half of quantitative evaluation” (Scriven, 2008a, p. iii), he did not immediately succeed in convincing most evaluators that program costs, and monetary program outcomes, were essential to assess. However, his publications, his supervision, and his encouragement of junior colleagues legitimized and recognized CIE as nothing else could.

Motor improvement of remote programming in patients with Parkinson's disease after deep brain stimulation: a 1-year follow-up.

Remote programming (RP) is an emerging technology that enables the adjustment of implantable pulse generators (IPGs) via the Internet for people with Parkinson's disease (PwPD) who have undergone deep brain stimulation (DBS). Previous studies have not comprehensively explored the effectiveness of RP in managing motor symptoms, often omitting assessments such as the rigidity and retropulsion tests during the follow-up. This study evaluates the comprehensive improvements in motor performance and the potential cost benefits of RP for PwPD with DBS. A retrospective analysis was conducted on two groups of patients-those who received RP and those who received standard programming (SP). Clinical outcomes including motor improvement, quality of life, and daily levodopa dosage were compared between the groups during a 12 (± 3)-month in-clinic follow-up. A total of 44 patients were included in the study, with 18 in the RP group and 26 in the SP group. No significant differences were observed in the frequency of programming sessions or clinical outcomes between the groups (p > 0.05). However, the RP group experienced significantly lower costs per programming session than the SP group (p < 0.05), despite patients in the former group living further from our center (p < 0.05). Our findings suggest that RP could significantly reduce the costs of programming for PwPD with DBS, especially without compromising the effectiveness of treatment across all motor symptoms in the short term.

Sabbatical Leave in the Private Sector: An Employee Benefit That Can Be a Cost Saver

Sabbatical leave is a benefit that is commonly associated with higher education but is rarely found in the private sector. The benefits that a sabbatical provides a professor, the opportunity to “recharge and refresh” and return to their responsibilities reinvigorated, would also apply to businesses offering this benefit. In light of the recent COVID disruption, employee claims of “burn-out” and the subsequent resignations of many workers, employee retention is a serious issue for many firms. Search and hiring costs are significant. This study examines the benefits to the firm of offering sabbaticals to their employees. It also provides a framework for businesses to compare search and hiring costs with the costs of a sabbatical program. The numerical example provided demonstrates that avoiding the costs associated with a search could fund an 8-week sabbatical for an employee.

Comparison of two multivalent modified live viral/bacterial combination vaccines in feedlot calves at ultra-high risk of developing undifferentiated fever/bovine respiratory disease

Vaccine 1 (VAC1 group) and Vaccine 2 (VAC2 group) are com­mercially available vaccines labeled for the control of bovine respiratory disease (BRD) in beef cattle. There are limited data from large-scale commercial feedlot trials comparing VAC1 and VAC2 arrival processing vaccination pro­grams. The objective of this study was to evaluate the relative effects of VAC1 and VAC2 arrival processing vacci­nation programs on animal health, feedlot performance and carcass characteristic outcomes in feedlot calves at ultra-high risk of developing undifferentiated fever/BRD under large-scale commercial production conditions. Animals were randomly allocated at feedlot arrival to 1 of 2 experimental groups: VAC1 or VAC2. Animals in the VAC1 group (6 multi-pen lots; 3,001 animals) received a bovine rhinotracheitis-virus diarrhea-parainfluenza 3-respiratory syncytial virus-Mannheimia hae­molytica-Pasteurella multocida vaccine per animal once at allocation. Animals in the VAC2 group (6 multi-pen lots; 3,005 animals) received a bovine rhinotracheitis-virus diarrhea-parainfluenza 3-respiratory syncytial virus vaccine with a Mannheimia haemolytica toxoid per animal once at allocation. Vaccines differed regarding viral strains, bacterial protection, means for providing bacterial immunity, and adjuvant use. Animals were housed by experi­mental group in commercial feedlot pens and followed from allocation until slaughter. Although histophilosis mortality was higher in the VAC1 group compared to the VAC2 group (P = 0.040), no statistical differences were detected in overall mor­tality or any of the other outcome variables (P ≥ 0.050). The relative cost effectiveness of each arrival processing vaccina­tion program in the study population is therefore dependent on relative program cost.

Patient Adherence to a Real-World Digital, Asynchronous Weight Loss Program in Australia That Combines Behavioural and GLP-1 RA Therapy: A Mixed Methods Study.

Increasingly large numbers of people are using digital weight loss services (DWLSs) to treat being overweight and obesity. Although it is widely agreed that digital modalities improve access to care in general, obesity stakeholders remain concerned that many DWLSs are not comprehensive or sustainable enough to deliver meaningful health outcomes. This study adopted a mixed methods approach to assess why and after how long patients tend to discontinue Australia's largest DWLS, a program that combines behavioural and pharmacological therapy under the guidance of a multidisciplinary care team. We found that in a cohort of patients who commenced the Eucalyptus DWLS between January and June 2022 (n = 5604), the mean program adherence was 171.2 (±158.2) days. Inadequate supplying of a patient's desired glucose-like peptide-1 receptor agonist medication was the most common reason for discontinuation (43.7%), followed by program cost (26.2%), result dissatisfaction (9.9%), and service dissatisfaction (7.2%). Statistical tests revealed that ethnicity and age both had a significant effect on patient adherence. These findings suggest that DWLSs have the potential to improve access to comprehensive, continuous obesity care, but care models need to improve upon the one observed in the Eucalyptus Australia DWLS to mitigate common real-world program attrition factors.

Changes in the cost-effectiveness of pneumococcal vaccination and of programs to increase its uptake in U.S. older adults.

Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost-effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs. A Markov model compared no vaccination and current recommendations (either 20-valent pneumococcal conjugate vaccine [PCV20] alone or 15-valent pneumococcal conjugate vaccine plus the 23-valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non-Black 65-year-old cohorts. Pre-pandemic population- and serotype-specific pneumococcal disease risk and illness/vaccine costs came from U.S. Program costs were $2.19 per vaccine-eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon. Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality-adjusted life year (QALY) gained compared with no vaccination; incremental cost-effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non-Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained. Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered.