Burden Of Disease Research Articles

WP3.8 - Estimating the Disease Burden and Epidemiological Characteristics of Burn Injuries in the United Kingdom: a systematic analysis of the global burden of disease study 2019

Abstract Background Burn injuries pose a substantial public health challenge globally, with profound physical, psychosocial, and financial consequences for individuals, households, and communities. This study aims to assess the disease burden and epidemiological characteristics of burn injuries in the United Kingdom (UK). Methods Utilising data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we estimated the prevalence, age-standardised incidence, and years lived with disability (YLD) for burn injuries in the UK. Burn injuries were further classified based on the total burn surface area (TBSA), distinguishing between <20% and >= 20% TBSA. Result In 2019, the age-standardised incidence rate of burn injuries in the UK was estimated at 330.65 per 100,000 (268.59-409.52). Incidence rates have demonstrated a stable downtrend since 1990. Over 90% of burn injuries in the UK were categorised as <20% TBSA. Younger age groups experienced a higher disease burden. England exhibited the highest age-standardised incidence rate of burn injuries (344.98 per 100,000), along with a threefold higher rate of burn injuries >20% TBSA (29.64 per 100,000) compared to Wales, Northern Ireland, and Scotland. The burden of disability attributed to burn injuries in the UK was estimated at 84.38 YLD per 100,000 (49.16-139.56), with the highest burden observed in England (88.90 per 100,000). Conclusion This study underscores the substantial disease burden imposed by burn injuries in the UK, alongside disparities in their distribution and warrant further studies in addressing the social and economic determinants of burn injuries.

Burden changes in notifiable infectious diseases in Taiwan during the COVID-19 pandemic.

This study aimed to assess the impact of the COVID-19 pandemic on the disease burden of Taiwan's notifiable infectious diseases (NIDs). We compared disease burdens between the pandemic and pre-pandemic year of 2020 (with non-pharmaceutical interventions (NPIs)) and 2010 (without NPIs), respectively, to understand the overall pandemic impact on NIDs in Taiwan. Forty-three national NIDs were analyzed using the Statistics of Communicable Diseases and Surveillance Report by estimating the premature death and disability via different transmission categories, sex, and age groups. The study evaluated the impact of diseases by assessing the years lost due to death (YLLs), the duration of living with disability (YLDs), and the overall disability-adjusted life years (DALYs) by measuring both the severity of the illness and its duration. Taiwan recorded 1,577 (2010) and 1,260 (2020) DALYs per million population and lost 43 NIDs, decreasing 317 DALYs per million population. Tuberculosis, HIV/AIDS and acute hepatitis B/D were the leading causes of DALYs, accounting for 89% (2010) and 77% (2020). Overall, this study provided the first insight of changes in disease burdens in NIDs between pre- and post-COVID-19 based on a nationwide viewpoint for further preventive measures and interventions to be focused on specific diseases by associated health administrations and policies.

Basivertebral Nerve Ablation for Treatment of Lower Back Pain

Lower back pain (LBP) is a widely prevalent global health issue, affecting over half a billion people and remaining the leading cause of years lived with disability (YLDs). LBP significantly impacts healthcare systems, with substantial costs related to surgical procedures and lost workdays. Vertebrogenic back pain (VBP), characterized by specific clinical symptoms and associated with Modic changes (MC) in vertebral endplates, best seen on MRI, is a significant subset of LBP. This paper explores the pathophysiology, diagnosis, and current reports and studies focusing on VBP and the role of basivertebral nerve (BVN) ablation as a therapeutic intervention. Multiple studies, including randomized controlled trials (RCTs) and meta-analyses, demonstrate the efficacy of BVN ablation in reducing pain and improving function in patients with chronic LBP associated with MC.

WP4.14 - Association of Socioeconomical Status and Disparity In Paediatric Burn: Results From The Global Burden Of Disease Study 2019

Abstract Background Burn represents a significant contributor to both morbidity and mortality in the paediatric population and is closely related to socioeconomic and geographic factors but is often overlooked. This study aims to estimate the unbalanced distributions, temporal trends and quality of care in paediatric burn. Methods Data focusing on paediatric population (<20 years old) was sourced from the Global Burden of Disease (GBD) Study 2019 stratified by Socio-demographic Index (SDI) and WHO region, including incidence, mortality and disability-adjusted life-years (DALYs). Joinpoint regression analysis and principal component analysis were conducted to compute the temporal trend and quality of care (QCI) index respectively. Result In 2019, 3,719,806 paediatric burn cases were reported, resulting in 23,986 deaths and 2,240,311 DALYs globally. Over 40% of deaths and DALYs attributable to burn occur in the African region, despite the region accounting for around 20% of the total incidence. The age-standardised incidence rate (ASIR) from 2010-2019 was 0.419 per 100,000 but death (ASDR) and DALYs (ASDALYs) were reduced at the rate of 3.04 per 100,000 and 2.92 per 100,000 respectively. The global QCI for paediatric burn was 88 with a proportional trend observed across SDI quintiles Significant association in between SDI scores and gender disparity and quality of care was observed. Conclusion This study highlights the significant burden of paediatric burn and its disproportionate global distribution. Preventive measures, enhancing access to quality healthcare, and addressing the social and economic determinants of burn should be addressed in future studies.

Global Burden of Inflammatory Bowel Disease Among Children and Adolescents: A Comprehensive Analysis (1990–2019)

ObjectiveWe summarize the global, regional, and national burden of inflammatory bowel disease (IBD) in children and adolescents from 1990 to 2019.MethodsBased on the Global Burden of Disease Study 2019, the data of IBD in children and adolescents were analyzed by sex, age, year, and location. Joinpoint analysis was applied to assess the temporal trend of the disease burden.ResultsFrom 1990 to 2019, the incidence of IBD in children and adolescents increased by 22.8%, from 20,897.42 to 25,658.55 cases, especially in high SDI region. During the same period, the DALY numbers decreased by 53.5%, from 243,081.06 to 113,119.86, with all SDI regions experiencing a clear drop in DALYs except high SDI regions. In 2019, early-onset IBD incidence and DALY numbers were reported at 2,053.52 (95% UI: 1,575.62 to 2,677.49) and 73,797.46 (95% UI: 43,655.86 to 105,998.63), respectively.ConclusionEarly-onset IBD in children and adolescents remains a significant global health concern. The disease burden has not improved in developed countries over the past 30 years, highlighting the need for targeted interventions.

Factors That Influence Medical Retrieval Decisions in Remote Central Australia

Introduction Medical retrieval services play a key role in the transportation of unwell patients from remote communities across Australia. Decision to retrieve a patient from a remote community is dependent on unique characteristics of remote locations and thus different to urban and rural retrievals. The study aims to explore various factors that affect medical practitioner decisions to retrieve patients from remote central Australian communities. Methods Semi-structured interviews were conducted with 36 staff involved in medical retrieval processes in central Australia. The data collection and analyses were part of a broader study evaluating a newly implemented medical retrieval model in central Australia. All interviews were recorded and transcribed. Transcripts were co-coded inductively by two researchers using NVivo software. Similar codes were grouped into themes, one of which related to the range of factors that affect decisions to retrieve a patient or request a retrieval which is the focus of this paper. Results: Decision-making about who, when and how to retrieve patients was complex and involved trade-offs. Severity of patient illness, resource availability (e.g. transport infrastructure, remote area staff workload and fatigue), the skills, experience and relationships with community of primary health care and medical retrieval staff, strength of primary health care systems in remote communities, specific primary health care and retrieval policies, and innovations in disease prevention and management influenced medical retrieval decisions. Conclusion: It is critical to understand that both general and contextual factors unique to remote communities affect medical retrieval decisions. Decisions are highly complex and necessitate trade-offs, frequently related to resource scarcity, which are somewhat different from those of urban retrieval services. Resource allocation in the context of providing retrieval services for remote populations must account for differences in burden of disease, cultural requirements, workforce characteristics and overall access to health care compared to urban populations.

Elevated risk of adverse effects from foodborne contaminants and drugs in inflammatory bowel disease: a review.

The global burden of Inflammatory bowel disease (IBD) has been rising over the last decades. IBD is an intestinal disorder with a complex and largely unknown etiology. The disease is characterized by a chronically inflamed gastrointestinal tract, with intermittent phases of exacerbation and remission. This compromised intestinal barrier can contribute to, enhance, or even enable the toxicity of drugs, food-borne chemicals and particulate matter. This review discusses whether the rising prevalence of IBD in our society warrants the consideration of IBD patients as a specific population group in toxicological safety assessment. Various in vivo, ex vivo and in vitro models are discussed that can simulate hallmarks of IBD and may be used to study the effects of prevalent intestinal inflammation on the hazards of these various toxicants. In conclusion, risk assessments based on healthy individuals may not sufficiently cover IBD patient safety and it is suggested to consider this susceptible subgroup of the population in future toxicological assessments.

The burden of chronic kidney disease in Asia region: a review of the evidence, current challenges, and future directions

The burden of chronic kidney disease in Asia region: a review of the evidence, current challenges, and future directions

Sourcing antimicrobial agents from Globimetula braunii: An in silico molecular docking and dynamic approach

The continued emergence of multi-drug resistance pathogens has been a major setback to lifting the burden of infectious diseases, especially bacterial illnesses. Natural- and/or nature-inspired compounds have so far become a therapeutic backbone on which many novel antibacterial agents are optimized. It is against this backdrop that we used an in silico molecular interaction-based approach to screen five previously identified compounds from Globimetula braunii, for lead inhibitors against bacterial illnesses. The compounds were chromatographed from the leaf ethyl acetate fraction and were characterized by spectroscopic means as 13,27-cycloursane (1), 13,27-cycloursan-3-one (2), methyl-3,5-dihydroxy-4-methoxybenzoate (3), 3-methyl-4-hydroxybenzoate (4), and 2-methoxyphenol (5). Upon their molecular docking at the active pocket of the Staphylococcus aureus gyrase B and the Escherichia coli DNA gyrase, 2 showed the highest binding affinities, with energy scores of -10 and -9.6 Kcal/mol. These were better than the standard antibiotics, Ampicillin (-7.5 and -8.0 Kcal/mol), and Ciprofloxacin (-6.9, -8.4 Kcal/mol). Further evaluation of the most promising compound 2 by molecular dynamics simulation showed the mean RMSD values of the 13,27-cycloursan-3-one - E. coli DNA gyrase protein complexes (complex 1) and 13,27-cycloursan-3-one - S. aureus gyrase B protein (complex 2) to be 0.7 and 0.9 Ǻ respectively, attaining stability at 102 and 108 ns. In contrast, complexes 1 and 2’s RMSF analysis revealed the fewest fluctuations and was generally stable over the course of the 120 ns. In conclusion, 13,27-cycloursan-3-one is unquestionably the most promising inhibitory candidate against the bacterial growth protein DNA gyrase, hence, it can be considered as a druggable substance against bacterial disease.

Oral Health Surveillance System in India: Need and Proposal

Public health surveillance is described as the ongoing systematic collection, analyzing, and interpreting of the data, closely integrated with the transmission of these data to public health practitioners, doctors, and policymakers responsible to prevent and manage disease as well as injury. Both developed and developing nations are becoming aware of the significance of information from efficient surveillance systems for allocating resources and evaluating programs. Over the past few decades, there was a significant change in oral health profiles around the world. Indicators of oral health have improved in many countries, but not in India. An organized system for providing, monitoring, and evaluating oral health care services is needed in India. Draft National oral health policy 2021 has mentioned specific objectives: (a) by 2025, establish baseline data on the burden of oral diseases in the nation, (b) by 2030, the mortality and morbidity from dental and oro-facial diseases reduce to 15%, (c) By 2025, community-based awareness initiatives and practices for oral health will be covered by the healthcare system by a factor of 50%, and by 2030, by a factor of 70%, (d) the creation of an electronic database at district-level on components of the health system by 2025. A well-defined oral health surveillance system in India will serve the purposes (a) to provide standardized recording procedures, standards, and techniques to collect, analyze and interpret the oral health data at the state and central levels (b) to prioritize oral diseases or conditions that will be the focus of oral health surveillance or disease elimination, (c) to digitally monitor and evaluate the progress of nation’s oral health care programs.

Estimating the burden of vaccine preventable lower respiratory tract disease in primary care, UK: protocol for a prospective surveillance study (AvonCAP GP2)

BackgroundThe true burden of acute lower respiratory tract diseases (aLRTD; includes acute lower respiratory tract infection, acute exacerbation of pre-existing heart failure and chronic lung disease) among adults presenting to primary care, and the proportion that are potentially vaccine preventable, is unknown.AimsTo describe aLRTD incidence in adults presenting to primary care; estimate proportions caused by RSV, SARS-CoV-2 and pneumococcus; and investigate disease burden from patient and NHS perspectives.Design & settingPrimary care prospective cohort study conducted in six representative General Practices (total ̴83 000 registered adults) in Bristol, UK.MethodAdults (aged≥18 years) registered at participating General Practices and presenting to primary care (in-hours or out-of-hours) or emergency department (if not admitted) with aLRTD will be eligible and identified by real-time primary care record searches. Researchers will screen electronic GP records, including free text, contact patients to assess eligibility, and offer enrolment in a surveillance study and an enhanced diagnostic study (urine, saliva and respiratory samples; physical examination; and symptom diaries). Data will be collected for all aLRTD episodes, with patients assigned to one of three arms: surveillance, embedded diagnostic, and descriptive dataset. Outcome measures will include clinical and pathogen defined aLRTD incidence rates, symptom severity and duration, NHS contacts and costs, health-related quality of life changes, and mortality (≤30 days post identification).ConclusionThis comprehensive surveillance study of adults presenting to primary care with aLRTD, with embedded detailed data and sample collection, will provide an accurate assessment of aLRTD burden due to vaccine preventable infections.

Psychological profiles in patients receiving maintenance dialysis: Classification, correlates, and behavioral health outcomes.

This study identified psychological profiles based on depressive symptoms, anxiety symptoms, positive affect, and posttraumatic growth in 298 patients receiving maintenance dialysis, and examined their relationships with self-management at baseline and 1-year follow-up. Five psychological response profiles were identified: well-being (42.95%), resilient (26.17%), moderate-distress-with-growth (17.79%), distressed (11.07%), and high-distress-with-growth (2.01%). Patients were more likely to be in the distressed profile if they were younger, had less social support, received peritoneal dialysis, and suffered from a greater symptom burden of kidney disease. The well-being profile showed better self-management behavior at baseline and 1-year follow-up. The distressed profile was associated with worse self-management at baseline and the resilient profile was associated with worse self-management at follow-up. The findings highlighted the beneficial role of positive psychological constructs in promoting self-management behavior, which implied that beyond eliminating psychological distress, it is important to facilitate positive psychological well-being.

The Economic Burden of Atherosclerotic Cardiovascular Disease in Italy.

Atherosclerotic cardiovascular diseases remain the primary cause of mortality in Italy. Individuals with a history of acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack face an elevated risk of recurrent major adverse cardiovascular events, including mortality. The population aging, coupled with increasing risk factors such as diabetes mellitus and obesity, exacerbates the disease's economic impact. This study aims to comprehensively assess the economic burden of atherosclerotic cardiovascular diseases in Italy, specifically focusing on direct healthcare costs. We analyzed real-world data from administrative databases in the Marche region and Local Health Unit Umbria 2. The economic burden of patients discharged with acute coronary syndrome, peripheral arterial disease, and ischemic stroke/transient ischemic attack was evaluated, with a focus on direct costs associated with hospitalizations, drugs, and outpatient visits. Results were stratified by age, sex, comorbidities at baseline, and adherence to lipid-lowering therapy and antihypertensive agents. Annually, nearly 350,000 patients were hospitalized for peripheral arterial disease, acute coronary syndrome, or ischemic stroke/transient ischemic attack. Direct health costs averaged €7190 per patient over a 2-year follow-up, with hospitalizations accounting for nearly 70% of the total. Male patients incurred significantly higher costs (€7467) than female patients (€6625). Costs correlated positively with age and with the number of baseline comorbidities, with a range from €5259 (0-1 comorbidities) to €17,095 (4+ comorbidities). Costs were significantly lower in adherent subjects (€6813) compared with non-adherent subjects (€7757). This study provides valuable insights into the economic implications of atherosclerotic cardiovascular diseases in Italy, emphasizing the necessity of a comprehensive approach to preventive measures, optimal medication adherence, and lifestyle modifications to mitigate its impact.

Low levels of hypertension screening in HIV care clinics in rural Uganda: A mixed methods study

Background The prevalence of hypertension among people living with HIV (PLHIV) has increased over the last decade globally. Given the dual burden of disease and significant prior investment in HIV care, integrating care for hypertension and HIV is recommended. However, data on hypertension screening, treatment, and control before such integration are lacking. Using a mixed-methods approach, we assessed the baseline status of hypertension screening, treatment, and control in 52 Ugandan public health facilities, participating in an ongoing cluster randomised trial of an integrated HIV/HTN care model. Methods From November 2020 to March 2021, we reviewed patient records and randomly sampled 50 PLHIV without a documented hypertension diagnosis per health facility and all PLHIV with a documented hypertension diagnosis per health facility. We surveyed the sampled participants, measured their blood pressure, and described the hypertension care cascade. We also conducted in-depth interviews with 24 patients and 12 providers to explore their experience with hypertension screening and care. We used an in-depth thematic approach to analyze the resulting qualitative data. Results Among 2,645 PLHIV, <1% (20/2,645) had their BP measured within 6 months before the survey. The prevalence of hypertension was 13.6% (359/2,645), including 278 (10.5%) new diagnoses and 32 (1.2%) prior diagnoses that were not documented in their health record. Of 49 with a previously documented hypertension diagnosis, 31 (63.3%) were on hypertension treatment, and 53.1% had controlled hypertension. In-depth interviews with providers and patients revealed a lack of blood pressure equipment, high patient load, limited technical hypertension knowledge, and patients' fear of anticipated long waiting times as reasons for low hypertension screening in the HIV clinics. Conclusion Regular screening for the detection of hypertension patients was hardly performed. There is an urgent need for interventions to advance the integration of hypertension care in HIV clinics.

Developing a framework for identifying risk factors and estimating direct economic disease burden attributable to healthcare-associated infections: a case study of a Chinese Tuberculosis hospital

Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.

Prognostic Value of Circulating Fibrosis Biomarkers in Dilated Cardiomyopathy (DCM): Insights into Clinical Outcomes

Background: Dilated cardiomyopathy (DCM) involves myocardial remodeling, characterized by significant fibrosis and extracellular matrix expansion. These changes impair heart function, increasing the risk of heart failure and sudden cardiac death. This study investigates the prognostic value of circulating fibrosis biomarkers as a less invasive method in DCM patients. Methods: Plasma samples from 185 patients with confirmed DCM were analyzed to measure 13 circulating biomarkers using Luminex bead-based multiplex assays and ELISA. The prognostic value of these biomarkers was evaluated concerning heart failure-associated events and all-cause mortality. Results: Elevated MMP-2 levels (>1519.3 ng/mL) were linked to older age, higher diabetes prevalence, lower HDL, increased NT-proBNP and hs-TnT levels, and severe systolic dysfunction. High TIMP-1 levels (>124.9 ng/mL) correlated with elevated NT-proBNP, more atrial fibrillation, reduced exercise capacity, and larger right ventricles. Increased GDF-15 levels (>1213.9 ng/mL) were associated with older age, systemic inflammation, renal impairment, and poor exercise performance. Elevated OPN levels (>81.7 ng/mL) were linked to higher serum creatinine and NT-proBNP levels. Over a median follow-up of 32.4 months, higher levels of these biomarkers predicted worse outcomes, including increased risks of heart failure-related events and mortality. Conclusions: Circulating fibrosis biomarkers, particularly MMP-2, TIMP-1, GDF-15, and OPN, are valuable prognostic tools in DCM. They reflect the severity of myocardial remodeling and systemic disease burden, aiding in risk stratification and therapeutic intervention. Integrating these biomarkers into clinical practice could improve DCM management and patient prognosis.

ThP5.12 - Safety of emergency laparoscopic cholecystectomy in the treatment of gall stone disease: A single centre observational study from a District General Hospital

Abstract Aim To evaluate the safety of emergency laparoscopic cholecystectomy in the treatment of gallstone disease. Methods This was a retrospective, single-centre observational study of 267 patients who were admitted with abdominal pain due to a gallstone related pathology during June 2021 to June 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, conservative or surgical treatment, emergency surgery or elective interval surgery, utilisation of dedicated "hot gallbladder list", re-admissions, and re-operations. Results Out of the 267 patients, 163 were female and 104 were male. The median age was 61 with the age ranging from 20 to 96. The median duration of symptoms was 2 days before admission. First-time admissions were 226 and re-admissions were 41. Ultrasound, CT and MRI were done on 188, 123 and 64 patients respectively. 178 patients were diagnosed to have acute calculous cholecystitis, 51 patients had acute gallstone pancreatitis and 38 had biliary colic due to lithiasis. 172 patients were treated with surgery of which 104 were operated on during the same admission, 20 in readmission and 48 as an interval elective surgery. Of the 124 emergency operations, 37 were performed on the dedicated "hot gallbladder list" and 87 were performed on the emergency CEPOD list. 2 patients were re-operated due to post-operative complications. 95 patients were managed conservatively. Conclusions Emergency laparoscopic cholecystectomy is a safe option when performed by experienced surgeons. A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.

Balancing barriers and strategies - Nurses' experiences of conducting lifestyle counseling.

Over 70% of the disease burden in Europe is the result of chronic diseases caused by lifestyle. Lifestyle counseling can improve lifestyle habits and thereby health. However, according to research, there are several barriers to healthcare personnel carrying out counseling. The aim of this study was to explore nurses' experiences of conducting lifestyle counseling. A qualitative descriptive study was conducted in southern Sweden between August 2021 and December 2021. Eleven nurses were recruited from both inpatient and outpatient care in northeastern Sweden through a combination of purposive and snowball sampling. Individual semistructured interviews were performed digitally using an interview guide. The interviews were analyzed via qualitative content analysis. The nurses experienced several challenges in performing lifestyle counseling. However, knowledge gaps, sensitive topics, organizational dynamics, and time constraints were balanced using strategies. The theme of their responses can be explained by the following categories: "Collaboration with patients is key," "From self-interest to teamwork," and "The organization can assist or hinder." Lifestyle counseling needs to be prioritized within healthcare. Nurses need tools and knowledge to be able to feel comfortable with the task. All healthcare organizations need to work with lifestyle counseling in a structured way according to national guidelines.

Respiratory syncytial virus vaccination strategies for older Canadian adults: a cost-utility analysis.

Respiratory syncytial virus (RSV) vaccines could reduce disease burden and costs in older Canadian adults, but vaccination program cost-effectiveness is unknown. We evaluated the cost-effectiveness of different age cut-offs for RSV adult vaccination programs, with or without a focus on people with higher disease risk due to chronic medical conditions. We developed a static individual-based model of medically attended RSV disease to compare alternative age-, medical risk-, and age-plus medical risk-based vaccination policies. The model followed a multiage population of 100 000 people aged 50 years and older. Vaccine characteristics were based on RSV vaccines authorized in Canada as of May 2024, with vaccine protection assumed to last 2 years (or 3 years in scenario analyses). We calculated sequential incremental cost-effectiveness ratios in 2023 Canadian dollars per quality-adjusted life year (QALY) from the health-system and societal perspectives, discounted at 1.5%. Although all vaccination strategies averted medically attended RSV disease, universal age-based strategies were not an efficient use of resources compared with medical risk-based strategies. Vaccinating adults aged 70 years and older with 1 or more chronic medical condition was the optimal strategy for a cost-effectiveness threshold of $50 000 per QALY. Results were sensitive to assumptions about vaccine price, but medical risk-based approaches remained optimal compared with age-based strategies, even when vaccine prices were low. Findings were robust to a range of alternative assumptions. Vaccination programs for RSV in some groups of older Canadians with underlying medical conditions are likely cost-effective. These findings can inform the design of vaccination programs.

EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis

Abstract Background Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage. Method A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality. Conclusion The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.