Health Utilization Research Articles

Cost-effectiveness of triplet therapies in metastatic hormone-sensitive prostate cancer used in PEACE-1 and ARASENS.

222 Background: Recent findings from the PEACE-1 and ARASENS trials have demonstrated survival benefits in men with newly diagnosed metastatic hormone-sensitive prostate cancer using different triplet therapies, including Abiraterone and Darolutamide added to Androgen Deprivation Therapy and Docetaxel. Given the rising costs of cancer care, this study aimed to assess the cost-effectiveness of these treatment regimens. Methods: Drug prices were obtained from drugs.com and assurance-maladie.ameli.fr at wholesale prices to evaluate both United States (US) and France payer perspectives. Survival and progression data were sourced from Kaplan-Meier curves of the PEACE-1 and ARASENS trials and fitted to Weibull distribution models in R. The parameters were imported into TreeAge Pro 2023 for partitioned survival analysis. Health states were classified as "Pre-Progression," "Post-Progression," and "Death," each assigned specific health utility values and costs. Outcomes including total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. Uncertainty was addressed through one-way and probabilistic sensitivity analyses. The baseline willingness-to-pay (WTP) threshold was $100,000 per QALY. Euros were converted to US Dollars. Results: At the baseline WTP of 100,000, generic Abiraterone (US, France) in PEACE-1 and Darolutamide in ARASENS from the French perspective were cost-effective. Generic Abiraterone was dominant, associated with lower net costs (-1,347 to -333) and higher QALYs (0.16) and Darolutamide had an ICER of .7,001 per QALY. In contrast, other triplet therapies increased both net costs and QALYs. Abiraterone yielded ICERs of 408,074 (US) and 114,995 (France) per QALY. Darolutamide in the US had an ICER of $383,732 per QALY. On one-way sensitivity analyses, most drugs would need to be priced at less than ~4,000 a month to be cost-effective at WTP of 100,000 per QALY. On probabilistic sensitivity analyses, with WTP of 100,000 per QALY, generic Abiraterone (US) was the cost-effective drug (88% of simulations), while brand Abiraterone and Darolutamide (US) were the least cost-effective (0% of simulations). Conclusions: Cost-effectiveness of therapies in metastatic hormone-sensitive prostate cancer vary significantly based on pricing and country payer perspective. At a WTP threshold of $100,000, only generic Abiraterone (US, FRA) and Darolutamide (France) were cost-effective. [Table: see text]

Meniscus Tear Requiring Intraoperative Repair Does Not Influence Midterm Patient-Reported Outcomes in Operatively Treated Tibial Plateau Fractures.

Evaluate whether intraoperatively repaired lateral meniscus injuries impact midterm patient-reported outcomes in those undergoing operative fixation of tibial plateau fracture. Retrospective cohort study. Level I trauma center. All patients (n = 207) who underwent operative fixation of a tibial plateau fracture from 2016 to 2021 with a minimum of 10-month follow-up. The Patient-Reported Outcomes Measurement Information System Physical Function, Knee Injury and Osteoarthritis Outcome Score, and the PROMIS-Preference health utility score. Overall, 207 patients were included with average follow-up of 2.9 years. Seventy-three patients (35%) underwent intraoperative lateral meniscus repair. Gender, age, body mass index, Charlson comorbidity index, days to surgery, ligamentous knee injury, open fracture, vascular injury, polytraumatic injuries, Schatzker classification, and Orthopaedic Trauma Association classification were not associated with meniscal repair ( P > 0.05). Rates of reoperation (42% vs. 31%, P = 0.11), infection (8% vs. 10%, P = 0.60), return to work (78% vs. 75%, P = 0.73), and subsequent total knee arthroplasty (8% vs. 5%, P = 0.39) were also similar between those who had a meniscal repair and those without a meniscal injury, respectively. There was no difference in Patient-Reported Outcomes Measurement Information System Physical Function (46.3 vs. 45.8, P = 0.707), PROMIS-Preference (0.51 vs. 0.50, P = 0.729), and all Knee Injury and Osteoarthritis Outcome Score domain scores at the final follow-up between those who had a meniscal repair and those without a meniscal injury, respectively. In patients with an operatively treated tibial plateau fracture, the presence of a concomitant intraoperatively identified and repaired lateral meniscal tear results in similar midterm PROMs and complication rates when compared with patients without meniscal injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Exploring humanistic burden of fatigue in adults with multiple sclerosis: an analysis of US National Health and Wellness Survey data

BackgroundThis retrospective study examined the humanistic burden of fatigue in patients with relapsing-remitting multiple sclerosis (RRMS), compared with adults without MS, using data from the 2017 and 2019 US National Health and Wellness Survey.MethodsThe 5-item Modified Fatigue Impact Scale (MFIS-5) was used to assess level of fatigue (MFIS-5 score <15: low fatigue [LF]; MFIS-5 score ≥15: high fatigue [HF]) in patients with RRMS. Health-related quality of life (HRQoL) measures (Short Form 36-Item Health Survey version 2, Euroqol-5 Dimensions-5 Levels [EQ-5D-5L], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], Perceived Deficits Questionnaire-5) and treatment-related characteristics were assessed.ResultsIn total, 498 respondents were identified as RRMS (n=375 RRMS+LF, n=123 RRMS+HF) and compared with 1,494 matched non-MS controls. RRMS+LF and RRMS+HF had significantly lower Short Form 6 Dimensions health utility, Mental and Physical Component Summary, and EQ-5D-5L scores and higher PHQ-9 and GAD-7 scores, compared with matched non-MS controls (all p<0.001); scores were worse for RRMS+HF than RRMS+LF across all measures (all p<0.001). A higher proportion of RRMS+HF reported moderate-to-severe depression and moderate-to-severe anxiety, compared with RRMS+LF and matched non-MS controls (both p<0.001). Fatigue was a significant predictor of poor HRQoL across all measures (all p<0.001).ConclusionsPatients with RRMS experienced lower HRQoL with higher levels of fatigue, highlighting an unmet need. Results may help to inform physician-patient communication and shared decision-making to address fatigue and its associated impact on patients’ HRQoL.

Association of hysterectomy with nonalcoholic fatty liver disease among US women

BackgroundA postmenopausal rise in the rates of nonalcoholic fatty liver disease (NAFLD) has been reported in women. This study thus sought to further probe the association of hysterectomy with NAFLD.MethodsThe data utilized in this investigation were attained from the 2017-March 2020 cycle of the National Health and Nutrition Examination Survey (NHANES), reflecting a strategic utilization of comprehensive health and nutrition information in the US population, to conduct a cross-sectional examination of the relationship between self-reported hysterectomy and NAFLD. Subjects included in this study were women aged 20 years or older. The multivariable logistic regression methodologies were utilized to determine the pertinent odds ratios (ORs) and their associated 95% confidence intervals (CIs).ResultsOf the 2,868 subjects enrolled in this study (mean age: 51.3 years, 95%CI: 50.0-52.6 years), 22.1% (95%CI: 19.7–24.7%) reported having undergone a hysterectomy, while 31.1% (95%CI: 28.1–34.1%) exhibited elastographic evidence of NAFLD, and 3.8% (95%CI: 2.6–5.6%) exhibited clinically significant fibrosis (CSF). Relative to women with no history of hysterectomy, those that had undergone hysterectomy exhibited a higher odd of NAFLD (OR:1.66, 95%CI: 1.24–2.21) in a multivariable model fully adjusted for age, ethnicity, body mass index, female hormone use, oophorectomy, diabetes, hyperlipidemia, and smoking status. Subgroup analyses revealed a stronger association among women who were not obese (OR:2.23, 95%CI:1.61–3.11), women who were not affected by diabetes (OR:1.76, 95%CI: 1.25–2.46), and without hyperlipidemia (OR: 1.87, 95%CI: 1.10–3.16). No significant association of hysterectomy with NAFLD encompassing CSF was identified.ConclusionsThe results of the present nationally representative analysis suggested an association between hysterectomy and increased NAFLD prevalence among US women. Knowledge of this relationship may better aid clinical efforts to screen for and manage NAFLD.

Descriptive epidemiological study assessing emergency department presentations associated with the Hawkesbury-Nepean flood plain

Floods disrupt essential services and infrastructure including food, utilities and dwellings. These disruptions affect health outcomes and access to essential health services. The increasing incidence of severe weather events has been linked to climate change (IPCC 2022) and highlights the importance of a climate-resilient health system to provide timely services. This paper considers the immediate effects that a severe flooding event within Nepean Blue Mountains Local Health District (NBMLHD) had on emergency health utilisation to inform future health planning and facilitate the evaluation of climate responsive interventions.

The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications.

Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF-related medications and adverse clinical outcomes (all-cause mortality, all-cause readmissions and HF readmissions) among older HF patients. A total of 38843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2years of follow-up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time-varying use of HF-related medications and clinical outcomes among distinct frailty subgroups. Of 38843 older HF patients (mean age 80.4±8.5years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter-quartile range-IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all-cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11-1.21), all-cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16-1.25) and HF-related readmissions (sHR 1.14, 95% CI 1.09-1.20) at 2years of follow-up. Those who used triple or more HF-related medications were at lower risk for all-cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44-0.54) and HF-related readmissions (aOR 0.42, 95% CI 0.37-0.47) at 2years of follow-up even in the severe frailty group. Frailty is highly prevalent and associated with increased risk of all-cause mortality, all-cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF-related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.

A Global View of Pemphigus: Geographical Variations.

Pemphigus, an autoimmune intraepidermal bullous disease group with roughly eight distinct forms, includes pemphigus vulgaris (PV) and pemphigus foliaceus (PF) as its predominant global forms. Despite the increased utilization of global health records and reporting systems, epidemiological data remain limited and poorly categorized. Therefore, this study aimed to conduct a review to track, identify, and characterize cases of PV and PF published and categorized worldwide. A research question was formulated; studies were selected based on the inclusion criteria; and data from these publications were systematically collected, summarized, and presented using narrative descriptions. The search strategy yielded 3,212 articles, of which 95 underwent critical analysis and data extraction. Studies from 52 countries contributed to the dataset, covering various pemphigus variants. Notably, only two countries, Iran (18.87%) and South Korea (11.43%), accounted for approximately a third of the reported PV cases, while Brazil contributed 40.25% of the foliaceus variants cases documented in the literature. These findings offer valuable insights into the global distribution of pemphigus and inform future research and healthcare efforts.

Cost-effectiveness of edaravone dexborneol versus human urinary kallidinogenase for acute ischemic stroke in China

BackgroundClinical trials have demonstrated the efficacy of edaravone dexborneol in the treatment of acute ischemic stroke. This study aims to determine the cost-effectiveness of edaravone dexborneol compared with human urinary kallidinogenase from China’s healthcare system perspective.MethodsA combination of the decision tree and Markov model was constructed to evaluate the cost-effectiveness of edaravone dexborneol versus human urinary kallidinogenase in the treatment of acute ischemic stroke over a lifetime horizon. Efficacy data were derived from pivotal clinical trials of edaravone dexborneol and human urinary kallidinogenase (TASTE trial and RESK trial, respectively) and adjusted using matching-adjusted indirect comparison. Cost and health utility inputs were extracted from published literature and open databases. One-way deterministic sensitivity and probabilistic sensitivity analyses were performed to examine the robustness of the results.ResultsCompared with human urinary kallidinogenase, edaravone dexborneol generated 0.153 incremental quality-adjusted life years (QALYs) with an incremental cost of ¥856, yielding an incremental cost-effectiveness ratio of ¥5,608 per QALY gained under the willingness-to-pay threshold (one-time gross domestic product per capita). Both one-way deterministic sensitivity analysis and probabilistic sensitivity analysis demonstrated the robustness of the base case results.ConclusionsEdaravone dexborneol is a cost-effective treatment choice for acute ischemic stroke patients compared with human urinary kallidinogenase in China.

Feasibility assessment of using the MiToS staging system for conducting economic evaluation in amyotrophic lateral sclerosis

ABSTRACT Objectives This study assessed the feasibility of using the Milano-Torino staging (MiToS) system for conducting economic evaluation to measure health outcomes in amyotrophic lateral sclerosis (ALS). Methods A Markov model was developed using the MiToS system and evaluated with a hypothetical treatment versus standard of care. Health utilities and transition probabilities were derived from the literature. Four-time horizons (1, 5, 10, and 20 years) were examined. Treatment effects of 20–35% relative risk reduction (RRR) of progressing to the next MiToS stage were assessed. Three patient distribution scenarios were tested: (1) all patients began in stage 0; (2) patient distribution based on real-world TONiC study; (3) distribution based on the PRO-ACT database. Health outcomes (quality-adjusted life-years [QALYs], life-years [LYs]) were reported with a 3% discount rate. Results A time horizon of 10 years fully captured treatment benefits: incremental QALYs were 0.28–0.60, 0.21–0.45, and 0.26–0.55 for scenarios 1–3, respectively; incremental LYs were 0.56–1.17, 0.46–0.97, and 0.53–1.11, respectively. Conclusion MiToS-based staging can be used for conducting economic analyses in ALS. Estimated incremental QALY and LY gains were meaningful within the context of ALS, for hypothetical treatments with RRR of 20–35%.

Evaluating the sensitivity of EQ-5D-5L in patients with brain metastases: a secondary analysis of NRG CC001.

EuroQoL EQ-5D is a commonly used measure of health-related quality of life (HRQOL) in clinical trials given the use of its index score as a measure of health utilities. It is unclear whether EQ-5D is sensitive to changes in neurocognitive function and progression that occur following brain radiation. This study sought to evaluate the sensitivity of EQ-5D-5L in reflecting these changes. A secondary analysis of NRG Oncology CC001 was performed. Mean EQ-5D-5L index and visual analog scale (VAS) score changes from baseline between groups of patients stratified by neurocognitive function and intracranial progression status were assessed. MD Anderson Symptom Inventory for brain tumor (MDASI-BT) symptom and interference items were also analyzed between groups. EQ-5D-5L index and VAS score changes between patients who had cognitive failure and those that had preserved cognition showed no significant differences at any time point. In contrast, VAS changes at 4 (1.61 vs -5.13, P = .05) and 6 months (8.17 vs -0.14, P = .04) were significantly improved in the patients who survived without intracranial progression.MDASI-BT cognitive factor scores were significantly improved in the cohort of patients with preserved neurocognitive function at 2 (1.68 vs 2.08, P = .05) and 4 months (1.35 vs 1.83, P = .04). MDASI-BT symptom interference was significantly associated with intracranial progression at 4 months, but not with neurocognitive status. EQ-5D-5L index and VAS scores were not sensitive to neurocognitive changes that patients experienced, but VAS scores were sensitive to progression. This study challenges the routine use of EQ-5D as a QoL metric in brain metastases clinical trials that are focused on preventing neurocognitive dysfunction. NCT# 02360215.

Psychometric Properties of Child Health Utility 9D (CHU9D) Proxy Version Administered to Parents and Caregivers of Children Aged 2-4 Years Compared with Pediatric Quality of Life Inventory™ (PedsQL).

This study examines the psychometric properties of the Child Health Utility 9D (CHU9D) proxy version administered to parents/caregivers of 2-4-year-old Australian children compared with Pediatric Quality of Life Inventory™ version 4.0 (PedsQL). Data collected in 2021/2022 from parents/caregivers of 2-4-year-olds from the Australian pediatric multi-instrument comparison study were used. Feasibility, ceiling/floor effects, test-retest reliability, convergent validity, known-group validity, and responsiveness were assessed. A total of 842 caregivers completed the survey at baseline, with 513 completing the follow-up survey. The CHU9D did not demonstrate ceiling effects in the sample with special health care needs, with only 6% of respondents reporting best levels for all nine dimensions. CHU9D correlated with PedsQL moderately-to-strongly between comparable items (correlation coefficients 0.34-0.70). CHU9D was able to differentiate between groups with known health differences with moderate-to-large effect sizes (Cohen's d 0.58-2.03). Moderate test-retest reliability was found for CHU9D in those reporting no health change at a 2-day follow-up (ICC 0.52). A standard response mean (SRM) of 0.25-0.44 was found for children with changes in general health and a SRM of 0.72-0.82 for children who reported worsened health when developing new illnesses, indicating small-to-large responsiveness according to different definitions of health changes. Compared with PedsQL, CHU9D had similar known-group validity and responsiveness and slightly poorer test-retest reliability. The CHU9D was found to be valid and reliable to measure health-related quality-of-life in children aged 2-4 years, although with relatively low test-retest reliability in some dimensions. Further development and validation work is warranted.

Effects of Dietary Supplementation of Stimbiotics to Sows on Lactation Performance, Immune Function, and Anti-Inflammatory and Antioxidant Capacities during Late Gestation and Lactation.

Stimbiotic supplementation may provide an innovative feed additive solution to accelerate the proliferation of beneficial fiber-degrading bacteria in the distal intestine and the utilization of dietary fiber. Optimal utilization of dietary fiber has multiple benefits for gut health and nutrient utilization. This study was conducted to evaluate the late gestation and lactation performance, the plasma, colostrum, and milk immunoglobulin (IgA, IgG, and IgM) concentrations, and the anti-inflammatory and antioxidant biomarkers in plasma of sows fed with or without a stimbiotic during the late gestation and lactation phase. A total of 40 sows were allocated to two treatment groups: control (CT) with no supplementation or 100 mg/kg stimbiotic (VP), with 20 sows per treatment. Sows were fed the treatment diets from d 85 of gestation to d 28 of lactation. In the results, the average daily weight gain of piglets during lactation was greater from sows fed in the VP group compared to that in the CT group (p < 0.05). The plasma concentrations of IgM at farrowing and IgG at weaning of the sows fed the diet with the stimbiotic supplementation were much higher than those in the CT sows (p < 0.05), respectively. In addition, the dietary stimbiotic increased the concentrations of IgM in the colostrum and of IgA and IgM in the milk at d 14 of lactation (p < 0.05). Plasma concentrations of malondialdehyde (MDA) on d 0 and d 28 of lactation tended to be lower in sows fed the VP diets compared with those of the sows fed the CT diets. Thus, our study indicated that stimbiotic supplementation could improve the daily weight gain of piglets and the immune function of sows in lactation.

The Effectiveness of Mobile Health Utilization to Prevent Non-Communicable Diseases at the Group of Majlis Taklim

Background: Mobile health application is a technological innovation that has proven effective use for the prevention and management of NCDs in other countries. However, there has been no test on the use of mobile health applications that have been launched in Indonesia, including the Halodoc application. The majlis taklim group is a target group in increasing community empowerment in the family order. Aims: This study was to examine Halodoc application in preventing noncommunicable diseases. Methods: The population is the member of the majlis taklim who was active in the last three months. The sample was respondents who were identified as having knowledge and bad behavior in NCD prevention efforts, 45 people. Descriptive analysis on respondents' characteristics and level of knowledge. While analytical analysis consists of dependent T tests to determine the difference in effectiveness before and after utilizing the application, the next test is the CBAM-Stage of Concern test, which is to assess respondents' perceptions through the level of respondents' concern for halodoc innovation. Results: Univariate analysis found that most respondents were poorly educated, namely 35 respondents (78%), as IRT 30 respondents (67%), family history of NCD disease 30 respondents (67%), and history of NCD disease in themselves 10 respondents (22%). The level of knowledge on the pretest was low at 23 respondents (51%), and the knowledge on the posttest was mostly high at 31 respondents (69%). Conclusion: The result of the dependent T test obtained a value of 0.000 means that statistically there is a significant difference in knowledge before and after the use of Halodoc for the prevention and management of NCDs. The test results with the Stage of Use Consern Questionnaire (SoC) analysis, obtained information on the percentage of respondents' perception of the highest acceptance of innovation before being given the Halodoc intervention (pretest) at the personal level, which is 60%. However, after utilizing Halodoc, most respondents' perceptions were at the level of unconcern, which was 81%.

Real world outcomes, healthcare utilisation and costs of Alzheimer's disease in England

BackgroundEvidence on health and social care resource utilisation and associated costs, and how this varies across people with Alzheimer's disease (AD) dementia is limited. MethodsRetrospective cohort, using the Discover dataset, which includes linked health and social care records for approximately 2.5 million people in North-West London. Individuals were followed up from the latter of 2010 or from diagnosis of AD dementia (index) up to 2019. Outcomes were overall survival, care home admission, health and social care utilisation and associated costs, and cardiovascular outcomes. Variation was explored in subpopulations and by stratifying by cost quintile. Generalised linear modelling was used to estimate the association between clinical and demographic characteristics and healthcare costs. ResultsThe cohort included 18,116 people diagnosed with AD dementia whose mean age at index was 81 years, 62 % were female and 65 % were of white ethnicity. Median survival from index was 4.9 years (95 %CI: 4.8–5.0). Mean healthcare costs were £4,548(£4,491–£4,604) per person year(ppy). Healthcare costs for the 48 % who used social care were £5,433ppy(£5,353–£5,514) and social care costs were £24,374ppy(£24,372–£24,376). In the overall cohort costs in the highest cost quintile were £13,665ppy(£13,420–£13,911), of which 70 % was from inpatient hospitalisation. Subpopulations admitted to care home (£7,535 £7,362–£7,709), with cardiovascular disease (£6,106;£5,990–£6,222) and with type 2 diabetes (£6,049;£5,901–£6,198) accrued the highest healthcare costs. Factors most strongly associated with cost were dying during follow up (+£2,224;£2,010–£2,493), being frail (+£1,246;£1,051–£1,440) and prior stroke (+£1,207;£908–£1,507). ConclusionCharacteristics of individuals with high healthcare costs include requirement for social care and cardiometabolic comorbidities. Identifying individuals early in their disease course may improve health outcomes and reduce the cost of AD dementia in later life.

Implementing an approach to prevent life-threatening bleeding: Guidance on forming a campus initiative.

A community that is trained to respond to life-threatening bleeding can reduce the risk of death from trauma and violence. Stop The Bleed is a nationally recognized, free, 1-hour bleeding control training designed for laypersons. Implementing a campuswide Stop the Bleed initiative can be daunting,yet vital to creating a safe, prepared campus. Guidance is offered by faculty, staff, and students from a Stop the Bleed initiative at a public university in the southern United States. This guide provides real-life examples and recommendations based on experience. Utilization of population health nursing students is a fundamental component of success.

Hazards and influence factors of arsenic in the upper pleistocene aquifer, Hetao region, using machine learning modeling

The Hetao region is one of the regions with the most serious problem of the greatest measured arsenic concentrations in China. The enrichment of arsenic in groundwater may poses a great risk to the health of local residents. A comprehensive understanding of the groundwater quality, spatial distribution characteristics and hazard of the high arsenic in groundwater is indispensable for the sustainable utilization of groundwater resources and resident health. This study selected six environmental factors, climate, human activity, sedimentary environment, hydrogeology, soil, and others, as the independent input variables to the model, compared three machine learning algorithms (support vector machine, extreme gradient boosting, and random forest), and mapped unsafe arsenic to estimate the population that may be exposed to unhealthy conditions in the Hetao region. The results show that nearly half the number of the 605 sampling wells for arsenic exceeded the WHO provisional guide value for drinking water, the water chemistry of groundwater are mainly Na-HCO3-Cl or Na-Mg-HCO3-Cl type water, and the groundwater with excessive arsenic concentration is mainly concentrated in the ancient stream channel influence zone and the Yellow River crevasse splay. The results of factor importance explanation revealed that the sedimentary environment was the key factor affecting the primary high arsenic groundwater concentration, followed by climate and human activities. The random forest algorithm produced the probability distribution of high arsenic groundwater that is consistent with the observed results. The estimated area of groundwater with excessive arsenic reached 38.81 %. An estimated 940,000 people could be exposed to high arsenic in groundwater.

Comparing Preferences for Disease Profiles: A Discrete Choice Experiment from a US Societal Perspective.

There is increasing interest in expanding the elements of value to be considered when making health policy decisions. To help inform value frameworks, this study quantified preferences for disease attributes in a general public sample and examined which combination of attributes (disease profiles) are considered most important for research and treatment. A discrete choice experiment (DCE) was conducted in a US general population sample, recruited through online consumer panels. Respondents were asked to select one of a set of health conditions they believed to be most important, characterized by attributes defined by a previous qualitative study: onset age; cause of disease; life expectancy; caregiver requirement; symptom burden (characterized by the Health Utilities Index with varying levels of ambulation independence, dexterity limitations, and degree of pain and discomfort); and disease prevalence. A fractional factorial DCE design was implemented using R, and 60 choice sets were generated (separated into blocks of 10 per participant). Data were analyzed using a mixed-logit regression model, and results used to assess the likelihood of preferring disease profiles. Based on individual attribute preferences, overall preferences for disease profiles, including a profile aligned with Duchenne muscular dystrophy (DMD), were compared. Fifty-two percent of respondents (n = 537) were female, and 70.6% were aged 18-54 years. Attributes considered most important were those related to life expectancy (odds ratio [OR], 95% confidence interval [CI] 1.88 [1.56-2.27] for a 50% reduction in remaining life expectancy vs no impact), and symptom burden (OR [95% CI] 1.84 [1.47-2.31] for severe vs mild burden). Greater importance was also found for pediatric onset, caregiver requirement, and diseases affecting more people. As an example of disease profile preferences, a DMD-like pediatric inherited disease with 50% reduction in life expectancy, extensive caregiver requirement, severe symptom burden, and 1:5000 prevalence had 2.37-fold higher odds of being selected as important versus an equivalent disease with adult onset and no life expectancy reduction. Of disease attributes included in this DCE, respondents valued higher prevalence of disease, life expectancy and symptom burden as most important for prioritizing research and treatment. Based on expressed attribute preferences, a case study of an inherited pediatric disease involving substantial reductions to length and quality of life and requiring caregiver support has relatively high odds of being identified as important compared to diseases reflecting differing attribute profiles. These findings can help inform expansions of value frameworks by identifying important attributes from the societal perspective.

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

BackgroundSubstance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades.MethodsData are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher’s exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades.ResultsMost participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049).ConclusionsWe identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women.Trial registrationNCT, NCT 21–34,978. Registered January 19, 2022.

A cost-utility study of elective haemorrhoidectomies in Canada.

The aim was to estimate the 10-year cost-utility of haemorrhoidectomy surgery with preference-based measures of health using Canadian health utility measures and costs. Patients undergoing elective haemorrhoidectomies by general and colorectal surgeons in British Columbia, Vancouver, between September 2015 and November 2022, completed preoperatively and postoperatively the EuroQol five-dimension five-level health-related quality of life questionnaire (EQ-5D-5L). Quality-adjusted life years (QALYs) attributable to surgery were calculated by discounting preoperative and postoperative health utility values derived from the EQ-5D-5L. Costs were measured from a health system perspective which incorporated costs of hospital stay and specialists' fees. Results are presented in 2021 Canadian dollars. Of 94 (47%) patients who completed both the preoperative and postoperative questionnaires, the mean gain in QALYs 10 years after surgery was 1.0609, assuming a 3.5% annual discounting rate. The average cost of the surgery was $3166. The average cost per QALY was $2985 when benefits of the surgery were assumed to accrue for 10 years. The cost per QALY was higher for women ($3821) compared with men ($2485). Participants over the age of 70 had the highest cost per QALY ($8079/QALY). Haemorrhoidectomies have been associated with significant gains in health status and are inexpensive relative to the associated gains in quality of life based on patients' perspectives of their improvement in health and well-being.

Health Expenditure and Utilisation of Poor Families in a Low-Income Community under the Philippine Conditional Cash Transfer Program

Pantawid Pamilyang Pilipino Program (4Ps) is the Philippine version of the conditional cash transfer (CCT) program that measures human development through the provision of conditional cash grants to the poorest of the poor. This research determines the health expenditure and utilisation of the poor families in a low-income community under the CCT program. A cross-sectional research design was adopted using mixed methods of data collection from 177 households between May and June 2017. Results reveal that most families under CCT devote the largest portion of household health expenditure for inpatient health seeking. About 40% of the total expenditure is covered by the National Health Insurance Program and the cost for hospitalisation mostly comes from the out-of-pocket source. Moreover, the common problems encountered during health utilisation and spending are poor customer service of healthcare facilities and uncompensated hospital bill by health insurance.