Health Care Costs Research Articles

Cost-effectiveness analysis of genotype-guided optimization of major depression treatment in Qatar.

Pharmacogenetic testing improves the efficacy and safety of antidepressant pharmacotherapy for moderate-severe major depressive disorder by identifying genetic variations that influence medication metabolism, and adjusting treatment regimens accordingly. This study aims to assess the cost-effectiveness of implementing a pharmacogenetic testing approach to guide the prescription of antidepressants. From the public hospital perspective, we developed a two-stage decision tree diagram of a short-term 6-week follow up, and a lifetime Markov model with 3-month cycles. The analysis compared the current standard of care with the alternative strategy of Pharmacogenetic-guided (multi-gene panel) testing in adult patients with moderate-severe major depressive disorder. Clinical outcomes and utilities were obtained from published studies, while healthcare costs were locally available. The short-term incremental cost-effectiveness ratio was against treatment response without side effects and without relapse, and against treatment response with/without side effects and without relapse. The long-term incremental cost-effectiveness ratio was against the quality-adjusted life year gained and years of life saved. Adopting the pharmacogenetic-guided therapy for adult patients with moderate-severe major depressive disorder in Qatar resulted in cost savings of Qatari Riyal 2,289 (95% confidence interval, -22,654-26,340) for the health system. In the short term, the pharmacogenetic-guided testing was associated with higher response rates without side effects and without relapse (mean difference 0.10, 95% confidence interval 0.09-0.15) and higher response rates with or without side effects and without relapse (mean difference 0.05, 95% confidence interval 0.04-0.06). For long term, the pharmacogenetic-guided testing resulted in 0.13 years of life saved and 0.06 quality-adjusted life year gained, per person, along with cost savings of Qatari Riyal 46,215 (95% confidence interval-15,744-101,758). The sensitivity analyses confirmed the robustness of the model results. Implementing pharmacogenetic testing to guide antidepressant use was found to improve population health outcomes, while also significantly reducing health system costs.

Improving racial/ethnic health equity and naloxone access among people at risk for opioid overdose: A simulation modeling analysis of community-based naloxone distribution strategies in Massachusetts, United States.

During the COVID-19 pandemic, there was a surge in opioid overdose deaths (OODs) in Massachusetts, USA, particularly among Black and Hispanic/Latinx populations. Despite the increasing racial and ethnic disparities in OODs, there was no compensatory increase in naloxone distributed to these groups. We aimed to evaluate two community-based naloxone expansion strategies, with the objective of identifying approaches that could mitigate mortality and racial and ethnic disparities in OODs. Individual-based simulation model. We measured naloxone availability using naloxone kits per OOD and evaluated scenarios of achieving higher benchmarks for naloxone availability (i.e. 40, 60 and 80 kits per OOD) from 2022 levels (overall: 26.0, White: 28.8, Black: 17.3, Hispanic/Latinx: 18.9). We compared two naloxone distribution strategies: (1) proportional distribution: achieving the benchmark ratio at the overall population level while distributing additional kits proportional to the 2022 level for each racial/ethnic group (at 40 kits per OOD benchmark: overall: 40, White: 44.3, Black: 26.6, Hispanic/Latinx: 29.1), and (2) equity-focused distribution: achieving the benchmark ratio among each racial/ethnic group (at 40 kits per OOD benchmark: 40 for all groups). Massachusetts, United States. People at risk of OOD. Annual number and rate of OODs, total healthcare costs of increasing naloxone availability. Both naloxone distribution strategies yielded comparable predicted reductions in total OODs in 2025 and incurred similar incremental costs. However, the relative reduction in the rate of OODs differed across groups. For achieving an 80 kits per OOD benchmark, proportional distribution resulted in a projected 6.7%, 6.5% and 7.1% reduction in annual OODs in 2025 among White, Black and Hispanic/Latinx populations, respectively. In contrast, equity-focused distribution achieved a reduction of 5.7%, 11.3% and 10.2% in the respective groups. In all scenarios, the cost per OOD averted was lower than the generally accepted thresholds for cost per life saved. An equity-focused naloxone distribution strategy designed to reduce racial and ethnic disparities in naloxone availability could improve health equity among racial and ethnic groups while potentially improving overall population health at lower healthcare costs per opioid overdose death averted than a proportional distribution strategy.

Fluticasone Furoate/Umeclidinium/Vilanterol Initiation Following a COPD Exacerbation: Benefits of Prompt Initiation on COPD Outcomes.

Previous real-world evidence suggests that prompt versus delayed initiation of single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following an exacerbation results in improved clinical outcomes for patients with chronic obstructive pulmonary disease (COPD). This prior study was conducted in the first 2years following FF/UMEC/VI approval, representing early trends. The current updated analysis aims to further elucidate the real-world evidence for FF/UMEC/VI. This was a retrospective cohort study using the IQVIA PharMetrics® Plus database. Patients with COPD initiating SITT with FF/UMEC/VI within 6months of an exacerbation (index date) were classified as prompt (≤ 30days following exacerbation) or delayed (31-180days) initiators. The baseline period comprised the 12months prior to index. Inverse probability of treatment weighting was used to balance differences in baseline characteristics between cohorts. COPD exacerbations, hospital readmission rates, and healthcare costs were compared between cohorts post-index. Overall, 5421 patients (prompt, 2057; delayed, 3364) were included. After weighting, baseline characteristics were well balanced between cohorts. For up to 12months post-index, prompt initiators of FF/UMEC/VI had significantly lower rates of exacerbations per person-year versus delayed initiators (0.74 vs. 1.06; rate ratio 0.70, 95% confidence interval [CI] 0.64-0.77; P < 0.001). A 1-day delay in FF/UMEC/VI initiation was associated with a 0.31% increase in the rate of exacerbations. At 90days post-index, Kaplan-Meier rates of all-cause (hazard ratio [HR] 0.62, 95%CI 0.45-0.86; P = 0.004) and COPD-related (HR 0.58, 95%CI 0.35-0.98; P = 0.042) hospital readmissions were significantly lower in the prompt versus delayed cohort. Total COPD-related healthcare costs per person per year were significantly lower for patients in the prompt versus delayed cohort. Healthcare providers should consider the positive impact of prompt FF/UMEC/VI initiation on exacerbation rate, hospital readmission rate, and costs when treating patients with COPD at risk of exacerbations.

Environmental sustainability in cardiovascular practice: current challenges and future directions.

Cardiovascular disease is the leading cause of morbidity and mortality worldwide, with a substantial amount of health-care resources targeted towards its diagnosis and management. Environmental sustainability in cardiovascular care can have an important role in reducing greenhouse gas emissions and pollution and could be beneficial for improving health metrics and societal well-being and minimizing the cost of health care. In this Review, we discuss the motivations and frameworks for sustainable cardiovascular care with an emphasis on the reduction of the climate-related and environmental effects of cardiovascular care. We also provide an overview of greenhouse gas emissions related to the provision of health care, including their measurement and quantification, carbon accounting, carbon disclosures and climate effects. The principles of life-cycle assessment, waste prevention and circular economics in health care are discussed, and the emissions associated with various sectors of cardiovascular care as well as the rationale for prevention as a powerful approach to reduce these emissions are presented. Finally, we highlight the challenges in environmental sustainability and future directions as applicable to cardiovascular practice.

Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes.

Although pseudoangina is most commonly caused by cervical disc herniation, several cases have been described where thoracic herniation produced symptoms of pseudoangina. If thoracic herniation can produce angina-like pain, then it is important to consider whether pathology of the thoracolumbar spine, in general, can trigger false pain syndromes distinct from pseudoangina. We seek to provide the most comprehensive study regarding the diagnosis and treatment of spinal conditions causing false pain syndromes. Systematic review of the current literature using PRISMA 2020 recommendations. We queried the literature and systematically selected relevant studies according to PRISMA guidelines. Across 22 selected studies, the sample size was 30 patients, and a total of 26 met the criteria for statistical analysis. Seven (26.9%) of these patients presented with a chief complaint of pseudoangina resulting from thoracic disc herniation. 73.1% (19/26) of patients exhibited pain mimicking visceral origin. Overall, 13/19 (68.4%) patients exhibited thoracic spine disease only and 4/19 (21.1%) patients were affected at lumbar levels only, while 2 (10.5%) patients exhibited thoracolumbar herniation. Presentations included abdominal pain (11/19) mimicking appendicitis or pancreatitis, flank pain mimicking renal colic (8/19), and 2 cases of scrotal pain/orchalgia. Symptom durations ranged from acute (<24h) to 7 years. Treatments were reported for 18/19 patients and all treated patients reported alleviated pain. Seven out of 18 patients were managed conservatively while 11/18 were treated surgically. Misdiagnosis resulted in unnecessary surgery (pancreaticojejunostomy) or other invasive procedures. In spinal disorders manifesting with atypical pain syndromes, delay in proper diagnosis and unnecessary treatments can, unfortunately, cause prolonged patient suffering and increased cost of health care. As a result, some have proposed that spinal screening should be incorporated into clinical examinations involving false pain syndromes.

Downstream Effects of Market Changes on Inhalers: Impacts on Individuals With Chronic Lung Disease.

COPD and asthma are two of the most common chronic lung diseases, affecting over 545 million people globally and 34 million in the United States. Annual health care costs related to chronic lung disease are estimated at €380 billion in the European Union, and $24-$50 billion in the United States averaging to $4,000 in out-of-pocket costs per person in the U.S. A full-text literature search was conducted for English publications between January 1, 2005-March 18, 2024. It returned over 5,000 publications that were further narrowed using key search words, resulting in 172 peer-reviewed articles. Using their experience and subject expertise, the authors further narrowed the peer-reviewed articles to 55 that were in their opinion relevant. Also, 38 recently published industry reports and news articles specific to downstream effects of inhaler market changes and the future impact were included. The literature suggests that individuals with chronic lung disease face increased challenges with access to inhaled medication due to rising medication costs, discontinuation of branded medications, introduction of generic medications not covered by insurance, exclusionary preferred drug list tactics that force health care providers into non-medical switching of medication or devices, and ongoing medication shortages. Providers experience ongoing hurdles in prescribing appropriate inhaled medications for individuals with chronic lung disease, including increased time and costs spent on administrative tasks due to inhaler denials, a loss of patient trust, and limits on their ability to prescribe appropriate inhaled medication for individuals with chronic lung disease.

An early economic evaluation of WireSafe™ to prevent guidewire retention in central venous catheter procedures

Background Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a ‘Never Event’ by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective. Methods We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50). Results NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398). Conclusions The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness.

Longitudinal assessment of the impact of prevalent diabetes on hospital admissions and mortality in the general population: a prospective population-based study with 19 years of follow-up

BackgroundHospitalization indicates the presence of severe disease and constitutes a leading cost in health care. We aimed to prospectively assess if prevalent diabetes mellitus contributes to excess all-cause and cause-specific hospital admissions and mortality at the population level.MethodsWe used a Swedish prospective population-based cohort, including 25,642 individuals of whom 4.2% had prevalent diabetes at baseline (mean age 61.2 ± 6.8 years, age range 44.8–73.4 years). We compared the number of hospitalizations and mortality classified according to the main chapters of the 10th revision of the International Classification of Diseases (ICD-10) during follow-up using nationwide inpatient registries, comparing individuals with and without prevalent diabetes, using multivariate adjusted negative binomial regression (incidence rate ratio, IRR) and Cox regression, respectively.ResultsDuring a median follow-up of 19 years, 18,904 subjects were hospitalized at least once [median 3 (IQR 2–6)] and 6767 (26.4%) individuals died. Overall, subjects with diabetes were hospitalized (IRR 1.83, p < 0.001) more often, and had a higher incidence rate of hospital admissions due to endocrine diseases (IRR 14.6, p < 0.001), dermatological diseases (IRR 3.7, p < 0.001), injuries and poisoning (IRR 2.7, p < 0.001), infectious diseases (IRR 2.5, p < 0.001), psychiatric diseases (IRR 2.0, p < 0.001), but also cardiovascular, hematological, genitourinary, neurologic and respiratory diseases compared with non-diabetic individuals. No difference was observed for hospital admissions due to cancer or musculoskeletal disorders. All-cause mortality was higher (HR 1.77, p < 0.001) in individuals with diabetes, with disease-specific mortality being significant only for cardiovascular and endocrine disease-related death.ConclusionsAt the population level, prevalent diabetes increased the hospitalization burden longitudinally due to diseases of most of the ICD-10 main chapters, except for cancer and musculoskeletal disorders. These novel findings challenge the current view on the spectrum of prevalent diabetes-related conditions and may have implications for screening and treatment strategies in diabetes.Permission of graphical illustrationsSource: Pixabay.com. No permission or acknowledgement is required.

Real-World Clinical and Healthcare Resource Burden Among Burosumab-Naïve Patients With Familial Hypophosphatemia.

To examine the real-world clinical and healthcare resource burden of familial hypophosphatemia (FH). In a retrospective, observational cohort study using MarketScan claims data from 2017 to 2021, clinical characteristics and healthcare resource utilization (HCRU) and costs were compared between burosumab-naïve pediatric and adult patients with ≥ 1 FH diagnosis code and matched controls without FH. Patient characteristics were evaluated at baseline, and disease characteristics, HCRU, and costs were evaluated over a 12-month follow-up period. Outcomes were analyzed descriptively. Costs were additionally analyzed using multivariate regression models. Overall, 570 patients with FH and 1710 non-FH matched controls were included. Approximately 10% of study participants were aged < 18 years. Patients with FH had 7.8-fold higher mean baseline comorbidity (Charlson Comorbidity Index). The prevalence of morbidities over the 12-month follow-up period was higher in patients with FH than controls, including renal disease (33% vs 3%), arthralgia (25% vs 10%), osteoarthritis (17% vs 6%), and delayed growth/walking difficulty (16% vs 2%; all P < .001). All-cause HCRU was significantly greater for patients with FH than controls over follow-up, including the proportion of patients with at least one inpatient admission (60% vs 4%), outpatient emergency room visit (52% vs 16%), and outpatient pharmacy prescription (96% vs 71%; all P < .001). The mean annual total healthcare cost per patient was also 22.6-fold higher for patients with FH than controls (adjusted cost difference = $129 643; P < .001). Differences were apparent across all age groups. Compared with non-FH matched controls, burosumab-naïve patients with FH experienced multiple morbidities and had substantially higher HCRU and costs.

A pan-genomic analysis based multi-epitope vaccine development by targeting Stenotrophomonas maltophilia using reverse vaccinology method: an in-silico approach.

Antibiotic resistance in bacteria leads to high mortality rates and healthcare costs, a significant concern for public health. A colonizer of the human respiratory system, Stenotrophomonas maltophilia is frequently associated with hospital-acquired infections in individuals with cystic fibrosis, cancer, and other chronic illnesses. The importance of this study is underscored by its capacity to meet the critical demand for effective preventive strategies against this pathogen, particularly among susceptible groups of cystic fibrosis and those undergoing cancer treatment. In this study, we engineered a multi-epitope vaccine targeting S. maltophilia through genomic analysis, reverse vaccination strategies, and immunoinformatic techniques by examining a total of 81 complete genomes of S. maltophilia strains. Our investigation revealed 1945 core protein-coding genes alongside their corresponding proteomic sequences, with 191 of these genes predicted to exhibit virulence characteristics. Out of the filtered proteins, three best antigenic proteins were selected for epitope prediction while seven epitopes each from CTL, HTL, and B cell were chosen for vaccine development. The vaccine was refined and validated, showing highly antigenic and desirable physicochemical features. Molecular docking assessments revealed stable binding with TLR-4. Molecular dynamic simulation demonstrated stable dynamics with minor alterations. The originality of this investigation is rooted in the thorough techniques aimed at designing a vaccine that directly targets S. maltophilia, a microorganism of considerable clinical relevance that currently lacks an available vaccine. This study not only responds to a pressing public health crisis but also lays the groundwork for subsequent research endeavors focused on the prevention of S. maltophilia outbreaks. Further evidence from studies in mice models is needed to confirm immune protection against S. maltophilia.

Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated. We aimed to determine if robotic assisted surgery and Pfannenstiel extraction decreased the rate of radiologically detected incisional hernias compared to standard laparoscopy with extra-corporeal anastomosis. The secondary outcomes aimed to evaluate incidence of port site hernias in 8mm robotic ports for which routine closure is not followed. Our single centre retrospective cohort study included patients who had minimally invasive right hemicolectomy and had cross-sectional imaging at least 1-year later. Patient demographics, body mass index, history of smoking or previous surgery was recorded. At imaging, evidence of new extraction site or port site-site hernia, contents and clinical impact was noted. A total of 100 patients (50 robotic and 50 laparoscopic) were included. Baseline characteristics appeared equally distributed. 16% (8 patients) who had laparoscopic surgery developed midline extraction site hernias which was significantly higher to RAS group (0 patients). 3 patients developed hernias at the site of robotic ports and this was more commonly at the right iliac fossa port. RAS, by simplifying intra-corporeal anastomosis has potential to eliminate incisional hernias, particularly when Pfannenstiel extraction is used. The potential for 8mm robotic ports to develop clinically significant hernias cannot be ignored and meticulous closure can prevent patient harm.

Nuciferine Alleviates High-Fat Diet- and ApoE-/--Induced Hepatic Steatosis and Ferroptosis in NAFLD Mice via the PPARα Signaling Pathway.

Nonalcoholic fatty liver disease (NAFLD) causes significant global mortality and healthcare costs with no recommended pharmacological intervention for clinical management. Nuciferine (Nuc) is an alkaloid with aromatic rings, abundantly found in Nelumbo nucifera Gaertn. In this study, we explored the protective mechanisms of Nuc against hepatic steatosis and ferroptosis in NAFLD. High-fat diet (HFD) and healthy male ApoE-/- mice were used to induce NAFLD and a hypercholesterolemia model. Nuc was administered to the mice for four consecutive weeks from the ninth week. Various assessments, including histopathology, RNA sequencing, lipid metabolism, and ferroptosis-related protein expression, showed that Nuc alleviated hepatic steatosis and ferroptosis. We further showed that Nuc improves fatty acid accumulation and ferroptosis through the PPARα signaling pathway in mice and RSL3-treated AML-12 cells. The PPARα inhibitor GW6471 blocked Nuc's protective effects, leading to excess accumulation of iron ions. Thus, Nuc may be a potential therapeutic agent for NAFLD.

Disease Overlap, Healthcare Resource Utilization, and Costs in Patients with Eosinophilic Granulomatosis with Polyangiitis: A REVEAL Sub-study.

Eosinophilic granulomatosis with polyangiitis (EGPA) is an eosinophil-associated disease (EAD) characterized by inflammation in small- to medium-sized blood vessels. Inthe REal-world inVestigation of Eosinophilic-Associated disease overLap (REVEAL) study, overlap among 11 EADswas assessed. In the present sub-study, we evaluated EGPA overlapwith other EADs, all-cause EAD- and EGPA-related healthcare resource utilization (HCRU) and costs, and their relationship with blood eosinophil count and treatments received. REVEAL, a retrospective study, used Optum's de-identified Clinformatics® Data Mart Database. In this sub-study, eligibility criteria included an age of ≥ 12years, ≥ 1 EAD, continuous health-plan eligibility, and compliance with the EGPA/GPA case definition per International Classification of Diseases Ninth/Tenth Revision diagnosticcodes between 1 January 2015 and 30 June 2018. Patients were grouped based on whether they had received immunomodulators/cyclophosphamide/mepolizumab (ICM) or not (non-ICM). Of 701 patients with EGPA, 29.5% were in the ICM group. Overall, 72.2% had ≥ 1 overlapping EAD. The number of overlaps was similar for the ICM and non-ICM groups. In patients with blood eosinophil counts ≥ 300 cells/µL, 22.8% had ≥ 1 overlapping EAD. The mean annual all-cause cost was $98,644, 54.1% of which was from outpatients and 33.6% from inpatients. The mean annual EAD- and EGPA-related costs were $23,820 and $9,306, respectively. Patients in the non-ICM groupversus the ICM group had higher all-cause ($101,560 vs $91,684) but lower EAD-related ($22,733 vs $26,412) and EGPA-related ($6,171 vs $16,786) costs. All-cause HCRU and costs increased with increasing overlap. EGPA was associated with substantial HCRU and costs, driven by outpatient and inpatient settings. More overlapping EADs were associated with higher HCRU and costs, highlighting the need for treatment to reduce healthcare expenditure in these patients. Infographic available for this article.

Cardiodiabesity: Epidemiology, resource and economic impact

ObjectiveTo assess i) the epidemiology of cardiodiabesity, ii) its association with healthcare resource utilization and cost of care, as well as iii) provide recommendations for its management. MethodsA cohort study of insured adults with early-stage and/or active cardiodiabesity from January 2019 to December 2021 identified through a longitudinal, and de-identified medical and pharmacy claims database was conducted. All patients were followed for one year through December 2022. Conditions include cardiovascular disease, prediabetes, Type 2 diabetes (T2D), chronic kidney disease (CKD), overweight and/or obesity. Rates of progression from early-stage cardiodiabesity to active cardiodiabesity and/or advanced cardiodiabesity with complications; frequency of emergency department, inpatient and outpatient visits; as well as total cost of care over one year were analyzed. ResultsA total of 3,273,813 and 1,628,407 patients had at least one of the comorbid conditions for early-stage and active cardiodiabesity, respectively. Among those with all early-stage cardiodiabesity conditions, 27.4 % progressed to active cardiodiabesity, while 88.4 % of those with all active cardiodiabesity conditions progressed to complications within one year. Predictors of progression from early-stage to active cardiodiabesity were hypertension (OR: 2.31, 95 % CI: 2.29–2.33, p < 0.001), hyperlipidemia (OR: 1.77, 95 % CI: 1.76–1.79, p < 0.001), CKD stages 1 and 2 (OR: 1.74, 95 % CI: 1.69–1.79, p < 0.001), prediabetes (OR: 1.64, 95 % CI: 1.63–1.66, p < 0.001) and living in areas with very high social needs (OR: 1.25, 95 % CI: 1.23–1.26, p < 0.001). Significant predictors of progression from active cardiodiabesity to complications were T2D (OR: 1.88, 95 % CI: 1.81–1.96, p < 0.001), CVD (OR: 1.47, 95 % CI: 1.44–1.51, p < 0.001), CKD stages 3 and 4 (OR: 1.37, 95 % CI: 1.34–1.41, p < 0.001) and obesity (OR: 1.29, 95 % CI: 1.26–1.32, p < 0.001). Average total cost of care increased significantly among those who progressed from one disease phase to the next (p < 0.05). ConclusionsCardiodiabesity is deadly and rapidly progressive with substantial economic burden on the healthcare system. However, it is preventable. Innovative approaches to better understand the holistic impact of cardiodiabesity on total cost of care, early intervention or management to halt disease progression and promote equity, as well as decrease resource utilization are needed.

Personalized and predictive strategies for diabetic foot ulcer prevention and therapeutic management: potential improvements through introducing Artificial Intelligence and wearable technology.

Diabetic foot ulcers represent a serious and costly complication of diabetes, with significant morbidity and mortality. The purpose of this study was to explore advancements in Artificial Intelligence, and wearable technologies for the prevention and management of diabetic foot ulcers. Key findings indicate that Artificial Intelligence-driven predictive analytics can identify early signs of diabetic foot ulcers, enabling timely interventions. Wearable technologies, such as continuous glucose monitors, smart insoles, and temperature sensors, provide real-time monitoring and early warnings. These technologies promise to revolutionize diabetic foot ulcer prevention by offering personalized care plans and fostering a participatory healthcare model. However, the review also highlights challenges such as patient adherence, socioeconomic barriers, and the need for further research to validate these technologies' effectiveness. The integration of artificial intelligence and wearable technologies holds the potential to significantly improve diabetic foot ulcer outcomes, reduce healthcare costs, and provide a more proactive and personalized approach to diabetic care. Further investments in digital infrastructure, healthcare provider training, and addressing ethical considerations are essential for successful implementation.

Transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality: a cost-utility analysis for Switzerland.

The 2021 European Society of Cardiology Guidelines on valvular heart disease recommend transcatheter aortic valve implantation (TAVI) for patients with symptomatic severe aortic stenosis at low surgical risk and age ≥75 years who are suitable for a transfemoral approach (recommendation class IA) based on two large randomised controlled trials (PARTNER 3 and Evolut Low Risk) comparing transcatheter aortic valve implantation with surgical aortic valve replacement (SAVR). Whether such an approach is cost-effective in Switzerland remains unclear. The aim of this cost-utility analysis was to compare transcatheter aortic valve implantation with SAPIEN 3 versus surgical aortic valve replacement in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of Swiss compulsory health insurance using data from the PARTNER 3 trial (reflecting specifically the safety and efficacy of the SAPIEN 3 TAVI device). A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted from the perspective of the Swiss compulsory health insurance system, using local or geographically close general population mortality and utility data, unit costs and medical resource use from publicly available sources and based on expert opinion. The model had a lifetime horizon with a 3% yearly discounting factor. The cost-utility analysis estimated changes in both direct healthcare costs and health-related quality-adjusted life years for transcatheter aortic valve implantation compared with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low risk of surgical mortality. Overall, transcatheter aortic valve implantation with SAPIEN 3 resulted in lifetime costs per patient of CHF 79,534 and quality-adjusted life years per patient of 9.64, compared with surgical aortic valve replacement lifetime costs and quality-adjusted life years per patient of CHF 76,891 and 8.96, respectively. Compared with surgical aortic valve replacement, transcatheter aortic valve implantation was estimated to offer an incremental improvement of +0.68 quality-adjusted life years per patient at an increased cost of +CHF 2643 per patient over a lifetime horizon. The incremental cost-effectiveness ratio was CHF 3866 per quality-adjusted life year gained and remained below CHF 50,000 per quality-adjusted life year gained across several sensitivity analyses. This analysis suggests that transcatheter aortic valve implantation using the SAPIEN 3 device is likely to be a highly cost-effective alternative for symptomatic severe aortic stenosis patients at a low risk of surgical mortality, treated in the contemporary Swiss setting. These findings may help to inform a holistic approach when making policy decisions for the management of this patient group.

Implementing a Hospital-Wide Programme Using iPARiHS to Prevent and Manage Incontinence-Associated Dermatitis and Improve Hospital-Acquired Pressure Injuries.

To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries. This is an empirical research study using mixed methods. The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys. Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success. This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks. Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care. No patient or public involvement. To describe the implementation study, we referred to the StaRI Guideline. This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved.

Evolving epidemiology of NAFLD in South Korea: incidence, prevalence, progression, and healthcare implications from 2010 to 2022.

Non-alcoholic fatty liver disease (NAFLD), now the most common chronic liver worldwide, has become a significant public health concern. This study aims to analyze the evolving epidemiology of NAFLD in South Korea. We utilized claim data from the Korean National Health Insurance Service from 2010 to 2022 to analyze NAFLD's incidence, prevalence, and progression. From 2010 to 2022, the incidence and prevalence rates of NAFLD each increased from 1.87% to 4.47% and from 10.49% to 17.13%, respectively. The differences in prevalence rates between urban and rural areas were minimal in 2012 and 2022, yet both areas showed significant increases in the prevalence of NAFLD over the decade. The NAFLD group had a higher prevalence of comorbidities compared to the control group, and the most common comorbid condition was hypertension. Moreover, the ten-year incidence rates of malignancy, heart disease, and stroke in the NAFLD group were 13.42%, 15.72%, and 8.36%, respectively, which were significantly higher than those in the control group. The incidence rates of cirrhosis and hepatocellular carcinoma in NAFLD over 10 years were 2.22% and 0.77%, respectively. The total medical costs of NAFLD patients more than doubled over ten years and were all significantly higher than those of the control group. A significant increase in NAFLD prevalence and its impact on healthcare utilization was observed in South Korea. With NAFLD leading to serious liver diseases and increased healthcare costs, integrated care strategies that include both medical treatment and lifestyle modifications are essential.

Real world comparison of filgrastim to filgrastim-sndz in patients with chemotherapy-induced neutropenia.

There exists some apprehension by prescribers, healthcare providers, and other stakeholders regarding the real-world safety and effectiveness of biosimilars. While some of the apprehension is likely due to clinician knowledge gaps in the biosimilarity exercise, additional data (including those generated from the real-world) regarding safety and efficacy could reduce a clinician's perception of biosimilar uncertainty and can potentially increase biosimilar acceptance and uptake. The published literature is lacking regarding the real-world impact on healthcare costs and clinical outcomes when a single healthcare institution converts from filgrastim to filgrastim-sndz as its short-acting Granulocyte Colony Stimulating Factor (GCSF), especially within diverse populations and indications not explicitly studied through the registration trials. Specifically, both filgrastim and filgrastim-sndz possess FDA-approved indications within patients with hematologic malignancies receiving high-dose chemotherapy and in those undergoing bone marrow transplantation. As a biosimilar to filgrastim, the FDA did not require prospective, randomized controlled trials to obtain these indications for filgrastim-sndz. The purpose of this study is to describe real-world healthcare resource costs, utilization patterns, and clinical outcomes in patients with hematologic malignancies who received filgrastim-sndz or filgrastim to support neutrophil recovery following chemotherapy (i.e., induction or consolidation) or a bone marrow transplant (BMT) at Yale New Haven Hospital (YNHH). A total of 148 patients were identified and met the following criteria: at least 18 years old, Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, absence of fever or infection, newly diagnosed acute myeloid leukemia or newly post-bone marrow transplant and received filgrastim-sndz (Zarxio®) or reference filgrastim (Neupogen®). Healthcare resource utilization outcomes were compared between biosimilar and reference filgrastim using descriptive statistics. There were no major differences between either cohort, including duration of hospitalization, the number of overall emergency room visits and additional hospital admissions with a primary diagnosis of febrile neutropenia or neutropenia within 30 days post-discharge from initial hospital admission, time to neutrophil recovery following GCSF support, and the incidence and duration of both fever and febrile neutropenia. The total cost based on treatment of all patients in each arm differed significantly with filgrastim-sndz being the most cost-effective choice. filgrastim-sndz significantly reduced healthcare utilization costs compared to reference filgrastim with similar effect on absolute neutrophil count, incidence of fever, and febrile neutropenia.

Clinical, Quality of Life, and Health Care Utilization Outcomes of Switching the Administration Route of Antipsychotic Medications Among People With Schizophrenia Spectrum Disorder: A Systematic Review and Meta-Analysis.

Using long-acting injectable (LAI) antipsychotic medications can improve the outcomes of patients with schizophrenia, such as reducing symptom severity and hospitalization risk. However, the outcomes of switching from oral to LAI antipsychotic medications are unclear. The purpose of this review is to provide a summary of the clinical, quality of life, and health care utilization outcomes of switching from oral to LAI antipsychotics among patients with Schizophrenia Spectrum Disorder. We thoroughly searched the PubMed, Scopus, PsycInfo, and CINAHL databases. To conduct the meta-analysis, we used the Comprehensive Meta-Analysis Program. Forty-one articles met our inclusion criteria. After switching to LAIs, symptom severity, the number of rehospitalizations, emergency department visits, and overall health care costs were reduced. Also, social functioning significantly improved. However, no differences were observed in the frequency of outpatient visits. Pharmacy costs were increased between pre- and post-LAI initiation. Our findings support evidence that changing the route of administration of antipsychotic medications from oral to long-acting intramuscular injections can improve the clinical, quality of life, and health care utilization outcomes in people with schizophrenia. Health care practitioners might consider encouraging LAI use earlier during treatment for schizophrenia for better clinical outcomes and to reduce health care utilization associated with treatment.