Long-term Economic Outcomes Research Articles

The role of rural circular migration in shaping weather risk management for smallholder farmers in India, Nepal, and Bangladesh

Circular migration, defined as migration where migrants return to their original home area, has become an increasingly important component of rural livelihoods and can significantly impact the risk management strategies of smallholder agricultural households in the face of climate change. To unpack the associations between climate change, migration decisions, and agricultural outcomes for smallholder agricultural households, we use an embedded mixed methods approach that uses quantitative data from a structured household survey from over 2,000 rural households in Nepal, India, and Bangladesh, along with qualitative data from interviews and focus group discussions. We use these data to identify the influence of socio-economic, climate, and weather factors on long (≥12 months) and short-term (<12 months) migration decisions and the impacts of migration on risk management strategies in agriculture. Our research shows that the drivers and effects of migration differ based on migration characteristics, including the length of time a family member migrates and whether the destination is domestic or international. We find that households with limited resources, such as constrained irrigation access, use short-term migration to cope with weather variability, whereas long-term migration is generally undertaken by wealthier households motivated to improve long-term economic outcomes. Considering the impacts of migration on risk management, we find that short-term migration of household members results in increased investment in agriculture, such as increasing inputs and adopting new varieties. In contrast, long-term and international migration is associated with disinvestments in agriculture, such as reduced cropped area and inputs. Our results highlight the importance of migration in shaping agricultural management practices amidst the challenges of climate change.

The intergenerational effects of welfare transfers among single mothers: Evidence from an Israeli welfare reform

This paper examines the intergenerational effects of a welfare reform that increased welfare benefits generosity and eased eligibility requirements for single mothers in Israel. Using large-scale restricted administrative data and a difference-in-differences design, I find that the rise in single mothers’ welfare participation rates following the reform had a significant impact on their children’s long-term economic outcomes. Girls exposed to the reform in childhood were likelier to be on welfare themselves as young adults, while boys experienced a long-lasting increase in labor earnings. The results suggest that generous welfare programs can have beneficial consequences for boys growing up in single-parent households.

The short-term impact of Schistosoma mansoni infection on health-related quality of life: implications for current elimination policies.

The WHO aims to eliminate schistosomiasis as a public health problem by 2030. However, standard morbidity measures poorly correlate to infection intensities, hindering disease monitoring and evaluation. This is exacerbated by insufficient evidence on Schistosoma's impact on health-related quality of life (HRQoL). We conducted community-based cross-sectional surveys and parasitological examinations in moderate-to-high Schistosoma mansoni endemic communities in Uganda. We calculated parasitic infections and used EQ-5D instruments to estimate and compare HRQoL utilities in these populations. We further employed Tobit/linear regression models to predict HRQoL determinants. Two-thirds of the 560 participants were diagnosed with parasitic infection(s), 49% having S. mansoni. No significant negative association was observed between HRQoL and S. mansoni infection status/intensity. However, severity of pain urinating (β = -0.106; s.e. = 0.043) and body swelling (β = -0.326; s.e. = 0.005), increasing age (β = -0.016; s.e. = 0.033), reduced socio-economic status (β = 0.128; s.e. = 0.032), and being unemployed predicted lower HRQoL. Symptom severity and socio-economic status were better predictors of short-term HRQoL than current S. mansoni infection status/intensity. This is key to disentangling the link between infection(s) and short-term health outcomes, and highlights the complexity of correlating current infection(s) with long-term morbidity. Further evidence is needed on long-term schistosomiasis-associated HRQoL, health and economic outcomes to inform the case for upfront investments in schistosomiasis interventions.

Much hypothesized, rarely tested: Public preschool attendance predicts executive functioning skills in 3rd grade

Public preschool enhances consequential long-term education, economic, and health outcomes in adolescence and adulthood. One much-hypothesized—but rarely tested—explanation is that preschool predicts improved executive functioning (EF) in middle childhood. Our study provides empirical support linking preschool to middle childhood EF. We draw on a large, racially-diverse sample of children from low-income families in Tulsa, OK (N = 685, Mage at 3rd = 8.5 years), home to a nationally-recognized universal public preschool program administered in school-based pre-k and Head Start classrooms. Using propensity score weighting, we compare the 3rd grade EF skills of children who attended school-based pre-k or Head Start to those who did not. School-based pre-k attendance predicts better impulse control and working memory skills in 3rd grade (d = .35–.37); Head Start attendance predicts better working memory (d = .47). This evidence highlights public preschool’s potential to promote the EF skills of diverse children from low-income families into middle childhood.

Modelling long-term outcomes and mortality risk in patients with post-stroke spasticity during abobotulinum toxin injections as part of rehabilitation

To date, there are no Russian or international studies investigating the long-term efficacy of botulinum therapy (abobotulinum toxin injections – AboBTX) during rehabilitation in patients with post-stroke spasticity in terms of its impact on the risk of death from all causes and the development of cardiovascular complications. A 10-year study conducted in the United Kingdom analyzed the effects of AboBTX injections in patients with post-stroke spasticity on long-term clinical (all-cause mortality, cardiovascular events, length and quality of life) and economic (direct medical costs) outcomes. For the first time ever, a model was developed to evaluate the clinical (quality-adjusted life expectancy) and economic benefits of AboBTX injections in the structure of rehabilitation compared to rehabilitation without botulinum therapy in patients with post-stroke spasticity. It was shown that the inclusion of regular injections of AboBTX in the rehabilitation process resulted in an 8.8% reduction in the risk of death from all causes, a 13% increase in life expectancy (and by 59% in quality-adjusted terms compared to rehabilitation without botulinum therapy) and proved to be cost-effective. The use of AboBTX injections in patients with post-stroke spasticity as part of rehabilitation is cost-effective in the long term and improves long-term outcomes, including post-stroke survival.

Cost-Effectiveness of Human Papillomavirus Vaccination in the UK: Two Versus Single-Dose of Nonavalent HPV Vaccination

IntroductionThe UK implemented a single-dose HPV vaccination policy in September 2023, aiming for sustained protection, better vaccine coverage, and reduced healthcare costs. This research assesses the cost-effectiveness of both one-dose and two-dose schedules from a healthcare perspective. MethodsUsing an age-structured dynamic model, the study analyzed long-term health and economic outcomes of these two different vaccination approaches. It focused on the effects of vaccinating 12- to 13-year-olds with the 9-valent HPV vaccine in either single-dose or two-dose regimens from 2023 to 2093. The analysis, conducted in 2023–2024, explored different immunity durations (10, 30 years, or lifetime) and efficacy levels for the single-dose strategy. ResultsThe study indicated that in the UK, vaccinating 12- to 13-year-olds with a two-dose regimen is not considered cost-effective compared to the single-dose option, assumed to be 90% as effective for ten years. The incremental cost-effectiveness ratios (ICERs) for two doses ranged from £230,903 to £1,082,916 per quality-adjusted life year (QALY), significantly exceeding the UK's £20,000/QALY willingness-to-pay threshold. Over 70 years, a switch from a two-dose to a single-dose vaccination schedule could potentially lead to savings of over £1,073 million in the healthcare system. Furthermore, the single-dose regimen was cost-effective compared to no vaccination, with an ICER below £2,040/QALY. ConclusionsThe study affirms the cost-effectiveness of the UK's single-dose HPV vaccine, in sync with its September 2023 policy shift. The shift not only provides financial benefits but also simplifies vaccine administration, strategically reducing HPV's epidemiological and economic impacts.

Chitogel improves long-term health economic outcomes following endoscopic sinus surgery in severe chronic rhinosinusitis patients.

Chronic rhinosinusitis causes severe symptoms that can affect patient quality of life. Endoscopic sinus surgery can be effective in improving symptoms, although surgical outcomes can be compromised post-operatively, and revision surgery is required in a proportion of patients. This study compares outcomes and healthcare resource use in patients undergoing sinus surgery with or without Chitogel as a post-operative dressing. A retrospective cohort study was conducted using deidentified audit data from adult patients with severe chronic rhinosinusitis, who underwent endoscopic sinus surgery between January 2016 and December 2021. Patients in the intervention group received Chitogel as a post-operative dressing, and control patients received standard best-practice care. Cox Proportional Hazards survival analysis was used to compare revision surgery rates and time to revision between treatment groups. The rate of revision surgery was used to estimate potential health sector savings associated with use of Chitogel following surgery compared to the control arm, considering initial treatment costs and the cost of revision surgery. Over 18-24 months, patients treated with Chitogel demonstrated significantly lower rates of revision surgery (p = 0.035), and a trend towards decreased use of post-operative steroids, compared to control. Potential health sector savings due to reduced rates of revision surgery following use of Chitogel are estimated as NZ $753,000 per 100 patients. Severe chronic rhinosinusitis patients treated with Chitogel had lower rates of revision surgery within the first 18-24 months post-operative. These findings suggest that use of Chitogel can improve long-term patient outcomes and should improve health system efficiency.

THE INTERSECTION OF GEOLOGY AND BUSINESS SUSTAINABILITY: A DATA-DRIVEN REVIEW OF U.S. CORPORATE ENVIRONMENTAL STRATEGIES

In the contemporary business landscape, the intersection of geology and corporate sustainability emerges as a critical area of exploration, particularly within the U.S. context. This study delves into this intersection, aiming to elucidate how geological insights are integrated into corporate environmental strategies and the ensuing implications for sustainable business practices. The background of the study is rooted in the growing emphasis on environmental stewardship in business operations, where geological considerations are becoming increasingly significant. The paper's aim is to dissect the convergence of geology and corporate sustainability, assessing the influence of geological data on corporate environmental strategies. The scope encompasses a qualitative thematic analysis of recent literature, focusing on current trends, regional variations and industry-specific applications of geological insights. It also explores the economic and environmental impacts of integrating geology into business decisions, highlighting its role in risk management and sustainable innovation. The study concludes that geological data is a strategic asset in business, driving innovation, shaping risk management strategies and influencing long-term economic and environmental outcomes. It recommends that businesses embrace geological data as a core component of their sustainability strategies and policymakers create conducive environments for this integration. Future research is encouraged to further explore this dynamic field. The study provides valuable insights for businesses, policymakers and researchers, underscoring the necessity of integrating geological insights into corporate strategies for sustainable development.&#x0D; Keywords: Geological Data, Corporate Sustainability, Environmental Strategies, Business Innovation, Risk Management, Sustainable Development.

Cost-utility of real-time continuous glucose monitoring versus self-monitoring of blood glucose in people with insulin-treated Type II diabetes in France.

Aim: Clinical trials and real-world data for Type II diabetes both show that glycated hemoglobin (HbA1c) levels and hypoglycemia occurrence can be reduced by real-time continuous glucose monitoring (rt-CGM) versus self-monitoring of blood glucose (SMBG). The present cost-utility study investigated the long-term health economic outcomes associated with using rt-CGM versus SMBG in people with insulin-treated Type II diabetes in France. Materials & methods: Effectiveness data were obtained from a real-world study, which showed rt-CGM reduced HbA1c by 0.56% (6.1mmol/mol) versus sustained SMBG. Analyses were conducted using the IQVIA Core Diabetes Model. A French payer perspective was adopted over a lifetime horizon for a cohort aged 64.5years with baseline HbA1c of 8.3% (67mmol/mol). A willingness-to-pay threshold of €147,093 was used, and future costs and outcomes were discounted at 4% annually. Results: The analysis projected quality-adjusted life expectancy was 8.50 quality-adjusted life years (QALYs) for rt-CGM versus 8.03QALYs for SMBG (difference: 0.47QALYs), while total mean lifetime costs were €93,978 for rt-CGM versus €82,834 for SMBG (difference: €11,144). This yielded an incremental cost-utility ratio (ICUR) of €23,772 per QALY gained for rt-CGM versus SMBG. Results were particularly sensitive to changes in the treatment effect (i.e., change in HbA1c), annual price and quality of life benefit associated with rt-CGM, SMBG frequency, baseline patient ageand complication costs. Conclusion: The use of rt-CGM is likely to be cost-effective versus SMBG for people with insulin-treated Type II diabetes in France.

Clinical and Economic Burden of Illness in Patients with Persistent or Chronic Primary Immune Thrombocytopenia Treated with TPO-Ras and Rituximab

Background Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by reduced platelet counts. Patients with ITP lasting for ≥3 months (persistent or chronic primary ITP), and who do not respond adequately or maintain a response to initial therapy, are usually treated with advanced therapies such as thrombopoietin receptor agonists (TPO-RAs [avatrombopag/romiplostim/eltrombopag]), rituximab, and fostamatinib. The economic and clinical outcomes among patients on advanced therapies for ITP are not well described in real-world data. Objective This study aimed to evaluate the clinical and economic burden among ITP patients (lasting ≥3 months) treated with TPO-RAs, or rituximab, or fostamatinib by therapy type. Methods This retrospective cohort study used the US administrative health insurance claims data from the Optum's de-identified Clinformatics ® Data Mart Database. Patients with ITP lasting ≥3 months (aged ≥18 years), treated with TPO-RAs, or rituximab, or fostamatinib (index) between October 1, 2015, to August 31, 2020, after a 180-days washout period were included. Patient characteristics were evaluated 180 days prior to index (baseline). Follow-up for clinical outcomes started one-day after the index date and on the index date for economic outcomes. Patients were censored on switch to another ITP therapy different from index, death, end of data, or end of enrollment. Clinical outcomes (bleeding events [overall and type of bleeding], thromboembolic events [TEs], and clinical events identified as potential drug related adverse reactions) were reported as rate of events per 1000 person-years (PY). Health care resource use included number of hospitalizations, hospital days, emergency room visits, number of intensive care unit (ICU) admissions (both reported as rate of events per 1000 PY), and length of ICU stay. All analyses were stratified by treatment type on index date, however formal adjusted comparisons were not performed. Outcomes for fostamatinib users are not presented due to low sample size. Results A total of 404 patients treated with TPO-RAs, 333 with rituximab, and 14 with fostamatinib were eligible for the analysis. The average age of patients across the three cohorts was 60 years; 57.0% were females. The most common comorbidities across the three cohorts were diabetes (26.8%), coronary artery disease (14.4%), chronic heart failure (9.3%), and any TE (10.5%). At baseline, 29.0% of TPO-RA users, 30.6% of rituximab users, and 28.6% of fostamatinib users had experienced bleeding events. At baseline, bacterial infections occurred in 2% to 4% of patients treated with TPO-RAs and rituximab. At baseline, 36.1% TPO-RA users, 52.9% rituximab users, and 42.9% fostamatinib users had required any rescue therapy (IV anti-D, IV immunoglobulins, IV steroids, and platelet transfusion). Patients initiating TPO-RAs and rituximab were observed for a median (interquartile range, IQR) duration of 629 (286-1077) days and 398 (75-991) days, respectively. TPO-RA users and rituximab users stayed on the therapy for a mean (SD) duration of 305 (356) days and 31 (20) days, respectively. Among rituximab users, 60.7% completed a 4-week treatment course at index. During follow-up, the rate of bleeding events among TPO-RA and rituximab users was 284 and 254 per 1000 PY, respectively. The most common bleeding events were gastrointestinal bleeding, hematuria, and epistaxis. The rate of bacterial infections was 71 per 1000 PY in patients treated with TPO-RAs and 58 per 1000 PY in those treated with rituximab. The rate of TEs among TPO-RA and rituximab users was 153 and 110 per 1000 PY, respectively (Table 1). During follow-up, 38.4% of TPO-RA users and 55.9% of rituximab users required rescue therapy. The rate of hospitalizations among patients treated with TPO-RAs and rituximab was 573 and 400 per 1000 PY, respectively. The rate of ICU stays in patients treated with TPO-RAs was 176 per 1000 person-years, and 143 per 1000 person-years for those treated with rituximab (Table 2). Conclusion ITP patients (lasting ≥ 3 months) treated with TPO-RAs and rituximab continue to experience substantial rates of infections, TEs and bleeding (often requiring rescue therapies). All-cause hospitalization was high in this population. Further studies are needed to understand long-term clinical and economic outcomes among ITP patients.

Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

BackgroundTo investigate the long-term follow-up and economic estimation outcomes of hematoma drainage for spontaneous intracerebral hemorrhage (SICH) with the assistance of neurosurgical navigation and positioning planning system (referred to as robot).MethodsData were retrospectively obtained from consecutive patients with SICH who were admitted to our single-center between March 2019 and March 2022. Different minimally invasive surgery (MIS) procedures were performed according to the inclusion/exclusion criteria. The different groups were sampled and matched using the propensity score method, with age, sex, history of stroke, hypertension, bleeding volume and site of bleeding as matching variables, and matched with inverse probability weighting using R statistical analysis software. From the time of discharge up until 1 year after the surgery, records were gathered on clinical results and medical expenditures. An analysis was conducted to compare the costs and health outcomes of both robot-assisted stereotactic hematoma drainage and neuro-endoscopic surgery, considering both short-term and long-term effects. Health outputs were measured using modified Rankin scale (mRS) and quality adjusted life years (QALYs).ResultsOf the 142 patients, there were 77 patients in the robotic surgery group and 65 patients in the neuro-endoscopic surgery group. Propensity score sampling was matched, resulting in a balanced and comparable group of 37 patients in each, with the robotic surgery group [mean age (57.29 ± 12.74) years, 27 males (72.97%), hematoma volume (44.54 ± 10.49 ml), 22 deep location (59.46%)] and the neuro-endoscopic surgery group [mean age (57.27 ± 11.12) years, 27 males (72.97%), hematoma volume (44.70 ± 10.86 ml), 23 deep location (62.16%)]. At both three-month and one-year postoperative follow-up, the proportion of mRS scores ≤3 was higher in the robotic surgery group (45.95%,70.27%) than in the neuro-endoscopic surgery group (35.14%, 62.16%), but there was no statistically significant difference (P = 0.344, 0.461). One year after surgery, the robotic group demonstrated cost savings of ¥36,862.14 per individual and a gain of 0.062 QALYs compared to the neuro-endoscopic group.ConclusionOur calculations based on a model for SICH suggest that robotic-assisted stereotactic drainage offers health economic benefits due to its lower cost and higher effectiveness. However, to confirm these findings, more data from multicenter, prospective randomized controlled trials with larger sample sizes are needed.

Long-term economic outcomes of ureteral injury in the United States

Objectives Ureteral injuries (UIs) during surgical procedures can have serious consequences for patients. Although UIs can result in substantial clinical burden, few studies report the impact of these injuries on payer reimbursement and patient cost-sharing. This retrospective study evaluated 30-day, 90-day, and 1-year healthcare resource utilization for patients with UIs and estimated patient and payer costs. Methods Patients aged ≥ 12 years who underwent abdominopelvic surgery from January 2016 to December 2018 were identified in a United States claims database. Patients were followed for 1 year to estimate all-cause healthcare visits and costs for patients and payers. Surgeries resulting in UIs within 30 days from the surgery date were matched to surgeries without UIs to estimate UI-attributable visits and costs. Results Five hundred and twenty-two patients with UIs were included. Almost a third (29.9%) of patients with UIs had outpatient surgery. Patients with UIs had slightly more healthcare visits and a 15.3% higher 30-day hospital readmission rate than patients without UIs. Patient costs due to UIs were not statistically significant, but annual payer costs attributable to UIs were $38,859 (95% CI = 28,142–49,576), largely driven by inpatient costs. Conclusions UIs add substantial cost for payers and result in more healthcare visits for patients. These findings highlight the importance of including inpatient and outpatient settings for UI prevention. Although UIs are rare, the associated patient and payer burdens are high; thus, protocols or techniques are needed to recognize and avert UIs as current guideline recommendations are lacking.

Stunting in infancy is associated with atypical activation of working memory and attention networks

Stunting is associated with poor long-term cognitive, academic and economic outcomes, yet the mechanisms through which stunting impacts cognition in early development remain unknown. In a first-ever neuroimaging study conducted on infants from rural India, we demonstrate that stunting impacts a critical, early-developing cognitive system—visual working memory. Stunted infants showed poor visual working memory performance and were easily distractible. Poor performance was associated with reduced engagement of the left anterior intraparietal sulcus, a region involved in visual working memory maintenance and greater suppression in the right temporoparietal junction, a region involved in attentional shifting. When assessed one year later, stunted infants had lower problem-solving scores, while infants of normal height with greater left anterior intraparietal sulcus activation showed higher problem-solving scores. Finally, short-for-age infants with poor physical growth indices but good visual working memory performance showed more positive outcomes suggesting that intervention efforts should focus on improving working memory and reducing distractibility in infancy.

Cost-utility of real-time continuous glucose monitoring versus self-monitoring of blood glucose in people with insulin-treated Type 2 diabetes in Canada.

Aim: Clinical trials and real-world data for Type 2 diabetes have shown that real-time continuous glucose monitoring (rt-CGM) lowers glycated hemoglobin (A1c) and reduces hypoglycemia relative to self-monitoring of blood glucose (SMBG). This analysis examined the long-term health and economic outcomes associated with using rt-CGM versus SMBG in people with insulin-treated Type 2 diabetes in Canada. Materials & methods: Clinical data were sourced from a real-world study, in which rt-CGM reduced A1C by 0.56% versus continued SMBG. The analysis was performed using the IQVIA Core Diabetes Model, from a Canadian payer perspective over a lifetime horizon for a cohort aged 65 years with an A1C of 8.3% at baseline. Future costs and clinical outcomes were discounted at 1.5% annually. Results: Projected total mean lifetime costs were CAD 207,466 for rt-CGM versus CAD 189,863 for SMBG (difference: CAD 17,602) and projected mean quality-adjusted life expectancy was 9.97 quality-adjusted life years (QALYs) for rt-CGM versus 9.02 QALYs for SMBG (difference: 0.95 QALYs), resulting in an incremental cost-utility ratio (ICUR) of CAD 18,523 per QALY gained for rt-CGM versus SMBG. Findings were sensitive to changes in the A1C treatment effect, annual cost and quality of life benefit associated with using rt-CGM, SMBG frequency, and baseline age, but ICURs remained below CAD 50,000 per QALY in all analyses. Conclusion: For people in Canada with insulin-treated Type 2 diabetes and poor glycemic control, use of rt-CGM is likely to be cost-effective relative to SMBG.

Impact of adherence to disease modifying therapies on long-term clinical and economic outcomes in multiple sclerosis: A claims analysis of real-world data.

Multiple sclerosis (MS) is a chronic neurodegenerative inflammatory disease that requires long-term commitment to treatment for optimal outcomes. A variety of disease-modifying therapies (DMTs) are now available that reduce relapses and delay disease progression in people with MS. However, adherence remains a significant issue, with a variety of mental, physical, and emotional factors contributing to non-adherence. In a large number of studies, non-adherence has been associated with worse clinical outcomes (relapses and disease severity), a higher economic burden, and loss of work productivity. However, many of these studies were short-term (1-2 years) or cross-sectional studies; thus, more data are needed on the long-term clinical and economic impacts of DMT non-adherence. The objective of this study was to determine the longer-term impact of adherence to DMTs on disease activity and healthcare resource utilization (HCRU) in people with MS. The study hypothesis was that non-adherence to DMTs would be associated long-term with worse clinical outcomes and a higher economic burden. A retrospective administrative claims analysis of the US MarketScan® Commercial database (2011-2017) in individuals (18-65 years) with MS (based on International Classification of Disease coding) was conducted. Adherence was classified by proportion of days covered (PDC) ≥0.8 and non-adherence by PDC <0.8; sensitivity analyses helped further categorize as moderately (PDC ≥0.6-<0.8) or highly (PDC <0.6) non-adherent. Cohorts were matched using propensity score matching. Time to first relapse, annualized relapse rate (ARR), time to use of assistive devices (cane/walker or wheelchair), and annual HCRU (inpatient, emergency room [ER], outpatient, and MRI visits and costs) were compared between cohorts. 10,248 MS cases were identified; 58% met adherence criteria, and 42% met non-adherence criteria. Mean follow-up from diagnosis or first DMT claim was 5.3 years. Adherent individuals had a longer time to first relapse (hazard ratio [HR] 0.83; 95% confidence interval [CI]: 0.77-0.90; p<0.0001), a lower ARR (0.13vs. 0.18, respectively; rate ratio [RR] 0.75 [95% CI: 0.71-0.79]; p<0.0001), and longer lag times to cane/walker use (HR 0.79 [95% CI: 0.66-0.94]; p=0.0067) and wheelchair use (HR 0.68 [95% CI: 0.55-0.83]; p=0.0002) than non-adherent individuals. Adherent individuals had fewer annual inpatient and ER visits and lower total costs than those who were non-adherent (p<0.0001). Sensitivity analyses showed that differences in disease activity and HCRU were generally more pronounced between matched adherent and highly non-adherent pairs than between matched adherent and moderately non-adherent pairs. Significant differences in MS disease activity and HCRU were observed based on adherence to DMTs. Our study underscores the negative impact of non-adherence to DMTs on long-term clinical and economic outcomes in MS.

Early-life Exposure to the Great Depression and Long-term Health and Economic Outcomes

Early-life Exposure to the Great Depression and Long-term Health and Economic Outcomes

Designing Guidelines for Those Who Do Not Follow Them: The Impact of Adherence Assumptions on Optimal Screening Guidelines

ObjectivesModel-based cost-effectiveness analyses can inform decisions about screening guidelines by quantifying consequences of alternative algorithms. Although actual screening adherence is imperfect, incorporating nonadherence into analyses that aim to determine optimal screening may affect the policy recommendations. We evaluated the impact of nonadherence assumptions on the optimal cervical cancer screening in Norway. MethodsWe used a microsimulation model of cervical carcinogenesis to project the long-term health and economic outcomes under alternative screening algorithms and adherence patterns. We compared 18 algorithms involving primary human papillomavirus testing (5-yearly) that varied follow-up management of different human papillomavirus results. We considered 12 adherence scenarios: perfect adherence, 8 high- and low-coverage “random-complier” scenarios, and 3 “systematic-complier” scenarios that reflect conditional screening behavior over a lifetime. We calculated incremental cost-effectiveness ratios and considered a strategy with the highest incremental cost-effectiveness ratio < 55 000 US dollars/quality-adjusted life-year as “optimal.” ResultsUnder perfect adherence, the least intensive screening strategy was optimal; in contrast, assuming any nonadherence resulted in a more intensive optimal strategy. Accounting for lower adherence resulted in both lower costs and health benefits, which allowed for a more intensive strategy to be considered optimal, but more harms for women who screen according to guidelines (ie, up to 41% more colposcopies when comparing the optimal strategy in the lowest-adherence scenario with the optimal strategy under perfect adherence). ConclusionsAssuming nonadherence in analyses designed to inform national guidelines may lead to a relatively more intensive recommendation. Designing guidelines for those who do not adhere to them may lead to over-screening of those who do.

Dupilumab: Direct Cost and Clinical Evaluation in Patients with Atopic Dermatitis.

Health care spending in Italy is high and continues to increase; assessing the long-term health and economic outcomes of new therapies is essential. Atopic dermatitis (AD) is a chronic, pruritic, immune-mediated inflammatory dermatosis, a clinical condition that significantly affects patients' quality of life at a high cost and requires continuous care. This retrospective study aimed to assess the direct cost and adverse drug reactions (ADRs) of Dupilumab and patients' clinical outcomes. All AD patients treated with Dupilumab at the Sassari University Hospital, Italy, between January 2019 and December 2021 were included. Eczema Area Severity Index, Dermatology Life Quality Index, and Itch Numeric Rating Scale scores were measured. ADRs and drug expenses were analyzed. A statistically significant posttreatment improvement was observed for all the indices measured: EASI (P < 0.0001), DLQI (P < 0.0001), NRS (P < 0.0001). The total expenditure for Dupilumab, in the observed period, amounted to € 589.748,66 for 1358 doses, and a positive correlation was shown between annual expenditure and delta percentage of variation pre- and posttreatment for the clinical parameters evaluated.

Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes

Little is known about the long-term economic and social outcomes for children with longitudinally assessed comorbid externalizing and internalizing symptoms, especially compared with children with externalizing symptoms or internalizing symptoms only. To examine the association between childhood trajectories of externalizing, internalizing, and comorbid symptoms and long-term economic and social outcomes. A 32-year prospective cohort study linked with administrative data was conducted in school-aged participants aged 6 to 12 years in the Québec Longitudinal Study of Kindergarten Children (N = 3017) followed up from 1985 to 2017. Data analysis was conducted between August 1, 2021, and March 31, 2022. Teacher-rated behavioral symptoms were used to categorize children from age 6 to 12 years into developmental profiles using group-based trajectory modeling. Multivariable regression models were used to test the association between childhood symptom profile group and adult employment earnings, welfare receipt, intimate partnership status, and having children living in the household. Participant sex, IQ, and socioeconomic background were adjusted for. Of 3017 participants in this sample, 1594 (52.8%) were male and 1423 (47.2%) were female. Per confidentiality rules established by Statistics Canada, income variables were rounded to base 100 and count variables were rounded to base 10; the mean (SD) age was 37 (0.29) years at follow-up. Four symptom profiles were identified: no/low (n = 1369 [45.4%]), high externalizing (882 [29.2%]), high internalizing (354 [11.7%]), and comorbid (412 [13.7%]) symptoms. Compared with the no/low symptom profile, participants in the high externalizing-only profile earned $5904 (95% CI, -$7988 to -$3821) less per year and had 2.0 (95% CI, 1.58-2.53) times higher incidence of welfare receipt, while participants in the high internalizing group earned $8473 (95% CI, -$11 228 to -$5717) less per year, had a 2.07 (95% CI, 1.51-2.83) higher incidence of welfare receipt, and had a lower incidence of intimate partnership (incident rate ratio [IRR], 0.89; 95% CI, 0.80-0.99). Participants in the comorbid profile fared especially poorly: they earned $15 031 (95% CI, -$18 030 to -$12 031) less per year, had a 3.79 (95% CI, 2.75-5.23) times higher incidence of annual welfare receipt, and were less likely to have an intimate partner (IRR, 0.71; 95% CI, 0.63-0.79) and children living in the household (IRR, 0.86; 95% CI, 0.80-0.92). Estimated lost earnings over a 40-year working career were $140 515 for the high externalizing, $201 657 for the high internalizing, and $357 737 for the comorbid profiles. In this cohort study, children exhibiting sustained childhood high externalizing, high internalizing, or comorbid symptoms were at increased risk of poor economic and social outcomes into middle age. These findings suggest that children exhibiting comorbid problems were especially vulnerable and that early detection and support are indicated.

Success or Self-Sufficiency? The Role of Race in Refugees’ Long-Term Economic Outcomes

AbstractThe United States has always prided itself as providing safe haven to those who are persecuted. Yet, the United States did not develop policy for admitting and resettling refugees until 1980. Unlike Asians and Europeans, African refugees in the 1980s were chosen primarily based on skill, but no research thus far examines whether this strategy led to greater long-term economic success for African refugees. This article examines racial differences in refugees’ likelihood of living in poverty, receiving welfare income, engaging in full-time employment and wages between 1990 and 2019. I find that refugees show improvement in all four outcomes. African refugees, however, earn less than nearly all other groups in all time periods suggesting blocked mobility, particularly among men. Analyses focus on the 1982–1987 entry cohort of refugees who had access to more assistance than future cohorts. Consequently, these findings likely show the best-case scenario for refugees’ long-term economic outcomes.