Reduction In Disability-adjusted Life Years Research Articles

Disease burden of mental disorders among children and adolescents considering both co-morbidities and suicide in Northeastern China

BackgroundFew studies have assessed the burden of mental disorders among children and adolescents considering the impact of co-morbidities and suicide on disability adjusted life years (DALYs).MethodsThis was a multicenter cross-sectional study. Our survey data in Liaoning Province (LN) were used to estimate the burden of six mental disorders, supplemented with data from other investigative studies conducted in China to assess four other disorders. DALYs were derived from the sum of years lived with a disability (YLDs) adjusted for co-morbidities, and the years of life lost (YLLs) adjusted for suicide. The changes in DALYs, YLDs, and YLLs were compared with and without adjustment for co-morbidities and suicide.ResultsThe DALYs rate of mental disorders among children and adolescents in LN decreased from 1579.6/105 to 1391.4/105, after adjusting for both co-morbidities and suicide (-11.9%). The DALYs rate for major depression, anxiety disorder, and conduct disorder (-80.8/105, -75.0/105 and -30.2/105, respectively) were the top three contributors to the DALYs reduction (-188.2/105). The YLDs decreased from 72724.8 to 62478.5 after co-morbidity adjustment (-17.8%), mainly due to the reduction by major depression (-35.3%) and attention deficit/hyperactivity disorder [ADHD] (-34.2%). The YLLs increased from 130 to 1697.8 after adjusting for suicides (+ 56.9% of all suicide YLLs), mainly due to the contribution of major depression (+ 32.4%) and anxiety disorder (+ 10.4%). Compared to GBD 2010, the estimated DALY rate for mental disorders in LN was to be about 80%, with the proportion of DALYs and DALY rates explained by major depressive disorder accounted for only approximately one-third (14.6% vs. 41.9% and 202.6 vs. 759.9, respectively). But the proportion and absolute level of DALY rates explained by anxiety disorders were approximately 2-fold higher (39.7% vs. 19.6% and 552.2 vs. 323.3, respectively).ConclusionsThe DALYs of mental disorders among Chinese children and adolescents were approximately 80% of the global level, with anxiety disorders imposing about 2 times the global level. Co-morbidity and suicide must be adjusted when calculating DALYs.

The 30 Years of Shifting in The Indonesian Cardiovascular Burden—Analysis of The Global Burden of Disease Study

ImportanceCardiovascular disease (CVD) remains the leading cause of mortality and morbidity. Compared with disease burden rates in 1990, significant reductions in Disability-Adjusted Life Years (DALYs) burden rates for CVD have been recorded. However, general DALYs rates have not changed in Indonesia in the past 30 years. Thus, assessing Indonesian CVD burdens will be an essential first step in determining primary disease interventions.ObjectiveTo determine the national and province-level burden of CVD from 1990 to 2019 in Indonesia.Design, Setting, and ParticipantsA retrospective observational study was conducted using data from the Global Burden of Disease (GBD) 2019, provided by the Institute of Health Metrics and Evaluation (IHME), to analyze trends in the burden of CVD, including mortality, morbidity, and prevalence characteristics of 12 underlying CVDs.ExposuresResidence in Indonesia.Main Outcomes and MeasuresMortality, incidence, prevalence, death, and DALYs of CVD.ResultsCVD deaths have doubled from 278 million in 1990 to 651 million in 2019. All CVDs recorded increased death rates, except for rheumatic heart disease (RHD) (− 69%) and congenital heart disease (CHD) (− 37%). Based on underlying diseases, stroke and ischemic heart disease (IHD) are still the leading causes of mortality and morbidity in Indonesia, whereas stroke and peripheral artery disease (PAD) are the most prevalent CVDs. Indonesia has the second worst CVD DALYs rates compared to ASEAN countries after Laos. At provincial levels, the highest CVD DALY rates were recorded in Bangka Belitung, South Kalimantan, and Yogyakarta. In terms of DALYs rate changes, they were recorded in West Nusa Tenggara (24%), South Kalimantan (18%), and Central Java (11%). Regarding sex, only RHD, and PAD burdens were dominated by females.ConclusionsCVD mortality, morbidity, and prevalence rates increased in Indonesia from 1990 to 2019, especially for stroke and ischemic heart disease. The burden is exceptionally high, even when compared to other Southeast Asian countries and the global downward trend. GBD has many limitations. However, these data could provide policymakers with a broad view of CVD conditions in Indonesia.

Hepatitis B and C in Europe: an update from the Global Burden of Disease Study 2019

In 2016, the World Health Assembly adopted the resolution to eliminate viral hepatitis by 2030. This study aims to provide an overview of the burdens of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Europe and their changes from 2010 to 2019 using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We used GBD 2019 estimates of the burden associated with HBV-related and HCV-related diseases: acute hepatitis, cirrhosis and other chronic liver diseases, and liver cancer. We report total numbers and age-standardised rates per 100 000 for mortality, prevalence, incidence, and disability-adjusted life-years (DALYs) from 2010 to 2019. For each HBV-related and HCV-related disease and each measure, we analysed temporal changes and percentage changes for the 2010-19 period. In 2019, across all age groups, there were an estimated 2·08 million (95% uncertainty interval [UI] 1·66 to 2·54) incident cases of acute hepatitis B and 0·49 million (0·42 to 0·57) of hepatitis C in Europe. There were an estimated 8·24 million (7·56 to 8·88) prevalent cases of HBV-related cirrhosis and 11·87 million (9·77 to 14·41) of HCV-related cirrhosis, with 24·92 thousand (19·86 to 31·03) deaths due to HBV-related cirrhosis and 36·89 thousand (29·94 to 45·56) deaths due to HCV-related cirrhosis. Deaths were estimated at 9·00 thousand (6·88 to 11·62) due to HBV-related liver cancer and 23·07 thousand (18·95 to 27·31) due to HCV-related liver cancer. Between 2010 and 2019, the age-standardised incidence rate of acute hepatitis B decreased (-22·14% [95% UI -35·44 to -5·98]) as did its age-standardised mortality rate (-33·27% [-43·03 to -25·49]); the age-standardised prevalence rate (-20·60% [-22·09 to -19·10]) and mortality rate (-33·19% [-37·82 to -28·13]) of HBV-related cirrhosis also decreased in this time period. The age-standardised incidence rate of acute hepatitis C decreased by 3·24% (1·17 to 5·02) and its age-standardised mortality rate decreased by 35·73% (23·48 to 47·75) between 2010 and 2019; the age-standardised prevalence rate (-6·37% [-8·11 to -4·32]), incidence rate (-5·87% [-11·24 to -1·01]), and mortality rate (-11·11% [-16·54 to -5·53]) of HCV-related cirrhosis also decreased. No significant changes were observed in age-standardised rates of HBV-related and HCV-related liver cancer, although we observed a significant increase in numbers of cases of HCV-related liver cancer across all ages between 2010 and 2019 (16·41% [2·81 to 30·91] increase in prevalent cases). Substantial reductions in DALYs since 2010 were estimated for acute hepatitis B (-27·82% [-36·92 to -20·24]), acute hepatitis C (-27·07% [-15·97 to -39·34]), and HBV-related cirrhosis (-30·70% [-35·75 to -25·03]). A moderate reduction in DALYs was estimated for HCV-related cirrhosis (-6·19% [-0·19 to -12·57]). Only HCV-related liver cancer showed a significant increase in DALYs (10·37% [4·81-16·63]). Changes in age-standardised DALY rates closely resembled those observed for overall DALY counts, except for HCV-liver related cancer (-2·84% [-7·75 to 2·63]). Although decreases in some HBV-related and HCV-related diseases were estimated between 2010 and 2019, HBV-related and HCV-related diseases are still associated with a high burden, highlighting the need for more intensive and coordinated interventions within European countries to reach the goal of elimination by 2030. Bill & Melinda Gates Foundation.

Association between universal health coverage and the disease burden of acute illness and injury at the global level

BackgroundThis study examines the relationship between universal health coverage (UHC) and the burden of emergency diseases at a global level.MethodsData on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables 1) coverage of essential health services and 2) proportion of the population spending more than 10% of household income on out-of-pocket health care expenditure, were extracted from the World Bank Database for years preceding our outcome of interest. A linear regression was used to analyze the association between UHC variables and DALYs for emergency diseases, controlling for other variables.ResultsA total of 132 countries were included. The median national coverage of essential health services index was 67.5/100, while the median national prevalence of catastrophic spending in the sample was 6.74% of households. There was a strong significant relationship between health service coverage and the burden of emergency diseases, with an 11.5-point reduction in DALYs of emergency medical diseases (95% CI -9.5, -14.8) for every point increase in the coverage of essential health services index. There was no statistically significant relationship between catastrophic expenditures and the burden of emergency diseases, which may be indicative of inelastic demand in seeking services for health emergencies.ConclusionIncreasing the coverage of essential health services, as measured by the essential health services index, is strongly correlated with a reduction in the burden of emergency conditions. In addition, data affirms that financial protection remains inadequate in many parts of the globe, with large numbers of households experiencing significant economic duress related to seeking healthcare. This evidence supports a strategy of strengthening UHC as a means of combating death and disability from health emergencies, as well as extending protection against impoverishment related to healthcare expenses.

Cost-Effectiveness and Cost-Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya.

Objective:To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls.Design:Cost-effectiveness and cost–benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year.Participants:Girls 14–16 years of age enrolled across 30 primary schools in rural western Kenya.Methods:Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs.Results:Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: −4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: −4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: −$32,000 to +$169,000).Conclusions:The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed. Trial registration: ISRCTN17486946.

Reduction in DALYs lost due to soil-transmitted helminthiases and schistosomiasis from 2000 to 2019 is parallel to the increase in coverage of the global control programmes.

Preventive chemotherapy interventions for the control of soil-transmitted helminthiases (STH) and schistosomiasis scaled up from a global coverage level of around 5% in the year 2000 to a coverage that surpassed 60% in the year 2019. The present paper analyses the concomitant reduction in the number of disability-adjusted life years (DALYs) lost due to STH and schistosomiasis during the same period, from 6.3 to 3.5 million DALYs. The cumulative gain during the 19-year period was estimated at over 26 million DALYs. Given the low cost of the intervention, our study suggests that deworming for STH and schistosomiasis is one of the most cost-effective public health interventions.

Global trends and the impact of chronic hepatitis B and C on disability-adjusted life years.

Advances in hepatitis B virus (HBV) and hepatitis C virus (HCV) therapies have improved morbidity and mortality, but global disparities in viral hepatitis outcomes remain. We evaluate global trends in the impact of HBV and HCV on disability-adjusted life years (DALYs). Using data from the 2010-2019 Global Burden of Diseases Study (GBD), overall all-cause DALYs for patients with acute HBV or HCV, HBV- or HCV-related cirrhosis, and HBV- or HCV-related hepatocellular carcinoma (HCC) was calculated as the sum of years of life lost because of premature death and years lived with disability. DALYs were presented as age-standardized rates per 100 000 population stratified by age and sex. From 2010 to 2019, the overall global impact of HBV on DALYs per 100 000 decreased from 27.6 to 20.9 for acute HBV and 168.6 to 129.8 for HBV-related cirrhosis but remained stable for HBV-related HCC. The impact of HCV on DALYs per 100 000 decreased from 5.23 to 3.3 for acute HCV, 159.2 to 146.2 for HCV-related cirrhosis, and 37.5 to 34.9 for HCV-related HCC. We observed significant differences in the impact of HBV and HCV on DALYs when stratified by world regions. Decreases in HBV and HCV DALYs from 2010 to 2019 were observed. Disparities in DALY improvements across world regions suggest unequal access to viral hepatitis care and treatment. Achieving goals of viral hepatitis elimination will require enhanced prevention efforts and funding for high-burden regions and regions that have not had substantial reductions in DALYs because of HBV and HCV.

Good soil management can reduce dietary zinc deficiency in Zimbabwe

BackgroundDietary zinc (Zn) deficiency is widespread in sub-Saharan Africa (SSA) with adverse impacts on human health. Agronomic biofortification with Zn fertilizers and improved soil fertility management, using mineral and organic nutrient resources, has previously been shown to increase Zn concentration of staple grain crops, including maize. Here, we show the potential of different soil fertility management options on maize crops to reduce dietary Zn deficiency in Zimbabwe using secondary data from a set of surveys and field experiments.MethodsAn ex-ante approach was used, informed by published evidence from studies in three contrasting smallholder production systems in Zimbabwe. To estimate current Zn deficiency in Zimbabwe, data on dietary Zn supply from non-maize sources from the Global Expanded Nutrient Supply (GENuS) data set were linked to maize grain Zn composition observed under typical current soil fertility management scenarios.ResultsA baseline dietary Zn deficiency prevalence of 68% was estimated from a reference maize grain Zn composition value of 16.6 mg kg−1 and an estimated dietary Zn intake of 9.3 mg capita−1 day−1 from all food sources. The potential health benefits of reducing Zn deficiency using different soil fertility management scenarios were quantified within a Disability Adjusted Life Years (DALYs) framework. A scenario using optimal mineral NPK fertilizers and locally available organic nutrient resources (i.e. cattle manure and woodland leaf litter), but without additional soil Zn fertilizer applications, is estimated to increase maize grain Zn concentration to 19.3 mg kg−1. This would reduce the estimated prevalence of dietary Zn deficiency to 55%, potentially saving 2238 DALYs year−1. Universal adoption of optimal fertilizers, to include soil Zn applications and locally available organic leaf litter, is estimated to increase maize grain Zn concentration to 32.4 mg kg−1 and reduce dietary Zn deficiency to 16.7%, potentially saving 9119 DALYs year−1. Potential monetized yield gains from adopting improved soil fertility management range from 49- to 158-fold larger than the potential reduction in DALYs, if the latter are monetized using standard methods.ConclusionFarmers should be incentivized to adopt improved soil fertility management to improve both crop yield and quality.

Incidence and disability-adjusted life years of maternal disorders at the global, regional, and national levels from 2007 to 2017: A systematic analysis for the Global Burden of Disease Study 2017.

To report the global burden of maternal disorders and their main subcategories in 195 countries and territories between 2007 and 2017. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimated maternal disease burden at global, regional, and country levels. Maternal disorders were disaggregated into 10 categories, and estimated incidence and disability-adjusted life years (DALYs) of maternal disorders were reported separately. Indicators were estimated in different geographic settings and different sociodemographic index (SDI) regions. Based on GBD 2017 estimates, we systematically examined the incidence and DALYs of maternal disorders and their main subcategories at the global, regional, and national levels during the period from 2007 to 2017 by age and SDI. Globally, a total of 7.98million maternal disorders occurred in 2017, with a 4.33% (95% uncertainty interval [UI] 3.24%-5.60%) decrease in age-standardized incidence rate and a more significant decrease (30.26%) in the age-standardized rate of DALYs. Most incidences and DALYs were found in low-income and middle-income countries, especially in the sub-Saharan region. The greatest incidence of maternal disorders was found to be in maternal abortion and miscarriage (2.00million), and the highest disease burden was in maternal hemorrhage (2.23million). A slight increase in the incidence of maternal disorders and substantial reductions in DALYs of overall maternal disorders and their main subcategories were found from 2007 to 2017, especially in low-income countries and the sub-Saharan region. Maternal hemorrhage, hypertensive disorders, and indirect maternal death were the top three causes of maternal disorders disease burden.

Trends in incidence and mortality of squamous cell carcinoma of the skin: An observational analysis of the Global Burden of Disease database from 1990 to 2017.

10569 Background: Epidemiological data relating to non-melanoma skin cancer (NMSC), including squamous cell carcinoma (SCC), is highly under-reported and under-studied due to its lower metastatic potential. In recent years, incidence and prevalence of SCC has increased in many countries due to earlier detection, increased ultraviolet light exposure, as well as increasing life expectancy. This investigation compared trends in SCC incidence, mortality and disability-adjusted life years (DALYs) in 33 countries. Methods: We utilized the Global Burden of Disease (GBD) database for 33 countries, including the European Union nations as well as other selected high-income countries including the UK and USA. We extracted data including age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs) and DALYs for SCC of the skin from 1990 to 2017. Joinpoint regression analysis was used to describe the trends. Results: For both sexes, the highest ASIRs were seen in the USA and Australia: ASIRs were 362.8/100,000 and 283.7/100,000 respectively for males, and 171.2/100,000 and 152.4/100,000 respectively for females. Males had higher ASIRs than females at the end of the observation period in all countries. In contrast, the highest ASMRs for males were observed in Australia (2.77/100,000) and Latvia (2.44/100,000), while the highest ASMRs for females were observed in Romania (0.95/100,000) and Croatia (0.90/100,000). The highest DALYs for both sexes were seen in Australia and Romania: DALYs were 58.4/100,000 and 43.8/100,000 respectively for males, and 16.9/100,000 and 14.9/100,000 respectively for females. Over the observation period, there were more countries demonstrating decreasing trends in mortality than in incidence. There was also a disparity between which countries had comparatively high mortality rates and which had high incidence rates – for instance, the USA, which had by far the highest SCC incidence rates, had among the lower mortality rates. Overall reductions in DALYs were observed in 24 of 33 countries for males, and 25 countries for females. Conclusions: Over the past 27 years, although trends in SCC incidence have risen in most countries, there is evidence that mortality rates have been decreasing, especially towards the end of the observation period. Overall, burden of disease as assessed using DALYs has decreased in the majority of countries. Future work will explore potential explanatory factors for the observed disparity in trends in SCC incidence and mortality.

Good soil management can reduce dietary zinc deficiency in Zimbabwe.

Abstract Dietary zinc (Zn) deficiency is widespread in sub-Saharan Africa (SSA) with adverse impacts on human health. Agronomic biofortification with Zn fertilizers and improved soil fertility management, using mineral and organic nutrient resources, has previously been shown to increase Zn concentration of staple grain crops, including maize. Here, we show the potential of different soil fertility management options on maize crops to reduce dietary Zn deficiency in Zimbabwe using secondary data from a set of survey and field experiments. An ex-ante approach was used, informed by published evidence from studies in three contrasting smallholder production systems in Zimbabwe. To estimate current Zn deficiency in Zimbabwe, data on dietary Zn supply from non-maize sources from the Global Expanded Nutrient Supply (GENuS) data set were linked to maize grain Zn composition observed under typical current soil fertility management scenarios. A baseline dietary Zn deficiency prevalence of 68% was estimated from a reference maize grain Zn composition value of 16.6 mg kg -1 and an estimated dietary Zn intake of 9.3 mg capita -1 day -1 from all food sources. The potential health benefits of reducing Zn deficiency using different soil fertility management scenarios were quantified within a Disability Adjusted Life Years (DALYs) framework. A scenario using optimal mineral NPK fertilizers and locally available organic nutrient resources (i.e. cattle manure and leaf litter), but without additional soil Zn fertilizer applications, is estimated to increase maize grain Zn concentration to 19.3 mg kg -1 . This would reduce the estimated prevalence of dietary Zn deficiency to 55%, potentially saving 2,238 DALYs year -1 . Universal adoption of optimal fertilizers, to include soil Zn applications and locally available organic leaf litter, is estimated to increase maize grain Zn concentration to 32.4 mg kg -1 and reduce dietary Zn deficiency to 16.7%, potentially saving 9,119 DALYs year -1 . Potential monetized yield gains from adopting improved soil fertility management range from 49- to 158-fold larger than the potential reduction in DALYs, if the latter are monetized using standard methods. Farmers should be incentivized to adopt improved soil fertility management to improve both crop yield and quality.

Impact of COVID-19 infection control measures on influenza-related outcomes in Hong Kong

ABSTRACT Following the announcement of coronavirus disease 2019 (COVID-19) cases in Wuhan on 31 December 2019, government officials in Hong Kong recommended the wearing of face masks as a public infection control measure against the COVID-19 virus and curtail the impact of the concurrent influenza season. The present study evaluated the influenza-related outcomes between the influenza season 2019 and 2020 in Hong Kong as a result of these infection control measures. A Monte Carlo simulation model was designed to estimate the number of influenza cases, clinic visits, hospitalization, deaths, direct medical cost and disability-adjusted life-years (DALYs) for the season 2018–2019 and 2019–2020 in six age groups: 0–5 years, 6–11 years, 12–17 years, 18–49 years, 50–64 years and ≥65 years in Hong Kong. Model inputs were derived from public data and existing literature. The model findings showed significant reduction in influenza-related cases, clinic visits, hospitalization, and deaths in 2020 versus 2019 (p < 0.05). Influenza-related direct costs in all age-groups were significantly reduced by 56%-82% (p < 0.01) in 2020 versus 2019. DALYs were also significantly decreased by 58%-85% (p < 0.01). The direct cost and DALYs avoided in 2020 was the highest among the age group of 0–5 years with a cost-saving of USD593,763 (95%CI 590,730–596,796) per 10,000 population and a DALY reduction of 57.67 (95%CI 57.54–57.83) per 10,000 population. This study illustrated the reduction of all influenza-related outcome measures in Hong Kong as a result of the implementation of public infection control measures against COVID-19.

Reduced Impact of Endovascular Thrombectomy on Disability in Real-World Practice, Relative to Randomized Controlled Trial Evidence in Australia.

Background and Aims: Disability-adjusted life years (DALYs) are an important measure of the global burden of disease that informs patient outcomes and policy decision-making. Our study aimed to compare the DALYs saved by endovascular thrombectomy (EVT) in the Australasian-based EXTEND-IA trial vs. clinical registry data from EVT in Australian routine clinical practice.Methods: The 3-month modified Rankin scale (mRS) outcome and treatment status of consecutively enrolled Australian patients with large vessel occlusion (LVO) stroke were taken from the International Stroke Perfusion Imaging Registry (INSPIRE). DALYs were calculated as the summation of years of life lost (YLL) due to premature death and years lived with a disability (YLD). A generalized linear model (GLM) with gamma family and log link was used to compare the difference in DALYs for patients receiving/not receiving EVT while controlling for key covariates. Ordered logit regression model was utilized to compare the difference in functional outcome at 3 months between the treatment groups. Cox regression analysis was undertaken to compare the difference in survival over an 18-year time horizon. Estimated long-term DALYs saved based on the EXTEND-IA randomized controlled trial (RCT) results were used as the comparator.Results: INSPIRE patients who received EVT treatment only achieved nominally better functional outcomes than the non-EVT group (p = 0.181) at 3 months. There was no significant survival gain from EVT over the first 3 months of stroke in both INSPIRE and EXTEND-IA patients. However, measured against no EVT in the long-term, EVT in INSPIRE was associated with no significant survival gain [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.78–1.08, p = 0.287] compared with the survival benefit extrapolated from the EXTEND-IA trial (HR: 0.42, 95% CI: 0.22–0.82, p = 0.01]. Offering EVT to patients with LVO stroke was also associated with fewer DALYs lost (11.04, 95% CI: 10.45–11.62) than those not receiving EVT in INSPIRE (12.13, 95% CI: 11.75–12.51), a reduction of −1.09 DALY (95% CI: −1.76 to −0.43, p = 0.002). The absolute magnitude of the treatment effect was lower than that seen in EXTEND-IA (−2.72 DALY reduction in EVT vs non-EVT patients).Conclusions: EVT for the treatment of LVO in a registry of routine care was associated with significantly lower DALYs lost than medical care alone, but the saved DALYs are less than those reported in clinical trials, as there were major differences in the baseline characteristics of the patients.

Early childhood education and life-cycle health.

This study forecasts the life-cycle treatment effects on health of a high-quality early childhood program. Our predictions combine microsimulation using nonexperimental data with experimental data from a midlife long-term follow-up. The follow-up incorporated a full epidemiological exam. The program mainly benefits males and significantly reduces the prevalence of heart disease, stroke, cancer, and mortality across the life-cycle. For men, we estimate an average reduction of 3.8 disability-adjusted life years (DALYs). The reduction in DALYs is relatively small for women. The gain in quality-adjusted life years is almost enough to offset all of the costs associated with program implementation for males and half of program costs for women.

Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017

ObjectiveTo describe the temporal and spatial trends of mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world during 1990-2017 using...

Cost-effectiveness of transplanting lungs and kidneys from donors with potential hepatitis C exposure or infection

Organ transplant guidelines in many settings recommend that people with potential hepatitis C virus (HCV) exposure or infection are deemed ineligible to donate. The recent availability of highly-effective treatments for HCV means that this may no longer be necessary. We used a mathematical model to estimate the expected difference in healthcare costs, difference in disability-adjusted life years (DALYs) and cost-effectiveness of removing HCV restrictions for lung and kidney donations in Australia. Our model suggests that allowing organ donations from people who inject drugs, people with a history of incarceration and people who are HCV antibody-positive could lead to an estimated 10% increase in organ supply, population-level improvements in health (reduction in DALYs), and on average save AU$2,399 (95%CI AU$1,155-3,352) and AU$2,611 (95%CI AU$1,835-3,869) per person requiring a lung and kidney transplant respectively. These findings are likely to hold for international settings, since this policy change remained cost saving with positive health gains regardless of HCV prevalence, HCV treatment cost and waiting list survival probabilities. This study suggests that guidelines on organ donation should be revisited in light of recent changes to clinical outcomes for people with HCV.

Bypassing the Closest Stroke Center for Thrombectomy Candidates: What Additional Delay to Thrombolysis Is Acceptable?

Background and Purpose- Patients with acute ischemic stroke who have large vessel occlusion benefit from direct transport to a comprehensive stroke center (CSC) capable of endovascular therapy. To avoid harm for patients without large vessel occlusion from delayed access to intravenous thrombolysis (IVT), it has been suggested to only redirect patients with high likelihood of large vessel occlusion for whom the additional delay to intravenous thrombolysis (IVT) caused by transport to the CSC is below a certain threshold. However, which threshold achieves the greatest clinical benefit is unknown. Methods- We used mathematical modeling to calculate additional-delay-to-IVT thresholds associated with the greatest reduction in disability-adjusted life years in abstracted 2-stroke center and multiple-stroke center scenarios. Model parameters were extracted from recent meta-analyses or large prospective cohort studies. Uncertainty was quantified in probabilistic and 2-way univariate sensitivity analyses. Results- Assuming ideal treatment time performance metrics, transport to the nearest CSC was the preferred strategy irrespective of additional delay-to-IVT when the transfer time between primary stroke center and CSC was <40 minutes (95% credible interval: 25-66 minutes); otherwise, the optimal additional delay-to-IVT-threshold ranged from 28 to 139 minutes. In multiple-stroke center scenarios, optimal additional-delay-to-IVT thresholds were 30 to 54 minutes in urban and 49 to 141 minutes in rural settings; use of optimal thresholds as compared with a 15 minute-threshold saved 0 to 0.11 and 0 to 0.37 disability-adjusted life years per triage case, respectively. Assuming slower treatment times at primary stroke centers and CSCs yielded longer permissible additional delays. Conclusions- Our results suggest that patients with acute ischemic stroke with suspected large vessel occlusion should be redirected to a CSC if the additional delay to IVT is <30 minutes in urban and 50 minutes in rural settings.

The Predicted Impact of Adopting Health-Promoting Behaviors on Disease Burden in a Commercially Insured Population.

The aim of this study was to better understand, in a commercially insured population, the potential impact of adopting six health-promoting behaviors relative to treating diseases and conditions. We combined survey and insurance claims data to compare the potential benefit from adopting behaviors relative with the burden from 27 groups of diseases and conditions. If every member adopted all six behaviors, an 11.6% reduction in disability-adjusted life years (DALYs) might be expected, and a 7.6% reduction in DALYs might be expected if they adopted the one most impactful behavior that they did not currently practice. These amounts are, respectively, greater than the DALYs attributed to all but the two and five most burdensome groups of diseases and conditions in this population. The potential impact of adopting health-promoting behaviors is large relative to the burden from most medical conditions.

The Perspectives Associated With the Computer-Based Diagnostic Method of Depressive Disorder.

Depressive disorder (DD) shortens a healthy and productive human life, has significant public health costs is and associated with high suicide rates. In depression sadness and emotional misery manifest in facial expressions, as psychomotor slowing, lack of energy, high tension, and attenuated sensory perception. Loss of appetite, changes to the taste of food, and the loss of pleasure in eating are important criteria in the diagnosis of DD. We hypothesized that a patient's facial expressions and emotional responses to different tastes can be used as the diagnostic moderators for the development of a new contactless, computer-based method for diagnosis of DD. The confirmation of this hypothesis can shed a new perspective on early contactless, computer-based psychiatric diagnostic strategies and early identification of DD symptoms, as DD is an important issue in public mental health. The benefits of this method are evidence from several perspectives (I) patients can use a self-rating instrument to assess DD symptoms; this may act as an incentive to seek professional help; (II) family and community can use an instrument for early recognition of DD symptoms and suicidal tendencies, making it possible to encourage the individual to seek professional health care; (III) general practitioners have a reliable instrument for preliminary diagnosis of DD in primary care, thus saving the time and resources; (IV) public health benefits include early diagnosis and treatment of DD and better outcomes, reductions in disability-adjusted life years and the global burden of the disease. It is nevertheless important to recognize the limitations and risks of contactless diagnosis of DD. As it is a self-assessment method it is not possible to rule out false positives and false negatives. However, this method might be used for early diagnosis of DD symptoms. Also, it should be mentioned that further evaluation and an experts opinion about this method is needed. The clinical diagnosis of DD should continue to be made by healthcare professionals. Finally, this method may perspectively predict DD at an early stage and may ensure a higher quality of the patients' primary care in the public health system.

Disability Adjusted Life Years due to Ischaemic Stroke Preventable by Real-Time Stroke Detection-A Cost-Utility Analysis of Hypothetical Stroke Detection Devices.

Background: Ischaemic stroke remains a significant contributor to permanent disability world-wide. Therapeutic interventions for acute ischaemic stroke (AIS) are available, but need to be administered early after symptom onset in order to be effective. Currently, one of the main factors responsible for poor clinical outcome is an unnecessary long time between symptom onset and arrival at a hospital (pre-hospital delay). In the future, technological devices with the capability of real-time detection of AIS may become available. The health economic implications of such devices have not been explored.Methods: We developed a novel probabilistic model to estimate the maximally allowable annual costs of different hypothetical real-time AIS detection devices in different populations given currently accepted willingness-to-pay thresholds. Distributions of model parameters were extracted from the literature. Effectiveness of the intervention was quantified as reduction in disability-adjusted life-years associated with faster access to thrombolysis and mechanical thrombectomy. Incremental costs were calculated from a societal perspective including acute treatment costs and long-term costs for nursing care, home help, and loss of production. The impact of individual model parameters was explored in one-way and multi-way sensitivity analyses.Results: The model yields significantly shorter prehospital delays and a higher proportion of acute ischaemic patients that fulfill the time-based eligibility criteria for thrombolysis or mechanical thrombectomy in the scenario with a real-time stroke detection device as compared to the control scenario. Depending on the sociodemographic and geographic characteristics of the study population and operating characteristics of the device, the maximally allowable annual cost for the device to operate in a cost-effective manner assuming a willingness-to-pay threshold of GBP 30.000 ranges from GBP 22.00 to GBP 9,952.00. Considering the results of multiway sensitivity analyses, the upper bound increases to GBP 29,449.10 in the subgroup of young patients with a very high annual risk of ischaemic stroke (50 years/20% annual risk).Conclusion: Data from probabilistic modeling suggest that real-time AIS detection devices can be expected to be cost-effective only for a small group of highly selected individuals.