Public Healthcare System Research Articles

Identification of strengths and weaknesses of the healthcare system for persons living with rare diseases in Catalonia (Spain), and recommendations to improve its comprehensive attention: the “acERca las enfermedades raras” project

BackgroundRare diseases (RDs) are a heterogeneous group of complex and low-prevalence conditions in which the time to establish a definitive diagnosis is often too long. In addition, for most RDs, few to no treatments are available and it is often difficult to find a specialized care team.ObjectivesThe project “acERca las enfermedades raras” (in English: “bringing RDs closer”) is an initiative primary designed to generate a consensus by a multidisciplinary group of experts to detect the strengths and weaknesses in the public healthcare system concerning the comprehensive care of persons living with a RD (PLWRD) in the region of Catalonia, Spain, where a Network of Clinical Expert Units (Xarxa d’Unitats de Expertesa Clínica or XUEC) was created and is being implemented since 2015. The additional primary aim was to propose recommendations to solve or improve the limitations found.MethodsA task force of 13 participants with multidisciplinary expertise on RDs completed a questionnaire and participated in two focus groups. A document was drafted with an item series of strengths and weaknesses of the healthcare system regarding the care of PLWRD, and a set of proposals or recommendations to overcome the problems identified.ResultsThe Catalan Government healthcare model of XUECs for the comprehensive care for RDs is currently valid and adapted to the needs of PLWRD and their families since its strategic optimal and operational framework, and it is aligned with the European Reference Networks (ERNs) thematic areas. The problems found in the current healthcare model were grouped into ten main areas: (1) the healthcare model for RDs; (2) coordination with primary healthcare providers and other tertiary and secondary hospitals; (3) access to and coordination with non-medical services; (4) the role of case manager in the XUEC; (5) genetic diagnosis; (6) undiagnosed patients; (7) treatments; (8) referring process, continuous follow-up, and transition from pediatric to adult centers; (9) research and education for professionals; and (10) associations of PLWRD and their families (patients’ advocacy). The need for more resources was currently detected as the common factor for most of them. Ten key recommendations to improve the healthcare system regarding RDs were postulated.ConclusionsCatalonia has established a unique healthcare model for RDs in Spain, with clear strengths and advantages. However, after analyzing them, the experts suggested that new governmental political and administrative decisions are needed to ensure the efficient implementation of a healthcare plan for PLWRD in Catalonia, which could be applied to other regions and nations worldwide.

Budget impact analyses of hemoglobin A1c and lipid panel point-of-care testing with Afinion™ 2 in Canada and Italy.

Aim: Screening and monitoring of diabetes or dyslipidemia frequently involves a multi-step process requiring patients to obtain test requisitions from their primary care physician (PCP), followed by a laboratory visit and re-consultation. Point-of-care testing (POCT) for hemoglobin A1c (HbA1c) and lipid panel can streamline the patient care pathway. This study assessed the budget impact of introducing Afinion™ 2 POCT (Abbott Rapid Diagnostics) from the Canadian and Italian societal perspectives. Methods: Budget impact models were developed for Canada and Italy over a 5-year time horizon (2025 to 2029). The analyses considered the screening and monitoring of diabetes or dyslipidemia for patients utilizing the public healthcare system and attending primary care, and included direct costs (testing, consultations) and indirect costs (productivity loss, transportation) based on published sources. The budget impact (BI) was calculated by comparing scenarios with and without POCT. All costs were adjusted to Canadian dollars ($) or 2024 Euros (€). Scenario analyses were conducted to explore the impact of alternative assumptions. Results: The 5-year cumulative BI was -$758,006,692 (-$50,709,964 direct, -$707,296,728 indirect) for HbA1c POCT and -$726,452,755 ($2,684,011 direct, -$729,136,766 indirect) for lipid panel POCT in Canada and -€1,380,658,764 (-€6,391,954 direct, -€1,374,266,809 indirect) for HbA1c POCT and -€851,792,115 (€55,962,879 direct, -€907,754,993 indirect) for lipid panel POCT in Italy. In both countries, cost savings for both the healthcare payer and patients were observed for HbA1c POCT, while costs savings were derived from patient indirect costs for lipid panel POCT. The analyses estimated that 1,558,062 and 1,501,260 PCP consultations in Canada, 4,962,338 and 1,951,026 PCP consultations in Italy were avoided with implementation of POCT for HbA1c and lipid panel, respectively. Scenario analyses demonstrated potential further cost savings with implementation of POCT in pharmacies. Conclusion: This study demonstrates that the adoption of Afinion 2 POCT for HbA1c and lipid panel can provide efficiencies to different types of healthcare systems through reducing PCP consultations, saving time and money for patients and providing cost savings for payers.

Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer for patients (2024 edition)

Lung cancer, a malignant tumor remaining high incidence and mortality rates in China and globally, places huge burdens to families and the public healthcare system. In order to improve the diagnosis and treatment of lung cancer, enhance patients' knowledge of the disease, promote evidence-based guidelines to patients, and facilitate shared decision-making, the Chinese Medical Association convened multidisciplinary experts, patients, and public representatives to develop the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer for patients. The guideline selected most concerned issues, drew on information from domestic and international guidelines, latest research findings, and clinical experience of lung cancer, and combined them with current clinical practices in China and patients' needs. This guideline aims to provide comprehensive, scientific, and practical information on lung cancer diagnosis and treatment for patients and their families, help them further understanding the basic knowledge, diagnosis and treatment process, treatment methods, and prognosis management of lung cancer, enhance the self-management ability of patients, and raise the public awareness and participation in lung cancer prevention and treatment.

Assessing tick attachments to humans with citizen science data: spatio-temporal mapping in Switzerland from 2015 to 2021 using spatialMaxent

BackgroundTicks are the primary vectors of numerous zoonotic pathogens, transmitting more pathogens than any other blood-feeding arthropod. In the northern hemisphere, tick-borne disease cases in humans, such as Lyme borreliosis and tick-borne encephalitis, have risen in recent years, and are a significant burden on public healthcare systems. The spread of these diseases is further reinforced by climate change, which leads to expanding tick habitats. Switzerland is among the countries in which tick-borne diseases are a major public health concern, with increasing incidence rates reported in recent years.MethodsIn response to these challenges, the “Tick Prevention” app was developed by the Zurich University of Applied Sciences and operated by A&K Strategy Ltd. in Switzerland. The app allows for the collection of large amounts of data on tick attachment to humans through a citizen science approach. In this study, citizen science data were utilized to map tick attachment to humans in Switzerland at a 100 m spatial resolution, on a monthly basis, for the years 2015 to 2021. The maps were created using a state-of-the-art modeling approach with the software extension spatialMaxent, which accounts for spatial autocorrelation when creating Maxent models.ResultsOur results consist of 84 maps displaying the risk of tick attachments to humans in Switzerland, with the model showing good overall performance, with median AUCROC values ranging from 0.82 in 2018 to 0.92 in 2017 and 2021 and convincing spatial distribution, verified by tick experts for Switzerland. Our study reveals that tick attachment to humans is particularly high at the edges of settlement areas, especially in sparsely built-up suburban regions with green spaces, while it is lower in densely urbanized areas. Additionally, forested areas near cities also show increased risk levels.ConclusionsThis mapping aims to guide public health interventions to reduce human exposure to ticks and to inform the resource planning of healthcare facilities. Our findings suggest that citizen science data can be valuable for modeling and mapping tick attachment risk, indicating the potential of citizen science data for use in epidemiological surveillance and public healthcare planning.Graphical

P1209 Temporal trends in surgery and hospitalization rates for crohn's disease in Brazil: A population-based study

Abstract Background Crohn's Disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, primarily affecting young adults and adolescents. Biological therapies have advanced CD management, reducing hospitalizations and surgeries. Methods This retrospective, population-based study analyzed CD patients treated by the Brazilian Unified Health System (SUS) from 2012 to 2022. Patients were categorized by pharmacological treatment (azathioprine [AZA], infliximab [IFX], adalimumab [ADA]) based on dispensing records. Prevalence data were extracted from the Brazilian Institute of Geography and Statistics. Hospitalizations, surgeries, and prevalence trends were analyzed using TT Disease Explorer® and quantified as annual and average annual percent changes (AAPC). Statistical analysis was conducted in R software. Results From 2012 to 2022, CD prevalence increased 288.07%, from 14.20 to 52.64 cases per 100,000 inhabitants. The proportion of patients treated with AZA decreased from 44.79% to 19.13%, while IFX remained stable and ADA slightly declined (figure 1). In absolute terms, IFX and ADA usage rose by 251.09% and 242.48%, respectively. Hospitalizations dropped by 59.29%, 6.19% to 2.52%, and surgical procedures by 55.08%, 1.09% to 0.49% (figure 2). Conclusion The results indicate that despite the increase in CD prevalence, therapeutic interventions, especially involving biological agents, have been effective in reducing hospitalizations and surgeries. However, the proportional stability in the use of IFX and ADA, despite the absolute increase, suggests challenges in access and implementation of these therapies across Brazil. Additionally, potential coding errors in hospital records may influence data accuracy, possibly underestimating the true burden of hospitalizations and surgeries. Improvements in health record quality are essential to provide more accurate data and promote more efficient public policies.Over 11 years, there was a significant increase in CD prevalence in Brazil, accompanied by a notable reduction in hospitalizations and surgical procedures. Biological therapies have played a crucial role in improving disease management, though the direct relationship between their use and clinical outcomes requires further investigation. Future studies should focus on reference centers to confirm these trends and assist in planning public policies that optimize CD treatment and improve access to effective therapies in Brazil. References Mowat C, Cole A, Windsor A, et al. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60(5):571-607. doi:10.1136/gut.2010.2241542. Quaresma AB, Kaplan GG, Kotze PG. The globalization of inflammatory bowel disease: the incidence and prevalence of inflammatory bowel disease in Brazil. Curr Opin Gastroenterol. 2019;35(4):259-264. doi:10.1097/MOG.00000000000005343. Quaresma AB, Damiao AOMC, Coy CSR, et al. Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study. Lancet Reg Health Am. 2022;13:100298. Published 2022 Jun 9. doi:10.1016/j.lana.2022.1002984. Palacio FGM, de Souza LMP, Moreira JPL, Luiz RR, de Souza HSP, Zaltman C. Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis. BMC Gastroenterol. 2021;21(1):192. Published 2021 Apr 27. doi:10.1186/s12876-021-01781-x Figure 1: Proportion of patients by therapy used in Brazil's Unified Health System from 2012 to 2022. Figure 2: Proportion of surgeries and hospitalizations among Crohn's Disease cases in Brazil's public healthcare system from 2012 to 2022.

Construction of a prognostic prediction model for colorectal cancer based on 5-year clinical follow-up data

Colorectal cancer (CRC) is a prevalent malignant tumor that presents significant challenges to both public health and healthcare systems. The aim of this study was to develop a machine learning model based on five years of clinical follow-up data from CRC patients to accurately identify individuals at risk of poor prognosis. This study included 411 CRC patients who underwent surgery at Yixing Hospital and completed the follow-up process. A modeling dataset containing 73 characteristic variables was established by collecting demographic information, clinical blood test indicators, histopathological results, and additional treatment-related information. Decision tree, random forest, support vector machine, and extreme gradient boosting (XGBoost) models were selected for modeling based on the features identified through recursive feature elimination (RFE). The Cox proportional hazards model was used as the baseline for model comparison. During the model training process, hyperparameters were optimized using a grid search method. The model performance was comprehensively assessed using multiple metrics, including accuracy, F1 score, Brier score, sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic curve, calibration curve, and decision curve analysis curve. For the selected optimal model, the decision-making process was interpreted using the SHapley Additive exPlanations (SHAP) method. The results show that the optimal RFE-XGBoost model achieved an accuracy of 0.83 (95% CI 0.76–0.90), an F1 score of 0.81 (95% CI 0.72–0.88), and an area under the receiver operating characteristic curve of 0.89 (95% CI 0.82–0.94). Furthermore, the model exhibited superior calibration and clinical utility. SHAP analysis revealed that increased perioperative transfusion quantity, higher tumor AJCC stage, elevated carcinoembryonic antigen level, elevated carbohydrate antigen 19–9 (CA19-9) level, advanced age, and elevated carbohydrate antigen 125 (CA125) level were correlated with increased individual mortality risk. The RFE-XGBoost model demonstrated excellent performance in predicting CRC patient prognosis, and the application of the SHAP method bolstered the model’s credibility and utility.

A genomic strategy for precision medicine in rare diseases: integrating customized algorithms into clinical practice

BackgroundDespite the use of Next-Generation Sequencing (NGS) as the gold standard for the diagnosis of rare diseases, its clinical implementation has been challenging, limiting the cost-effectiveness of NGS and the understanding, control and safety essential for decision-making in clinical applications. Here, we describe a personalized NGS-based strategy integrating precision medicine into a public healthcare system and its implementation in the routine diagnosis process during a five-year pilot program.MethodsOur approach involved customized probe designs, the generation of virtual panels and the development of a personalized medicine module (PMM) for variant prioritization. This strategy was applied to 6500 individuals including 6267 index patients and 233 NGS-based carrier screenings.ResultsCausative variants were identified in 2061 index patients (average 32.9%, ranging from 12 to 62% by condition). Also, 131 autosomal-recessive cases could be partially genetically diagnosed. These results led to over 5000 additional studies including carrier, prenatal and preimplantational tests or pharmacological and gene therapy treatments.ConclusionThis strategy has shown promising improvements in the diagnostic rate, facilitating timely diagnosis and gradually expanding our services portfolio for rare diseases. The steps taken towards the integration of clinical and genomic data are opening new possibilities for conducting both retrospective and prospective healthcare studies. Overall, this study represents a major milestone in the ongoing efforts to improve our understanding and clinical management of rare diseases, a crucial area of medical research and care.

DEMOGRAPHY OF AGEING POPULATION IN NIGERIA: TRENDS, CHALLENGES AND IMPLICATIONS

Nigeria, like many other African countries, is experiencing a rapidly ageing population, with significant implications for healthcare, social security, and economic growth. Lack of functional national policy on the care and welfare of older persons in Nigeria, the breakdown of the family structure and the absence of a social security system, present unique challenges to the elderly in Nigeria. This paper analyzes the demography of the ageing population in Nigeria with a focus on the trends, challenges, and implications for healthcare, social security and economic growth. The paper relied on secondary sources of data such as journal articles and books in the area of the ageing population in Nigeria for its analysis. The Disengagement Theory provided theoretical pathway for the study. Based on the review, it was found that the rapidly ageing population poses challenges to Nigeria’s development including strains on social security system, increased healthcare costs, and potential decline in economic productivity. These challenges are due to lack of policies and the appointment of personnel capable of understanding and responding to the current social priorities and complex needs of an increasingly aging population in the country. The paper recommends among others, the need for policy makers to put in place, functional policies towards a robust public pension, insurance and healthcare system to ensure a more sustainable and equitable future for the ageing population in Nigeria.

Acceptance and adoption determinants of telemedicine in public healthcare institutions

Background: One of the challenges facing the usage of telemedicine technology in South Africa, particularly in the North West province (NWP), is lack of user acceptance by health care professionals which prevents piloted project to produce the desired outcomes.Objectives: The purpose of this study was to investigate the influential factors for the adoption of telemedicine by health care professionals from three selected hospitals (Bophelong, Taung and Klerksdorp) in the NWP.Method: The study adopted a case study approach and gathered data through questionnaires, which were distributed to the health care professionals of the three selected hospitals. In order to ensure that the instrument was accurate, a pilot study was carried out prior to the main investigation. Both the alpha and power values were set at 0.05 for the statistical analysis. The statistical tool used for the data analysis was SPSS v. 23.0.Results: Attitude towards the use of telemedicine technology (ATUTT), perceived usefulness (PU) and acceptance of telemedicine technology (ATT) were considered to be the influential factors in the adoption of telemedicine technology. The association between perceived ease of use (PEOU) and perceived usefulness (PU) (0.150, p = 0.034), PEOU and Attitude towards the use of telemedicine technology (ATUTT) (0.211, p = 0.002), PEOU and Acceptance of telemedicine technology (ATT) (0.245, p = 0.000), PU and (ATT) (0.212, p = 0.002), ATUTT and (ATT) (0.189, p = 0.005). However, PEOU was found to have an insignificant relationship with (0.048, p = 0.093). Hypotheses 1, 3, 4, 5, and 6 are supported while H2 was not supported.Conclusion: The study aims to fill the knowledge vacuum identified, helping poor countries effectively implement telemedicine technology to modernise the health care sector. In addition, results from this study shed insight on the varied impacts of individual, technical, clinical and multidimensional social influence variables on health care providers’ decisions to use telemedicine.Contribution: This study contributes to the body of knowledge by investigating the success factors for telemedicine technology adoption in South African public hospitals. These results have important implications for the public health care system in South Africa, both for the direction of future research and for the methods used to promote the use of telemedicine.

Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective.

The pharmacoinvasive (PhI) strategy is the standard-of-care for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (pPCI) is unfeasible. Optimal timing for post-fibrinolytic PCI (lysis-PCI) remains elusive. Therefore, this study aimed to assess the clinical and economic impacts of early vs. delayed lysis-PCI in patients with STEMI. This retrospective cohort study included 1,043 STEMI patients classified by lysis-PCI timing. The primary outcome was in-hospital major adverse cardiovascular events (4p-MACE), with secondary outcomes such as 3p-MACE, in-hospital mortality, and costs. Multivariable logistic regression models were used to assess the association between lysis-PCI timing and outcomes. Cost analyses were conducted from the perspective of Brazilian public healthcare system, with values converted to international dollars (Int$) for broader applicability. Every 4-h delay in lysis-PCI was associated with a 44% reduction in in-hospital mortality [OR = 0.560 (95% CI: 0.381-0.775); p = 0.001] and a 13% decrease in 4p-MACE [OR = 0.877 (95% CI: 0.811-0.948); p = 0.001]. Additionally, 4-h delay in lysis-PCI was also associated with a significant reduction in in-hospital costs (Int$916.20 ± 99) and disease-induced years of productivity lost (β = -41.79 ± 151 years; p = 0.001). These significant trends remained consistent even after adjusting for confounders and applying propensity score matching. Older adults (aged ≥80) experienced an increase in 3p-MACE with earlier lysis-PCI. Delaying lysis-PCI was found to be associated with reduced in-hospital cardiovascular adverse events and lower costs, particularly among older adults. Further research should develop evidence-based lysis-PCI protocols that optimize both clinical outcomes and cost-effectiveness.

Patient Acceptability of the First Integrative Pediatric Oncology Unit in Spain-The Pediatric Cancer Center Barcelona Experience: A Retrospective Study.

Pediatric cancer patients and their families are increasingly combining conventional treatment with complementary therapies. These therapies are not covered by most public healthcare systems, and Spain is not an exception. To address this need, the Pediatric Cancer Center Barcelona, at the Hospital Sant Joan de Déu (Spain), established the first integrative pediatric oncology unit in 2019. The objective of this study is to describe the feasibility of implementing a pediatric integrative oncology unit, in terms of the acceptance of the interventions, as well as to present initial data on the care activities; Methods: This is a retrospective single-center study, conducted in the Pediatric Cancer Center Barcelona, at the Hospital Sant Joan de Déu. Data from patients during a two-year period were collected by reviewing medical records in a pseudonymous manner; Results: From 1 September 2019 to 30 September 2021, the unit was visited by 433 patients. The median age of patients was 9 years [range 0-34 years], with 266 boys (61.4%) and 167 girls (38.6%). Of these patients, 90.1% were in active treatment, 7.6% were survivors, and 2.3% were at the end of life. Acupuncture was recommended to 227 patients, with a 94.7% acceptance rate. Aromatherapy was recommended to 114 patients, with a 100% acceptance. The reflexology team visited 129 patients, delivering a total of 414 sessions, with a 96.1% acceptance.; Conclusions: The findings of our study support the feasibility of implementing an Integrative Pediatric Oncology Unit within a patient-centered care model in a comprehensive pediatric cancer center. The high acceptance rates of various complementary therapies highlight their potential role in enhancing supportive care for pediatric oncology patients.

Development of a value assessment framework for Health Technology Assessment in rare diseases drugs: insights from a Delphi study in Brazil.

The aim of this study is to propose and validate a value assessment framework for Health Technology Assessment (HTA) for rare diseases drugs in Brazil. A scoping review was performed to identify criteria used by HTA agencies in countries with public healthcare systems when evaluating orphan drugs. Based on the findings, a criteria framework for rare disease drugs was proposed for Brazil. Content validity was conducted over three rounds using Delphi technique and content validity ratio (CVR) approach was employed to evaluate the ratings from the eighteen stakeholders (experts and patients). Twenty-nine HTA criteria for rare disease drugs were identified to compose the Brazilian framework. After three Delphi rounds, the final value framework comprised fifteen criteria categorized into four domains: disease-related factors, treatment-related factors, social and political factors, and economic factors. Among the most well-rated criteria by the CVR, considering the relevance attribute, were "relevance of outcomes for a rare disease," "impact on patient's quality of life," "price negotiation," and "adjusted cost-effectiveness threshold." On the other hand, "budget impact threshold," "innovative nature of treatment," and "willingness to accept greater uncertainty in clinical evidence" received negative evaluations and were excluded from the final framework. A value assessment framework validated by key stakeholders of rare diseases in Brazil could contribute to improve HTA transparency, decision making, and efficiency of the healthcare system, and inspire the development of a local guidance for rare-disease HTA.

Evaluating the Quality of Real-World Data on Adherence to Oral Endocrine Therapy in Breast Cancer Patients: How Real Is Real-World Data?

The aim of this study was to compare estimates of adherence to oral endocrine therapy (OET) based on real-world data (RWD) and on clinical evaluation in people diagnosed with breast cancer in the public healthcare system in Catalonia (Spain). We conducted two retrospective cohort studies. Cohort 1 (RWD) consisted of women diagnosed with breast cancer in 2021 in the public healthcare system of Catalonia (Spain). Sources of RWD were the pharmacy billing register, hospital discharge records, and the Catalan health division's central insurance registry. Nonadherence was defined as below 80% adherence in the first year of treatment. Data for cohort 2 came from two population-based cancer registries in Girona and Tarragona (Catalonia), with diagnoses from 2007 to 2011. We evaluated the impact of variables missing from RWD, such as stage and hormonal status. Analyses were performed using a chi-square test and logistic regression, with results stratified by age group and drug type. Nonadherence at one year was 10.9% in cohort 1 and 11.3% in cohort 2. When we reviewed the medical records of a selection of nonadherent women from cohort 1, we found only 59.4% had documented treatment interruptions. Reasons for interruptions in the patients from RWD cohort included adverse effects (48.8%), patient decision (40.0%), medical reasons (29.4%), and other clinical causes (14.7%). Women aged under 50 years and those receiving tamoxifen or a sequential regimen had lower adherence. Determinants associated with nonadherence were similar in both approaches used. This study confirms the validity of estimating adherence with RWD from the Spanish national health system, although when combined with reviewing medical records, this may provide more reliable and higher-quality data. The RWD method provides valuable evidence to help oncologists discuss adherence with their patients.

Endoscopic sleeve gastroplasty versus lifestyle modifications for class II obesity patients: a French cost-effectiveness analysis.

Obesity is a worldwide epidemic, with up to 17% of French population affected. European guidelines recommend surgical management at specific weight and comorbidity level; however, less than 2% of eligible patients undergo surgical bariatric interventions. To extend the benefits of bariatric interventions to the untreated population with obesity, endoscopic techniques such as endoscopic sleeve gastroplasty (ESG) have been developed. Analysis of costs and long-term benefits of ESG across stakeholders is needed. This work aimed to assess the healthcare economic and outcomes for ESG in the French healthcare system. A cost-utility analysis study was conducted to evaluate class II obesity patients, stratified into ESG and lifestyle modifications or lifestyle modifications alone groups. Health benefits were measured as quality-adjusted life years (QALY) and costs benefits expressed as incremental cost-effectiveness ratio (ICER). A 6-state Markov model was used and base case scenario analysis was used to assess ESG benefits against lifestyle modifications only. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis were performed to evaluate uncertainty on health care interventions and worse case scenarios, respectively. ESG population from the France center included 59 patients, lifestyle modification group was drawn from the MERIT cohort. The base case scenario showed higher costs for ESG procedure compared to lifestyle modifications alone; however, gain in terms of QALY (+ 1,3) is observed maintaining ICER below the set threshold. Also OWSA and probabilistic analysis confirmed ESG cost-effectiveness. OWSA allowed identification of ICER-influencing factors; probabilistic sensitivity analysis confirmed ESG to be cost-effective in 99.29% of iterations. ESG is cost-effective in the French healthcare system. Its potential to reach an untreated portion of the population living with obesity should prompt its uptake into clinical practice. The results of this study should sustain ESG implementation throughout France and possible integration of its reimbursement by the public healthcare system.

Morbidity in males with 45,X/46,XY resembles the morbidity pattern in Turner syndrome: a national population-based study.

Few studies have reported on males with 45,X/46,XY mosaicism. Most studies stem from pediatric settings and knowledge of natural history and long-term health outcomes are therefore lacking. To describe long-term health outcomes in males with 45,X/46,XY in comparison to the general population. A national population-based registry study. A public uniform health care system. All males in Denmark diagnosed with 45,X/46,XY mosaicism from 1967-2016 (n=135) and 1:100 age-matched males from the background population. Hospital diagnoses, prescribed medication and surgery codes were analyzed using a Cox proportional hazards regression model yielding hazard ratios (HR). 45,X/46,XY was associated with an increased risk of being admitted to hospital (HR=1.6, CI:1.3-1.9), undergoing surgery (HR=1.8, CI:1.4-2.2), and being prescribed medication (HR=1.2, CI:1.03-1.5). This risk applied to 15/18 diagnostic groups, 6/14 medication groups, and 10/16 surgery groups. Diagnoses with increased HRs included diabetes, thyroid disorders, obesity, hypertension, ischemic heart disease, osteoporosis, and inflammatory bowel disease. Half of all 45,X/46,XY males (69/135) had ≥1 diagnosis related to the genitourinary system and nearly one-third (39/135) underwent urogenital surgery. 45,X/46,XY mosaicism in males impacts long-term health significantly. The morbidity pattern includes a wide range of diseases, most known to occur at increased frequencies in Turner syndrome. The study underscores the importance of identifying these males and follow them with systematic screening as in Turner syndrome.

Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in South Africa.

The treatment of chronic myeloid leukemia through tyrosine kinase inhibitors (TKIs) has achieved promising efficacy and safety outcomes, however the costs are associated with a substantial economic burden. The objective of this study was to develop a Markov model with a 20-year time horizon to assess the cost effectiveness of TKIs from a public healthcare system perspective in South Africa. We constructed a Markov model to compare three strategies in which treatment was initiated with either imatinib, nilotinib, or dasatinib. Treatment was switched to another TKI in the case of intolerance or resistance to the initial TKI. Effectiveness and utility data were obtained from published literature. Cost data was obtained from local sources for generic imatinib and branded second-generation TKIs and based on national tariffs. Outcomes were reported in total costs and quality-adjusted life years (QALYs). Outcomes were based on calculated incremental cost effectiveness ratios (ICERs) and compared to a willingness-to-pay (WTP) threshold. Sensitivity analyses were conducted to determine the robustness of the model outcomes. The base-case results showed that imatinib was favored over nilotinib and dasatinib by having the lowest cost at $120 719.55 and providing 5.93 QALYs. Compared to imatinib strategy, nilotinib had an ICER of $26 620.27 per QALY and dasatinib had an ICER of $35 934.94 per QALY, both exceeding the WTP threshold of $18 760 per QALY gained. The sensitivity analysis indicated the robustness of the results. Imatinib remains the most cost-effective first-line treatment for adults diagnosed with CML in South Africa, with a high probability of being cost-effective across a range of WTP thresholds. Nilotinib and Dasatinib, though offering clinical benefits, their affordability remains a challenge within the current healthcare system and should remain reserved for second-line treatment.

A Medicina Nuclear no Sistema Único de Saúde

Abstract Nuclear Medicine plays an important role in the management of patients with chronic diseases, especially oncological and cardiovascular conditions. In this study, an analysis of the evolution of this field in Brazil was conducted within the framework of the Unified Health System. Retrospective analyses from 2015 to 2021 of public data were performed. Although Brazil has a considerable number of facilities, their geographical distribution is uneven. The same disparity is observed in relation to units that produce and distribute radiopharmaceuticals, limiting access for the Brazilian population, particularly to those with a half-life of less than two hours. There is a noticeable high technological dependence on foreign companies, with little or no domestic production, contributing to a deficit in the trade balance. Despite the increasing demands due to factors such as population aging and epidemiological changes, the area did not expand. It is crucial to implement social and economic policies to reduce vulnerabilities in the public healthcare system, ensure its sustainability, and promote equal and universal access to Nuclear Medicine.

Bronchiectasis Exacerbation Increases the Risk of Adverse Renal Outcomes-Results From a Large Territory-Wide Cohort Study.

Bronchiectasis exacerbation (BE) is associated with unfavorable sequelae in other organs such as the cardiovascular system; data regarding its impact on adverse term renal outcomes, however, is lacking. A territory-wide retrospective cohort study was conducted in Hong Kong between 1/1/1993 and 31/12/2017. All patients with bronchiectasis followed in the public healthcare system in 2017 were classified as "Exacerbators" or "Non-Exacerbators," and their adverse renal outcomes (renal progression [decrease in eGFR by 30 mL/min lasted for more than 12 months during follow up], acute kidney injury [AKI], and annual rate of eGFR decline) in the ensuing 7 years were compared. Results were also analyzed in the 1:1 propensity score matched (PSM) cohort. A total of 7929 patients (1074 "Exacerbators" group and 6855 "Non-exacerbators") were followed for 6.2 ± 1.6 years. A total of 1570 patients (19.8%) had renal progression, and 935 (11.8%) patients developed AKI. "Exacerbators" showed significantly increased risk of renal progression (adjusted odds ratio [aOR] 1. 27 [95% CI 1.08-1.50, p = 0.003]), more rapid eGFR decline (-3.67 [-1.74 to -6.54] vs. -3.03 [-1.56 to -5.12] mL/min/1.73 m2/year, p = 0.004) and AKI (aOR 1.99; 95% CI 1.44-2.73, p < 0.001) than the "Non-exacerbators." Annual number of BE was associated with renal progression (aOR 1.45; 95% CI 1.22-1.72, p < 0.001) and AKI (aOR 2.00; 95% CI 1.38-2.91, p < 0.001). Results were consistent in the analysis with the PSM cohort. Renal progression and AKI are common among patients with bronchiectasis, and BE is an independent risk factor for adverse renal outcomes.

A Review of Initial and Ongoing Training Needs through the Alabama Regional Center for Infection Prevention and Control.

Established in 2021, the Alabama Regional Center for Infection Prevention and Control (ARC IPC) aims to address critical gaps in infection prevention and control (IPC) across Alabama's public health and healthcare systems. Through a comprehensive needs assessment, the Center identified priority areas which informed its targeted training and technical assistance programs. This paper examines the Center's multifaceted approach to addressing significant IPC challenges throughout the state, with particular emphasis on underserved areas.

Biogenic amine testing in the South African public health care system

Biogenic amine testing in the South African public health care system