Year Of Life Research Articles

Managed Entry Agreements for High-Cost, One-Off Potentially Curative Therapies: A Framework and Calculation Tool to Determine Their Suitability.

To construct a framework and calculation tool to compare the consequences of implementing different payment models for high-cost, one-off potentially curative therapies and enable decision making to ultimately enhance timely patient access to innovative health interventions. A framework outlining steps to determinepotentially suitable payment models was developed. Based on the framework, a supporting calculation tool operationalised as an Excel-based model was constructed to quantify the associated costs for an average patient during the timeframe of the intended payment agreement, the total budget impact and associated benefits expressed in quality-adjusted life-years for the total expected lifetime of the patient population. To demonstrate the potential of the framework, three case studies were used: onasemnogene abeparvovec (Zolgensma®), brexucabtagene autoleucel (Tecartus®) and etranacogene dezaparvovec (Hemgenix®). A hypothetical case study was used to illustrate the output of the calculation tool. Part 1 of the framework presents steps for matching a suitable reimbursement and payment model with the disease and treatment characteristics. The reimbursement and payment models are further specified in Part 2. Part 3 guides end users through the setup of a calculation tool with which the financial impact can be calculated of two payment models: a price discount model and an outcome-based spread payment model with a discount. Part 4 concerns the output of the calculation tool, showing how different payment models lead to different financial consequences under three assumptions of longer term effectiveness. The presented framework provides decision makers with insight into the financial consequences of their chosen payment model under different assumptions. This can aid reimbursement negotiations by clarifying the optimal choice given a therapy's characteristics.

Executive function deficits in congenital heart surgical patients: prevalence and timing of presentation.

Congenital heart patients undergoing congenital heart surgery in the first year of life are at high risk of having a neurodevelopmental disorder. The most common difficulties are related to executive functioning. The following questions were assessed in the current project: Are patients having congenital heart surgery after one year of life at lower risk for neurodevelopmental disorders? At what age do executive function deficits manifest? We evaluated executive function in four groups of congenital heart patients who had undergone congenital heart surgery. These groups were high-risk patients with and without a genetic syndrome associated with a neurodevelopmental disorder and low-risk patients with and without a genetic syndrome associated with a neurodevelopmental disorder. We evaluated executive function using the Behavior Rating Inventory of Executive Function - Preschool Version, Behavior Rating Inventory of Executive Function-2, and Minnesota Executive Function Scale at various ages. We compared the rates of executive function deficits in the high- and low-risk groups as well as compared that to the published norms for age. We also assessed at what age these deficits become apparent. We found that both high- and low-risk groups had higher levels of executive functioning deficits compared to the norms for age. The low-risk group's degree of executive function deficits appeared a little lower than the high-risk group. However, it was difficult to comment on the statistical significance. We also saw that executive function deficits often do not become apparent for many years after surgery. This finding highlights the need for continued evaluation of functioning as these kids mature.

Regression of microcephaly as a protective factor of neuropsychomotor development in fetal surgery for occipital encephalocele.

Encephaloceles are neural tube closure defects characterized by herniation of intracranial contents through the skull, with a mortality rate of 33.3%. Approximately 50% of patients who survived have some degree of neuropsychomotor developmental impairment or seizures. This study aimed to analyze the relationship between good neuropsychomotor development (NPMD) in patients undergoing fetal occipital encephalocele correction and the reversal of microcephaly, comparing these outcomes with those observed in patients who underwent postnatal surgery. The 22 participants were categorized into two groups: 10 in the fetal group (FG) and 12 in the postnatal group (PNG). During the study, 1 patient was excluded from the FG and 2 patients were excluded from the PNG, totaling 19 patients in the study. All patients were diagnosed, evaluated, and monitored by the same healthcare service between July 2012 and July 2018. All participants were subjected to a careful developmental assessment using the Bayley Scale of Infant Development, Second Edition (BSID-II), up to 2years and 11months of age. Additionally, CP measurements were taken during the first year of life to monitor their progress. The relationship between microcephaly reversal and NPMD was studied. The CP adjusted for gestational age showed a tendency toward the reversal of progressive microcephaly after correction of encephaloceles in the FG. We found a statistically significant difference in the median BSID-II score between the PNG and FG. Patients in the FG maintained normal CP development in the first year of life, whereas those in the PNG remained microcephalic. The reversal of microcephaly in the FG directly influences good NPMD and can be considered a protective factor.

Cost-utility of sirolimus in the treatment of vascular malformations.

Sirolimus is being increasingly employed to manage specific vascular anomalies. We performed an exploratory cost-utility analysis to evaluate sirolimus as a treatment for vascular malformations from the Australian healthcare system perspective. Over a one-year time horizon, sirolimus treatment was associated with an increased expenditure of AU$2832.80 and a gain of 0.08 quality-adjusted life years (QALYs) when compared to supportive care, resulting in an incremental cost-effectiveness ratio of AU$35,410/QALY. By most metrics, sirolimus would be considered a cost-effective treatment for vascular malformations.

The burden of healthcare-associated infections in New Zealand public hospitals 2021.

There are no contemporary data on the burden of healthcare-associated infections (HAIs) in New Zealand. To estimate the economic burden of HAIs in adults in New Zealand public hospitals by number and monetary value of bed days lost; number of deaths, number of life years lost, and the monetary value (in NZ dollars); Accident Compensation Commission (ACC) HAI treatment injury payments; and disability-adjusted life years (DALYs). The annual incidence rate was calculated from the observed prevalence of HAIs in New Zealand, and length of patient stays. Total HAIs for 2021 were estimated by multiplying adult admissions by incidence rates. The excess length of stay and mortality risk attributed to those with HAI was calculated using a multistate model. Payments for treatment injuries were obtained from the ACC. DALYs for HAIs were estimated from the literature. The incidence rate of HAI was 4.74%, predicting 24,191 HAIs for 2021, resulting in 76,861 lost bed days, 699 deaths, with 9,371 years of life lost (YoLL). The annual economic burden was estimated to be $955m comprised of $121m for lost bed days, $792m for cost of YoLL, and $43m ACC claims. There were 24,165 DALY which is greater than many other measured injuries in New Zealand, eg motor vehicle traffic crashes with 20,328 DALY. HAIs are a significant burden for patients, their families, and the public health system. Preventive guidelines for many HAIs exist and a strategic plan is needed to reduce HAIs in New Zealand.

A Nationwide Physical Activity Intervention for 654,500 Adults in Singapore: Cost-Utility Analysis.

Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising health care expenditure and productivity losses. As Singapore's aging population grows, there is an increased disease burden on Singapore's health systems. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges with the uncertainty of long-term health impact and high implementation costs, hindering their adoption. We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health (mHealth) intervention to increase physical activity, from both the health care provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs. We used a Markov model to assess the long-term impact of increased physical activity from the NSC on adults aged 17 years and older. A Monte Carlo simulation with 1000 samples was conducted to compare two situations: the NSC conducted yearly for 10 years against a no-intervention situation with no NSC. The model projected inpatient and outpatient costs and mortality arising from diabetes and hypertension, as well as their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. All future costs and QALYs were discounted at 3% per annum. Sensitivity analyses were done to test the robustness of our model results. We estimated that conducting the NSC yearly for 10 years with a mean cohort size of 654,500 participants was projected to prevent 6200 diabetes cases (95% credible interval 3700 to 9100), 10,500 hypertension cases (95% credible interval 6550 to 15,200), and 4930 deaths (95% credible interval 3260 to 6930). This led to a reduction in health care costs of SGD (Singapore dollar) 448 million (95% credible interval SGD 132 million to SGD 1.09 billion; SGD 1=US $0.73 for the year 2019). There would be 78,800 (95% credible interval 55,700 to 102,000) QALYs gained. Using a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-saving. When indirect costs were included, the NSC was estimated to reduce societal costs by SGD 1.41 billion (95% credible interval SGD 353 million to SGD 3.80 billion). The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance. In this modeling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension and reducing mortality from these diseases. Our results provide important information for decision-making in countries that may consider introducing similar large-scale physical activity programs.

Cost-effectiveness intervention thresholds for romosozumab and teriparatide in the treatment of osteoporosis in the UK.

To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting. A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG). The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18-35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27-57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture. The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture.

Body mass index across development and adolescent hair cortisol: the role of persistence, variability, and timing of exposure.

Research suggests a putative role of the glucocorticoid stress hormone cortisol in the accumulation of adiposity. However, obesity and weight fluctuations may also wear and tear physiological systems promoting adaptation, affecting cortisol secretion. This possibility remains scarcely investigated in longitudinal research. This study tests whether trajectories of body mass index (BMI) across the first 15 years of life are associated with hair cortisol concentration (HCC) measured two years later and whether variability in BMI and timing matter. BMI (kg/m2) was prospectively measured at twelve occasions between age 5 months and 15 years. Hair was sampled at age 17 in 565 participants. Sex, family socioeconomic status, and BMI measured concurrently to HCC were considered as control variables. Latent class analyses identified three BMI trajectories: "low-stable" (59.2%, n = 946), "moderate" (32.6%, n = 507), and "high-rising" (8.2%, n = 128). BMI variability was computed by dividing the standard deviation of an individual's BMI measurements by the mean of these measurements. Findings revealed linear effects, such that higher HCC was noted for participants with moderate BMI trajectories in comparison to low-stable youth (β = 0.10, p = 0.03, 95% confidence interval (CI) = [0.02-0.40]); however, this association was not detected in the high-rising BMI youth (β = -0.02, p = 0.71, 95% CI = [-0.47-0.32]). Higher BMI variability across development predicted higher cortisol (β = 0.17, p = 0.003, 95% CI = [0.10-4.91]), additively to the contribution of BMI trajectories. BMI variability in childhood was responsible for that finding, possibly suggesting a timing effect. This study strengthens empirical support for BMI-HCC association and suggests that more attention should be devoted to BMI fluctuations in addition to persistent trajectories of BMI.

Cost-Effectiveness of Bivalent Respiratory Syncytial Virus PrefusionF (RSVpreF) Vaccine During Pregnancy for Prevention of Respiratory Syncytial Virus Among Infants in Argentina.

Lower respiratory tract illness (LRTI) caused by respiratory syncytial virus (RSV) is common among young children in Argentina. Use of the currently available prophylactic agent is limited to children aged ≤ 2years with selected high-risk conditions, and thus the majority of infants remain unprotected. We estimated the value-based price (VBP) of a novel RSVpreF vaccine for use among pregnant people for prevention of RSV-LRTI among infants during the first year of life. Clinical outcomes and economic costs of RSV-LRTI during infancy and expected impact of RSVpreF vaccination during pregnancy were projected using a population-based Markov-type cohort model. Model results-estimated on the basis of gestational age at birth, disease/fatality rates, and mother's vaccination status-include total numbers of RSV-LRTI cases, RSV-LRTI-related deaths, and associated costs. Base case analyses (RSVpreF vs. no vaccine) were conducted from the healthcare system perspective. Probabilistic sensitivity analyses (PSA; 1000 replications) were also conducted. Willingness-to-pay (WTP) was $10,636 per quality-adjusted life-year (QALY; i.e., 1 × 2021 gross domestic product [GDP] per capita) in base case analyses and PSA. Costs are reported in USD, estimated on the basis of the June 22, 2023 exchange rate. Use of RSVpreF among 342,110 pregnant persons provided protection to 330,079 infants at birth. In total, RSVpreF prevented 3915 RSV hospitalizations, 6399 RSV cases requiring emergency department care, 6182 RSV cases requiring a physician office visit, and 67 disease-related deaths. Direct costs were projected to be reduced by $5.0million. With 2061 QALYs gained and vaccine administration cost of $1.4million, the VBP of RSVpreF was estimated to be $74.46 per dose. In PSA, mean VBP was $75.02 (95% confidence interval 54.24-97.30). RSVpreF among pregnant persons would significantly reduce the clinical and economic burden of RSV-LRTI among infants in Argentina and would be considered a cost-effective intervention up to a price of approximately $75.

Evaluating cost-effectiveness of PFO management strategies: closure with cardioform vs. amplatzer, and treatment with medical therapy alone, for secondary stroke prevention

Aim The aim of this study was to evaluate the cost-effectiveness of patent foramen ovale (PFO) closure using CARDIOFORM Septal Occluders versus AMPLATZER Septal Occluders, as well as compared to Medical Therapy Alone, from a payor perspective in the United States. Methods An economic evaluation compared the value of CARDIOFORM, AMPLATZER, and Medical Therapy Alone. A Markov model simulated a cohort of 1,000 individuals with PFO and a history of cryptogenic stroke, with baseline demographic and clinical characteristics reflecting individuals enrolled in the REDUCE and RESPECT trials over a five-year time horizon. The costs and health consequences associated with complications and adverse events, including recurrent stroke, were compared over a time horizon of 5 years. Results PFO closure using CARDIOFORM was economically dominant, providing both cost-savings and improved effectiveness compared to closure with AMPLATZER. It resulted in an estimated savings of over $1.3 million, an additional 24.8 quality-adjusted life-years (QALYs) gained, and 26 strokes avoided in a cohort of 1,000 patients. When compared to Medical Therapy Alone, closure with CARDIOFORM was found to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of $36,697 per QALY gained. Sensitivity and scenario analysis showed the model findings to be highly robust across reasonable changes to baseline input values and assumptions. Conclusions The results of this analysis suggest that PFO closure using the CARDIOFORM Septal Occluder is the most cost-effective treatment strategy for patients with a PFO-associated stroke, particularly compared to AMPLATZER where it resulted in both cost-saving and improved patient outcomes.

The burden of type 2 diabetes attributable to dietary risks in China: Insights from the global burden of disease study 2021

ObjectivesThis study aims to comprehensively assess how dietary risk factors have influenced the prevalence of Type 2 Diabetes Mellitus (T2DM) in China from 1990 to 2021. The study seeks to provide robust data and scientific evidence essential for formulating effective preventive and control strategies to combat T2DM in China. Study designThis cross-sectional study conducted secondary analyses using data from the Global Burden of Disease 2021 (GBD 2021) to assess the burden of T2DM in China attributable to dietary risks. MethodsThe study analyzed age-adjusted metrics related to T2DM, including death counts, Disability-Adjusted Life Years (DALYs), and Age-Standardized Rates (ASRs), using GBD 2021 data, stratified by age and sex. Additionally, Estimated Annual Percentage Changes (EAPCs) were employed to track trends over time. ResultsIn 2021, the results show that 21.43 % of T2DM-related deaths and 23.51 % of DALYs were attributable to dietary risk factors, notably a diet low in whole grains and high in red and processed meats. Over the period from 1990 to 2021, there has been an increasing trend in the EAPCs of death rates and DALYs associated with dietary risks in China, suggesting a substantial impact of dietary factors on the burden of T2DM in the country. ConclusionThis study highlights the urgent need for targeted public health interventions to promote dietary changes and reduce the burden of T2DM in China.

Mapping the health impacts of transport noise in the densely populated area of the Île-de-France region

The European Noise Directive (END) requires agglomerations of more than 100,000 inhabitants to produce strategic noise maps. In the Ile-de-France region, 14 agglomerations with a total population of 10,5 million inhabitants are concerned. Bruitparif applied the health impact assessment methodology recommended by the WHO to carry out a detailed territorial diagnosis of the issues related to transport noise. For this purpose, population exposure was assessed on the basis of strategic noise maps produced according to the 4th round of the END and the associated risks were calculated using the exposure-response functions published by the WHO in October 2018. The work continued with the valuation of healthy life years lost due to transport noise. Two types of maps have been produced with a 200 m2 grid as well as at the city scale: maps of collective health impacts related to population noise exposure and maps of average individual risk corresponding to the potential impact per individual. The combination of these two types of information has made it possible to highlight significant territorial disparities and to identify the sectors most concerned by the health issues related to noise, a prerequisite for prioritizing public action.

Comprehensive pulmonary function analysis identifies predominant obstructive phenotype in former premature infants around one year of age.

Preterm infants suffer from significant respiratory morbidity during the first years of life, but the underlying lung pathophysiology is not fully understood. This study aimed to comprehensively characterize the pulmonary functions of preterm infants using full infant pulmonary function testing (iPFT). Between 2008 and 2019, we recruited 150 infants (Mage 10.5 ± 6 months) of them 104 preterm infants (median gestational age [GA] = 34 weeks (28-36), n = 23 with bronchopulmonary disease [BPD]) and 46 controls born at term. We compared full iPFT parameters of preterm infants to a control group of term infants. Subanalysis included a comparison of preterm infants by BPD status and GA. Preterm infants had impaired flow parameters, reduced compliance, and air trapping, compared to term infants. Only 15% (n = 14) of the preterm group had normal iPFT, compared to 69% (n = 31) of the term group. The majority of the impaired iPFT in preterm infants were obstructive and 72% (n = 69) had no response to bronchodilators. Reduced maximal flow at the functional residual capacity point (V'maxFRC) was associated with low birth weight and GA. There were no major differences between preterm infants with or without BPD. Preterm infants in the first year of life, demonstrated a high prevalence of obstructive iPFT unresponsive to bronchodilators. BPD status did not add to the degree of pulmonary impairment. These data reveal an airway-predominant pathology of the modern-era prematurity-associated lung disease. Pulmonary function screening tests at an early age may be of value in determining the presence and severity of lung disease in the preterm population. V'maxFRC may provide a good assessment of pulmonary impairment in preterm infants.

Методика «Эталоны» для оценки развития восприятия современных старших дошкольников (действие отнесения к эталону)

<p>Adaptation and standardization of the “Standards” test from a set of mental development diagnostic methods for preschool children (L.A. Venger and co-workers) were carried out, aimed at assessing the level of development of the action of comparison with the standard for older preschoolers. Two groups of children took part in the study: 1062 children aged 5-6 years (average age 66±3 months) and 1574 children aged 6-7 years (average age 77±3 months). Both versions of “Standards” test (for six- and seven-year-old children) showed good internal consistency (Cronbach's alpha=0,80-0,88; SRMR=0,02; CFI=0,99 for both samples). External validity is confirmed by correlations with intellectual development level, measured by Raven's Colored Progressive Matrices test (r=0,51 for children of the sixth year of life and r=0,39 for children of the seventh year of life). No differences were found by gender or the presence of disabilities. Age norms for modern children for the action of comparison with the standard have been determined. An adapted version of the test can be used by psychologists for scientific and practical purposes, to accompany the educational process that promotes the development of perception in children of senior preschool age.</p>

Стандартизация методики «Перцептивное моделирование» для детей 5-6 и 6-7 лет

<p>In modern sociocultural conditions, reliable diagnostic tools are needed to assess the mental development of a child, which would at the same time make it possible to adjust the objectives of educational work. The article reflects the results of adaptation and standardization of the "Perceptual modeling" test included in the diagnostic set for assessing the mental development of preschoolers (L.A. Wenger and colleagues). The study sample consisted of two groups: children 5-6 (N=1003) and children 6-7 (N=1516) years old. In these groups, children were offered various test options based on their age-related perceptual modeling capabilities. The adaptation of the "Perceptual modeling" test involved converting it into electronic form, changing the system for evaluating the results obtained and statistically verifying the possibility of using it in this form to solve diagnostic problems. The test standardization procedure has shown good external and internal validity, and its diagnostic reliability. Statistical analysis revealed the absence of significant gender differences in the performance of the test and the presence of significant differences between children with normal development and children with disabilities (speech, hearing impairment and mental retardation). As a result of standardization, age norms for mastering perceptual modeling actions for children with normal development and children with disabilities were determined by children of the sixth and seventh years of life.</p>

Newborn Screening for Sickle Cell Disease in Catalonia between 2015 and 2022-Epidemiology and Impact on Clinical Events.

In 2015, Catalonia introduced sickle cell disease (SCD) screening in its newborn screening (NBS) program along with standard-of-care treatments like penicillin, hydroxyurea, and anti-pneumococcal vaccination. Few studies have assessed the clinical impact of introducing NBS programs on SCD patients. We analyzed the incidence of SCD and related hemoglobinopathies in Catalonia and the change in clinical events occurring after introducing NBS. Screening 506,996 newborns from 2015 to 2022, we conducted a retrospective multicenter study including 100 screened (SG) and 95 unscreened (UG) SCD patients and analyzed SCD-related clinical events over the first six years of life. We diagnosed 160 cases of SCD, with an incidence of 1 in 3169 newborns. The SG had a significantly lower median age at diagnosis (0.1 y vs. 1.68 y, p < 0.0001), and initiated penicillin prophylaxis (0.12 y vs. 1.86 y, p < 0.0001) and hydroxyurea treatment earlier (1.42 y vs. 4.5 y, p < 0.0001). The SG experienced fewer median SCD-related clinical events (vaso-occlusive crisis, acute chest syndrome, infections of probable bacterial origin, acute anemia requiring transfusion, acute splenic sequestration, and pathological transcranial Doppler echography) per year of follow-up (0.19 vs. 0.77, p < 0.0001), a reduced number of annual emergency department visits (0.37 vs. 0.76, p < 0.0001), and fewer hospitalizations (0.33 vs. 0.72, p < 0.0001). SCD screening in Catalonia's NBS program has effectively reduced morbidity and improved affected children's quality of life.

Global health impacts of high BMI: A 30-Year analysis of trends and disparities across regions and Demographics

ObjectiveThis study explores the global disease burden associated with high Body Mass Index (BMI) from 1990 to 2021, using data from the Global Burden of Disease Study 2021 (GBD 2021). MethodsWe applied Joinpoint regression to assess trends in deaths and Disability-Adjusted Life Years (DALYs) and employed ARIMA models to project future BMI-related burdens. ResultsFrom 1990 to 2021, global deaths linked to high BMI surged by 153.97%, rising from 1.46 million to 3.71 million. DALYs increased by 167.57%, with the highest rises in North Africa, the Middle East, and South Asia. Women, particularly those aged 75 and above, experienced the most significant burden, with a faster rate of increase in disease burden compared to men post-2000. Future projections indicate a continued rise in BMI-related health impacts, particularly in low- and middle-income countries. ConclusionsThe global disease burden attributable to high BMI is increasing rapidly, particularly in low- and middle-income regions. Targeted public health interventions, especially for women and the elderly, are crucial to addressing this growing health challenge.

Burden of Chronic Kidney Disease for Adults 70 Years and Older in Iran During 1990-2021

Objectives: To report the burden of chronic kidney disease (CKD) among those aged 70 and above in Iran by age, sex, and province from 1990 to 2021. Design: Systematic analysis. Outcome measures: Data were obtained from the Global Burden of Disease study 2021. All estimates were reported as counts and age-standardized rates per 100000 individuals, with their corresponding 95% uncertainty intervals (UIs). Results: In 2021, CKD recorded an age-standardized prevalence of approximately 44 thousand per 100000 population among adults 70 years and older in Iran (95% UI: 39807–47784.5 per 100000). This rate meant a 5% increase compared to 1990, which was statistically significant. CKD also accounted for 8,725 deaths in the elderly population of Iran in 2021. Furthermore, disability-adjusted life years (DALY) rates were 3697.7 per 100000 population and had a 28.2% increase in the span of 1990–2021. Fars and Chahar Mahaal and Bakhtiari had the highest and lowest point prevalence per 100000 at 50357.2 and 40453.9, respectively, in the elderly population. In 2021, the prevalence, deaths, and DALYs due to CKD did not differ significantly between the two sexes, although the numbers were slightly higher in the female population. Moreover, the age-standardized prevalence, deaths, and DALYs of CKD in the elderly of Iran in 2021 started to rise in the 70–74 and increased with aging. Conclusions: The burden of CKD in the elderly of Iran has increased over the past 30 years. This is in line with the increase in the elderly population and the rising of its related risk factors. Preemptive measures, public knowledge raising, and the implementation of risk management policies can brighten the future of Iran’s elderly population in terms of non-communicable diseases, especially CKD.

Global, regional, and national burden of pancreatitis in children and adolescents.

Pancreatitis poses a growing public health concern among children and adolescents, yet comprehensive data on its prevalence, incidence, mortality, and disability-adjusted life years (DALYs) remain scarce. This study aims to analyze global, regional, and national trends in pancreatitis burden over the past 3decades. Using data from the Global Burden of Disease (GBD) 2019 database spanning 1990-2019, we assessed pancreatitis prevalence, incidence, mortality, and DALYs, reporting on numbers, rates, age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, region, and socio-demographic index (SDI) using jointpoint analysis and predictive modeling. Globally, pancreatitis prevalence and incidence rates have increased (AAPC prevalence=0.13, 95% CI: 0.11-0.16; AAPC incidence=0.30, 95% CI: 0.28-0.32), while mortality and DALYs rates have decreased (AAPC mortality=-1.30, 95% CI: -1.53, -1.07; AAPC DALYs=-1.21, 95% CI: -1.41, -1.01). Both genders showed similar trends. Children under 5 and adolescents 15-19 had higher mortality and DALYs rates. Low SDI regions experienced the greatest increase in ASIR. Eastern Europe exhibited high and rising ASIR, ASMR, and ASDR. Projections indicate continued rise in prevalence with declining mortality and DALYs. Pancreatitis burden in children and adolescents has surged globally, especially in lower SDI regions. These findings underscore the urgent need for targeted interventions and healthcare resources in affected areas.

Cost-effectiveness of surgical interventions in low-income and middle-income countries: a systematic review and critical analysis of recent evidence

BackgroundCost-effectiveness evidence is a critical tool to support resource allocation decisions. There is growing recognition that the development of benefit packages for surgical care should be guided by such evidence,...