Year Of Life Research Articles

Cost-effectiveness of strengthening blood pressure classification in South Korea: comparing the 2017 ACC/AHA and KSH guidelines

BackgroundHypertension is a significant risk factor for cardiovascular disease (CVD), with hypertension-related deaths increasing annually. While South Korea uses the Korean Society of Hypertension (KSH) guideline of 140/90 mmHg, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their guidelines in 2017 to 130/80 mmHg. This study evaluates the cost-effectiveness of transitioning to the 2017 ACC/AHA guidelines by estimating early treatment impacts and potential CVD risk reduction.MethodsA Markov state-transition simulation model with a 10-year horizon was used to estimate cost-effectiveness, focusing on strengthening target blood pressure. Quality-adjusted life years (QALYs) served as the measure of effectiveness. Cohorts of 10,000 individuals representing South Koreans in their 20s through 80s were compared in scenario analyses from the healthcare system perspective. A 4.5% annual discount rate was applied to costs and effectiveness. Primary outcomes were incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The willingness-to-pay (WTP) threshold was < KRW 30,000,000/QALY gained. Probabilistic sensitivity analyses (PSAs) addressed model input parameter uncertainties.ResultsThe base-case analysis showed an ICER value of KRW 1,328,395/QALY gained across all populations. ICER values increased with age, from − KRW 3,138,071/QALY for 20-year-olds to KRW 16,613,013/QALY for individuals over 80. The 60s age group showed the greatest benefit with an incremental QALY gain of 0.46. All scenarios had ICERs below the WTP threshold, with a PSA probability of 98.0% that strengthening blood pressure classification could be cost-effective.ConclusionsThis economic evaluation found that adopting the 2017 ACC/AHA guidelines may result in early treatment, reduce the potential incidence of CVD events, and be cost-effective across all age groups. The study findings have implications for policymakers deciding whether and when to revise official guidelines regarding target blood pressure levels, considering the impacts on public health and budgetary concerns.

Transcatheter aortic valve implantation versus surgical aortic valve replacement in Chinese patients with intermediate and high surgical risk for aortic stenosis: a decision analysis on effect, affordability and cost-effectiveness

ObjectiveExamine the cost-effectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for Chinese patients with severe aortic stenosis (AS) at intermediate and high surgical risk.DesignA two-phase model, comprising a 1-month decision tree to simulate perioperative outcomes and a 5-year Markov model with monthly cycles to simulate long-term outcomes, has been developed to evaluate the cost-effectiveness of TAVI compared with SAVR for Chinese patients with AS at intermediate and high risk. The event rates for both phases are sourced from the Placement of Aortic Transcatheter Valves IA and IIA trials, while the cost inputs and utility values are sourced from local sources or published literature. Adjustments for inflation were made using consumer price indexes for healthcare to enhance precision. To ensure the reliability and robustness of the model, sensitivity analyses were conducted to assess their impact on outcomes.SettingChina healthcare system perspective.ParticipantsA hypothetical cohort of Chinese patients with AS in intermediate and high surgical risk.InterventionsTAVI versus SAVR.Outcome measuresCost, quality-adjusted life-years (QALYs), life-years gained and incremental cost-effectiveness Ratio (ICER).ResultFor both intermediate- and high-risk AS patients, offering TAVR resulted in high healthcare costs but moderate benefits compared with SAVR. Specifically, in the intermediate-risk population, TAVR led to a 0.34 QALY increase over SAVR, with an incremental cost of $16 707.58, resulting in an ICER of $49 176.60/QALY. Similarly, in the high-risk population, TAVR showed a 0.15 QALY increase over SAVR, with an incremental cost of $18 093.52, leading to an ICER of $122 696.37/QALY. However, both ICERs exceeded the willingness-to-pay threshold of $37 654.50/QALY. Sensitivity analyses confirmed the model’s stability under parameter uncertainty.ConclusionTAVI was deemed not cost-effective compared with SAVR for patients with AS at intermediate or high surgical risk in the Chinese healthcare system. Lowering valve costs was considered an effective approach to improve the cost-effectiveness of TAVI.

Risk-stratified hepatocellular carcinoma screening according to the degree of obesity and progression to cirrhosis for diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD) in Japan: a cost-effectiveness study.

To evaluate the cost-effectiveness of risk-stratified hepatocellular carcinoma (HCC) screening in diabetic patients with metabolic dysfunction-associated steatotic liver disease (MASLD). A state-transition model from a healthcare payer perspective on a lifetime horizon. Japan. A hypothetical cohort of 50-year-old diabetic patients with MASLD risk-stratified according to degree of obesity and progression to cirrhosis. Metabolic dysfunction-associated steatotic liver (MASL), metabolic dysfunction-associated steatohepatitis (MASH) and MASH cirrhosis are progressive manifestations of this specific type of liver disease. Abdominal ultrasound (US), US with alpha-fetoprotein (AFP), US with AFP and lectin-reactive alpha-fetoprotein (AFP-L3), CT, extracellular contrast-media-enhanced MRI (ECCM-MRI), gadoxetic acid-enhanced MRI (EOB-MRI) and no screening. Costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), early-stage HCC cases, advanced-stage HCC cases and HCC-related deaths. EOB-MRI is the most cost-effective screening method for non-obese diabetic patients with MASH cirrhosis and for obese diabetic patients with MASH and MASH cirrhosis. Cost-effectiveness was sensitive to HCC incidence in non-obese diabetic patients with MASH cirrhosis and obese diabetic patients with MASH, and the adherence rate of HCC screening in obese diabetic patients with MASH. When the semiannual HCC incidence was between 0.008 and 0.0138 in non-obese diabetic patients with MASH cirrhosis, US with AFP was more cost-effective than EOB-MRI. Cost-effectiveness acceptability curves showed that EOB-MRI was 50.7%, 96.0% and 99.9% cost-effective in obese diabetic patients with MASH and non-obese diabetic patients with MASH cirrhosis, and obese diabetic patients with MASH cirrhosis at a willingness-to-pay level of $50 000 per QALY gained. Compared with no screening in 100 000 non-obese diabetic patients with MASH cirrhosis and obese diabetic patients with MASH cirrhosis, EOB-MRI reduced total costs by US$69 million and by US$142 million, increased lifetime effectiveness by 12 546 QALYs and by 15 815 QALYs, detected 17 873 and 21 014 early-stage HCC cases, and averted 2068 and 2471 HCC-related deaths, respectively. Of all HCC screening methods for diabetic patients with MASH cirrhosis, EOB-MRI yields the greatest cost-saving with the highest QALYs, detects the greatest number of early-stage HCC cases and averts the greatest number of advanced-stage HCC cases and HCC-related deaths. The findings provide important insights for the precise implementation of risk-stratified HCC surveillance to reduce morbidity and mortality and improve the quality of life in diabetic patients with MASLD.

Cost-Effectiveness Study of Difamilast 1% for the Treatment of Atopic Dermatitis in Adult Japanese Patients.

Difamilast has proven to be an effective treatment for the treatment of atopic dermatitis (AD) in Japan, but its cost-effectiveness remains unknown. Therefore, the objective of the current study was to determine the cost-effectiveness of difamilast 1% compared with delgocitinib 0.5% in Japanese adult patients with moderate-to-severe AD and compared with placebo in Japanese adult patients with all-severity AD from a Japanese public health-care perspective. The analysis was conducted using a cost-effectiveness model from the Japanese public health-care perspective. This model had four health states ("clear," "mild," "moderate," and "severe") defined according to the Eczema Area and Severity Index score. The time horizon of the analysis was 1year. Because the analysis period was short, no discount rate was applied. The proportions of patients previously estimated by the anchored matching-adjusted indirect comparison were implemented in the model. The model was further populated with data from the literature. The main model outcomes were quality-adjusted life-years (QALY), costs, and outcomes, including the incremental cost-effectiveness ratio. All prices were stated in JPY at the price level from 2018 April to 2019 March. One-way sensitivity analysisand probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the results. In the base case, the cost-effectiveness of difamilast 1% compared with delgocitinib 0.5% and placebo was JPY 827,054/QALY and JPY 1,518,657/QALY, respectively. The PSA showed that the cost-effectiveness of difamilast 1% compared with delgocitinib 0.5% and placebo had a 66.6% and 99.6% probability of being below the JPY 5 million/QALY threshold, respectively. The results suggest that difamilast 1% is a more cost-effective treatment option compared with delgocitinib 0.5% in Japanese adult patients with moderate-to-severe AD and compared with placebo in adult patients with all-severity AD from a Japanese public health-care perspective.

Small-Molecule Drugs Offer Comparable Health Benefits To Biologics At Lower Costs.

The Inflation Reduction Act of 2022 requires that Medicare negotiate a Maximum Fair Price for selected small-molecule drugs nine years after their Food and Drug Administration (FDA) approval and thirteen years postapproval for selected biologics. The discrepancy between these time frames raises questions about the relative value of small-molecule drugs versus biologics. We compared the incremental quality-adjusted life-year (QALY) gains, incremental costs, and incremental cost-effectiveness ratios (ICERs) of small-molecule drugs and biologics approved by the FDA during the period 1999-2018. We used the Mann-Whitney U test (to compare medians) and Kolmogorov-Smirnov test (to compare the distributions). We found that small-molecule drugs and biologics offer similar magnitudes of incremental QALY gains (0.08 versus 0.10). Small-molecule drugs tend to be associated with lower additional costs ($4,738 versus $16,020) and more favorable cost-effectiveness ($108,314 per QALY versus $228,286 per QALY). Creating parity regarding time to Medicare price negotiation may be appropriate.

Windows of susceptibility and joint effects of prenatal and postnatal ambient air pollution and temperature exposure on asthma and wheeze in Mexican children

IntroductionPrenatal and early-life exposure to air pollution and extreme temperatures are associated with childhood asthma and wheeze. However, potential windows of susceptibility and their sex-specific and interactive effects have not been fully elucidated. We aimed to identify critical windows of susceptibility and evaluate sex-specific effects in these associations, and evaluate exposure interactions. MethodsWe analyzed data from 468 mother–child pairs enrolled in the PROGRESS birth cohort in Mexico City. Daily residential levels of PM2.5, NO2, and temperature were generated from our validated spatiotemporally resolved models from conception to age 4 years. Childhood asthma and wheeze outcomes were collected at 4–6 and 7–8 years. Distributed lag nonlinear models (DLNMs) were used to identify susceptible windows for prenatal weekly-specific and postnatal monthly-specific associations of air pollution and temperature with respiratory outcomes adjusting for covariates. To evaluate sex-specific effects, DLNMs were stratified. Joint effects were assessed using relative excess risk due to interaction and attributable proportion. ResultsMid-gestation was a critical window for both PM2.5 (weeks 20–28, cumulative OR: 1.18 [95% CI: 1.01, 1.37]; weeks 19–26, cumulative OR: 1.18 [95% CI: 1.02, 1.36]) and NO2 (weeks 18–25, cumulative OR: 1.16 [95% CI: 1.02, 1.31]) exposure, associated with higher odds of wheeze. Postnatal exposure to PM2.5 and NO2 during the first year of life was also linked to higher odds of wheeze. The warmer and colder temperatures showed mixed effects on respiratory outcomes. We observed a synergistic interaction between high PM2.5 and high temperature exposure during the first year of life, associated with higher odds of current wheeze. The associations of prenatal air pollution and temperature exposure with respiratory outcomes were more pronounced in males. ConclusionsEarly-life air pollution exposure contributes to the development of childhood asthma and wheeze, while exposure to temperature showed mixed associations with respiratory outcomes.

Association between infant sleep and neurodevelopment in a prospective birth cohort study

ObjectivesTo investigate the association of infant sleep and sleep trajectories through the first year of life with infant neurodevelopment. MethodsThis study was conducted with 3251 infants in China. Sleep parameters were evaluated by the Brief Infant Sleep Questionnaire at 42days, 6months, and 1year of age. Neurodevelopment was evaluated at 1year of age using the Bayley Scales of Infant and Toddler Development, Third Edition. The latent variable growth curve model was used to evaluate the developmental trajectories of infant sleep, including total sleep duration trajectories, night awakening trajectories and sleep onset latency trajectories. Poisson regression was applied to assess the association between sleep parameters and sleep trajectories and infant neurodevelopment. ResultsInfants with frequent night awakenings at 6months had a higher risk of nonoptimal gross motor development. Additionally, infants with prolonged sleep onset latency at 1year had an increased risk of nonoptimal fine and gross motor development. A consistent frequent night-awakening trajectory increased the risk of nonoptimal gross motor development (adjusted relative risk, 1.52; 95% confidence interval, 1.09 to 2.10). Furthermore, an increasing trajectory in sleep onset latency was associated with an increased risk of nonoptimal fine (adjusted relative risk, 2.70; 95% confidence interval, 1.12 to 6.51) and gross motor development (adjusted relative risk, 2.76; 95% confidence interval, 1.70 to 4.48). However, no significant association was observed between total sleep duration, or its trajectory, and infant neurodevelopment. ConclusionsSleep problems or specific sleep trajectories during the initial year of life may increase risk of compromised neurodevelopment.

Antibiotic usage within the first year of life has a protective effect against ulcerative colitis in South Korea: A nationwide cohort study

BackgroundAntibiotic usage in early life has been proposed as a risk factor for inflammatory bowel disease, especially Crohn's disease. However, most studies were conducted in Western countries. AimsWe evaluated the association between antibiotic usage and the incidence of inflammatory bowel disease in the Asian population. MethodsThis nationwide population-based retrospective cohort study included 2,941,889 South Korean infants born between 2007 and 2015, using the National Health Insurance Service database. We assessed whether antibiotic use was associated with the incidence of inflammatory bowel disease. Additionally, we conducted sensitivity analyses, considering protopathic bias and dietary variables. The Cox proportional hazards model was used. ResultsAmong 2,941,889 infants, 2,566,390 (87 %) used antibiotics within a year after birth. Antibiotic usage within a year, number of antibiotic classes, and cumulative days of usage were shown to decrease the risk of ulcerative colitis. This association was particularly prominent with earlier antibiotic exposure. Penicillin was the only antibiotic class related to the reduced risk. The results were robust after adjusting for dietary variables and considering protopathic effect. ConclusionsAntibiotic exposure during the first year of life, particularly at a younger age, is linked to a reduced risk of early-onset ulcerative colitis in South Korea.

Premature Thelarche: An Updated Review.

Premature thelarche is the most common pubertal disorder in girls. The condition should be differentiated from central precocious puberty which may result in early epiphyseal fusion and reduced adult height, necessitating treatment. The purpose of this article is to familiarize physicians with the clinical manifestations of premature thelarche and laboratory tests that may help distinguish premature thelarche from central precocious puberty. A search was conducted in September 2022 in PubMed Clinical Queries using the key term "Premature thelarche". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used to compile the present article. Premature thelarche denotes isolated breast development before the age of 8 years in girls who do not manifest other signs of pubertal development. The condition is especially prevalent during the first two years of life. The majority of cases of premature thelarche are idiopathic. The condition may result from an unsuppressed hypothalamic-pituitary-gonadal axis in the early years of life, an "overactivation" of the hypothalamic-pituitary axis in early childhood secondary to altered sensitivity to steroids of the hypothalamic receptors controlling sexual maturation, increased circulating free estradiol, increased sensitivity of breast tissue to estrogens, and exposure to exogenous estrogens. The cardinal feature of premature thelarche is breast development which occurs without additional signs of pubertal development in girls under 8 years of age. The enlargement may involve only one breast, both breasts asymmetrically, or both breasts symmetrically. The breast size may fluctuate cyclically. The enlarged breast tissue may be transiently tender. There should be no significant changes in the nipples or areolae and no pubic or axillary hair. The vulva, labia majora, labia minora, and vagina remain prepubertal. Affected girls have a childlike body habitus and do not have mature contours. They are of average height and weight. Growth and osseous maturation, the onset of puberty and menarche, and the pattern of adolescent sexual development remain normal. Most cases of premature thelarche can be diagnosed on clinical grounds. Laboratory tests are seldom indicated. No single test can reliably differentiate premature thelarche from precocious puberty. Premature thelarche is benign, and no therapy is necessary apart from parental reassurance. As enlargement of breasts may be the first sign of central precocious puberty, a prolonged follow- up period every 3 to 6 months with close monitoring of other pubertal events and linear growth is indicated in all instances.

School-based nutrition education programs alone are not cost-effective for preventing childhood obesity: A microsimulation study

Although interventions to change nutrition policies, systems, and environments (PSE) for children are generally cost-effective for preventing childhood obesity, existing evidence suggests that nutrition education curricula, without accompanying PSE changes, are more commonly implemented. Estimate the societal costs and potential for cost-effectiveness of three nutrition education curricula frequently implemented in U.S. public schools for childhood obesity prevention. In 2021, we searched for nutrition education curricula in the SNAP-Ed Toolkit, a catalogue of interventions for obesity prevention coordinated by the federal government. Standard costing methodologies estimated the societal costs from 2023-2032 of nationwide implementation of each identified curriculum. Using the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model, which projects the costs, healthcare costs saved, and cases of obesity prevented for childhood obesity prevention interventions, we conducted threshold analyses for each curriculum, estimating the cost per quality-adjusted life year (QALY) for a range of hypothetical effects on child body mass index (BMI) to determine how large of an effect each curriculum would need to have to meet a cost-effectiveness threshold of $150,000 per QALY. Three nutrition education curricula without PSE were identified from SNAP-Ed; none had evidence of an impact on obesity risk. From 2023 to 2032, the estimated implementation costs of the curricula nationwide ranged from $1.80 billion (95% UI: $1.79-$1.82 billion) to $3.48 billion (95% UI: $3.44-$3.51 billion). Each curriculum would have to reduce average child BMI by 0.10 kg/m2 or more-an effect size that has not been reported by any of the three curricula, or by more comprehensive existing prevention programs-to be considered cost-effective at this threshold. SNAP-Ed-endorsed nutrition education curricula alone are unlikely to be cost-effective for preventing childhood obesity. Continued efforts to implement interventions with strong evidence for effectiveness, including PSE approaches, are needed.

Metformin in the Diabetes Prevention Program 3-year trial: The cost-effectiveness that never was.

To highlight oversimplified quality-adjusted life year (QALY) calculations and incremental cost-effectiveness ratios (ICERs) regarding lifestyle metformin and placebo as flaws in the trial-based (Diabetes Prevention Program) cost-effectiveness analysis. We revised the QALY calculations to conform to convention and calculated appropriate ICERs using both original and revised QALYs results. We used several additional health economics tools to present results, showing the consistency of each method and the added value of each. We presented net monetary benefits, assessed decision uncertainty and calculated net losses. We also used graphics, making correct interpretation clearer and allowing illustration and calculation of technical and economic inefficiencies of treatments that were not cost-effective. ICERs with either QALY calculation indicated that metformin was technically and economically inefficient and not cost-effective. There was virtually no decision uncertainty. All methods employed pointed to an identical conclusion. In contrast to original claims, although lifestyle was cost-effective in diabetes prevention, metformin was not, and acting otherwise imposes significant monetary and health costs. Various available tools of economic evaluation would probably have prevented the original misinterpretation by the authors had they been used. The varied tools implemented here illustrate with a common example their consistency and value to the field, showing how to depict the results in various ways.

The burden of refraction disorders in 204 countries and territories from 1990 to 2021: A systematic analysis from the Global Burden of Disease 2021

BackgroundRefraction disorders are common eye conditions that cause blurred vision and, if left uncorrected, remain a leading cause of moderate to severe visual impairment worldwide. Despite this, a comprehensive assessment of the associated burden is lacking. This study aims to describe and predict the burden and regional distribution of refraction disorders using data from the 2021 Global Burden of Disease (GBD) study. MethodsThis study utilised data from the Global Burden of Disease (GBD) 2021 on refraction disorders from 1990 to 2021. We analysed the prevalence and disability-adjusted life years (DALYs) of refraction disorders and calculated the corresponding average annual percentage changes (AAPCs) in different gender and age groups across 204 countries and territories and 21 geographical regions. We employed the Bayesian Age-Period-Cohort (BAPC) model to predict the future burden of refraction disorders. ResultsFrom 1990 to 2021, the global age-standardized prevalence rate (ASPR) of refraction disorders decreased from 2053.56 (95% Uncertainty Interval [UI], 1835.31 to 2275.80) to 1919.66 (95% UI, 1715.24 to 2135.28), with an average annual percentage change (AAPC) of -0.21% (95% Confidence Interval [CI], -0.23% to -0.19%). The age-standardized DALY (Disability-Adjusted Life Years) rate also declined from 88.04 (95% UI, 62.19 to 125.15) to 79.11 (95% UI, 54.94 to 114.14) with an AAPC of -0.33% (95% CI, -0.36% to -0.31%). Refraction disorders remain a significant burden in regions with lower Socio-demographic Index (SDI), particularly in parts of South Asia and Western Sub-Saharan Africa. Older individuals and females are disproportionately affected. The age-standardized DALY rate is expected to decline steadily before stabilising at approximately 77.94 per 100,000 by 2030.

Cost-effectiveness of clinical decision support to improve CKD outcomes among First Nations Australians

IntroductionThe Northern Territory (NT) is a hotspot for chronic kidney disease (CKD) and has a high incidence of kidney replacement therapy (KRT). The Territory Kidney Care clinical decision support tool (CDS) aims to improve diagnosis and management of CKD in remote NT, particularly amongst First Nations Australians. We model the cost-effectiveness of the CDS versus usual care. MethodsTaking a healthcare funder perspective, we modelled a cohort of people from remote NT at risk of or with CKD, as of 1 January 2017. A Markov cohort model was developed using 6 years of observed patient-level data (2017 to 2023), extrapolated to a 15-year time horizon. The CDS tool was modelled to improve CKD diagnosis (scenario 1), improve management (scenario 2), or improve both diagnosis and management (scenario 3). ResultsThe remote NT cohort consisted of 23,195 people, predominantly (89%) First Nations, with a mean age of 42. Scenario 3 (improved diagnosis and management) was most cost-effective at an incremental cost-effectiveness ratio (ICER) of $96,684 per patient avoiding KRT, $30,086 per patient avoiding death. Scenario 1 (improved diagnosis) was less cost-effective, and scenario 2 (improved management) was least cost-effective. The ICER per quality adjusted life years gained ranged from $3,427 (scenario 3) to $63,486 (scenario 2). ConclusionTerritory Kidney Care is highly cost-effective when it supports early diagnosis of CKD and increases optimal management in diagnosed patients. These results support investing in CDS tools, implemented in strong partnerships, to improve outcomes in settings with a high burden of CKD.

Economic Evaluation of Once-Weekly Insulin Icodec from Italian NHS Perspective.

Icodec, once-weekly basal insulin, aims to simplify therapy management by reducing injection frequency for diabetic patients. The efficacy and safety of icodec were evaluated in the ONWARDS clinical development program. This study evaluates icodec economic and quality of life impact from the Italian National Healthcare System (NHS) perspective. A pharmacoeconomic study was developed to assess the once-weekly insulin icodec value, highlighting its potential to decrease needle use while improving adherence and quality of life. In the base case, a differential cost and cost-utility analysis over one year compared to once-daily insulin degludec were developed. Based on the comparison with degludec, a scenario analysis was planned between icodec and the mix of basal insulins available on the market. Economic evaluations included drug and administration costs, needles, and impact on adherence. The cost-utility analysis measured the utility associated with the weekly injection compared to the daily ones, resulting in an incremental cost-effectiveness ratio (ICER), measured as Δ€/ΔQALY (Quality Adjusted Life Years). To assess the robustness of the results, a deterministic one-way sensitivity analysis and a probabilistic sensitivity analysis were carried out. At an annual cost 25% higher than degludec, considering the economic benefits generated by the needle use reduction (-€51.10) and adherence improvement (-€54.85), once-weekly icodec grants no incremental cost and even potential savings per patient. Furthermore, icodec reported a utility advantage (0.023). It achieved a dominant incremental cost-effectiveness ratio (ICER) compared to degludec. The comparison with the mix of basal insulins also reported a cost-effectiveness profile. Sensitivity tests conducted confirmed the robustness of the findings, highlighting the key drivers of the analysis. Icodec represents a new therapeutic option to simplify basal insulin treatment. It also improves the patient's management and his quality of life, without increasing the economic burden for the Italian NHS, while guaranteeing an excellent cost-effectiveness profile.

Development of liposomal amniotic mesenchymal stem cell metabolite products (AMSC-MP) loaded-scaffold for in vitro osteogenesis induction

The use of scaffolds with good biocompatibility and mechanical properties largely determines the success of bone defect therapy intended to improve quality-adjusted life years. Furthermore, amniotic mesenchymal stem cell metabolite product (AMSC-MP) is required to accelerate bone regeneration with sustained release required to maximize the effectiveness of therapy. This study aims to evaluate the effect of different phospholipids on the osteogenesis capacity of AMSC-MP liposome loaded into scaffold. The thin layer hydration method was employed to create the AMSC-MP liposomes which had different lipid components: L-α-phosphatidylcholine (PC) an unsaturated or hydrogenated soybean phosphatidylcholine (HSPC), a saturated phospholipid, with different types of charged phospholipids i.e., 1,2-dioleoyltrimethylammoniumpropane (DOTAP) or 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE), which were cationic and non-ionic lipids respectively.AMSC-MP liposomes were embedded in the scaffold during a 24-hour incubation period. The results indicated that the particle sizes of liposomes prepared with saturated phospholipids, HS-DOTAP (132.35 ± 2.75 nm) and HS-DOTAP (152.85 ± 5.86 nm) were larger than those with saturated phospholipids, namely PC-DOTAP (139.355 ± 2.75 nm) and PC-DOTAP (91.85 ± 0.07 nm). The use of DOTAP in AMSC-liposomes resulted in positively charged vesicles i.e., +5 mV for HSPC-DOTAP and + 10 mV for PC-DOTAP. Moreover, the results of an MTT viability test conducted on 7f2 cells and MSC indicated that all the formulas demonstrate good in vitro biocompatibility. Formulations containing DOPE produced high cellular uptake values and had superior sustain release properties compared to the others. This result correlates positively with cell attachment to the liposome scaffold which was higher than the others. Moreover, DOPE-containing formulations increased RUNX2 expression, indicating enhanced in vitro osteogenesis capacity. Therefore, Liposome AMSC-MP loaded scaffold demonstrates high potential for use in bone regeneration therapy.

Thresholds for the value judgement of health technologies in the United Arab Emirates: a consensus approach through voting sessions

BackgroundIn the evolving healthcare landscape of the United Arab Emirates (UAE), establishing cost-effectiveness thresholds (CETs) is pivotal to informing decision-makers about the value of health technologies.ObjectiveThis study aimed to establish...

Quality of Life Based Health Economics Research on Pharmaceutical Intervention in Cancer Chemotherapy

The adverse chapter of cancer chemotherapy negatively impact QOL, and pharmacists play a key role in improving QOL by providing optimal drug therapy through pharmaceutical interventions. Although outpatient cancer chemotherapy is now common, the impact of pharmaceutical interventions from a QOL perspective has not been thoroughly studied. Therefore, this study investigated the impact and cost-effectiveness of pharmaceutical interventions on QOL using the EuroQol 5 Dimension (EQ-5D) and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD). The study was conducted between 2013 and 2015 on 39 patients who underwent their first outpatient chemotherapy for breast cancer at Gifu Municipal Hospital. The results showed that pharmaceutical interventions improved social relationship QOL in patients experiencing fatigue during the first cycle and enhanced psychological QOL in patients with adverse events of nausea during the second cycle. Furthermore, the maximum incremental cost-effectiveness ratio (ICER) was found to be 1.3 million yen per quality-adjusted life years (QALY) according to cost utility analysis. The pharmaceutical interventions by pharmacists in outpatient cancer chemotherapy improve QOL, and the ICER remains well below the Japanese threshold, signifying clear medical and economic benefits.

Cost-effectiveness of falls prevention strategies for older adults: protocol for a living systematic review

IntroductionOne-third of adults aged 65+ fall annually. Injuries from falls can be devastating for individuals and account for 1.5% of annual healthcare spending. With the growing ageing population, falls place...

Gradually increasing context-sensitivity shapes the development of children's verb marking: A corpus study.

There is substantial evidence that children's apparent omission of grammatical morphemes in utterances such as "She play tennis" and "Mummy eating" is in fact errors of commission in which contextually licensed unmarked forms encountered in the input are reproduced in a context-blind fashion. So how do children stop making such errors? In this study, we test the assumption that children's ability to recover from error is related to their developing sensitivity to longer-range dependencies. We use a pre-registered corpus analysis to explore the predictive value of different cues with regards to children's verb-marking errors and observe a developmental pattern consistent with this account. We look at context-independent cues (the identity of the specific verb being used) and at the relative value of context-dependent cues (the identity of the specific subject+verb sequence being used). We find that the only consistent effect across a group of 2- to 3-year-olds and a group of 3- to 4-year-olds is the relative frequency of unmarked forms of specific subject+verb sequences being used. The relative frequency of unmarked forms of the verb alone is predictive only in the younger age group. This is consistent with an account in which children recover from making errors by becoming progressively more sensitive to context, at first the immediately preceding lexical contexts (e.g., the subject that precedes the verb) and eventually more distant grammatical markers (e.g., the fronted auxiliary that precedes the subject in questions). RESEARCH HIGHLIGHTS: We provide a corpus analysis investigating input effects on young children's verb-marking errors (e.g., Mummy go) across development (between 2 and 4 years of age). We find evidence that these apparent errors of omission are in fact input-driven errors of commission that persist into the third year of life. We compare the relative effect on error rates of context-independent (e.g., verb) and context-dependent (e.g., subject+verb sequence) cues across developmental time. Our findings support the proposal that children recover from making verb-marking errors by becoming progressively more sensitive to preceding context.

Reimagining maternal resilience: Incorporating the socioecological framework, lifecourse theory, and weathering hypothesis.

Women of color are at least twice as likely as non-Hispanic White women to die during the perinatal period or deliver infants who are low birthweight, preterm, or die within the first year of life. Maternal stress before and during pregnancy is associated with adverse obstetric outcomes. A growing body of literature has explored maternal resilience as protective factors contributing to healthy maternal and child health (MCH) outcomes. However, several gaps exist in how this construct has been conceptualized and operationalized. First, extant research has primarily conceptualized maternal resilience as individual attributes that enable women to "bounce back" after facing adversity during pregnancy, thereby failing to incorporate the broader systemic and environmental factors that contribute to chronic stress, particularly among vulnerable groups. Second, the literature has largely neglected to examine resilience in relation to maternal stress, therefore not acknowledging that women who experience greater stress will likely require more resources. Third, though resilience has been investigated at discrete life stages, longitudinal research has not been conducted to explore how it develops over the lifecourse. This article critically evaluates the resilience literature, expands upon the gaps described, and proposes a conceptual framework that reimagines material resilience using three population health theories, including Bronfenbrenner's socioecological framework, Elder's lifecourse theory, and Geronimus' weathering hypothesis. The proposed framework will inform future research that examines the development of multilevel resilience resources over the lifecourse as well as interventions to increase resilience and ultimately yield healthier MCH outcomes among vulnerable communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).