Pub Date : 2024-02-28DOI: 10.1101/2024.02.26.24303288
Michaela Theilmann, Sneha Sarah Mani, Pascal Geldsetzer, Shivani A. Patel, Mohammed K. Ali, Harsha Thirumurthy, KM Venkat Narayan, Viswanathan Mohan, Dorairaj Prabhakaran, Nikhil Tandon, Nikkil Sudharsanan
Background: In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. Methods: Using six waves of population-representative cohort data (N = 15,573), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. Findings: We find that screening individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.1, p-value: 0.82), treatment (-0.2, p-value: 0.49), or BP levels (systolic: -1.8, p-value: 0.03; diastolic: 0.5, p-value: 0.39). This null effect is robust across subpopulations and alternative specifications. Interpretation: Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioral barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for translating India's screening efforts into improved population health.
{"title":"Does home-based screening and health information provision improve hypertension diagnosis, treatment, and control? A regression discontinuity analysis in urban India","authors":"Michaela Theilmann, Sneha Sarah Mani, Pascal Geldsetzer, Shivani A. Patel, Mohammed K. Ali, Harsha Thirumurthy, KM Venkat Narayan, Viswanathan Mohan, Dorairaj Prabhakaran, Nikhil Tandon, Nikkil Sudharsanan","doi":"10.1101/2024.02.26.24303288","DOIUrl":"https://doi.org/10.1101/2024.02.26.24303288","url":null,"abstract":"Background:\u0000In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India.\u0000Methods: Using six waves of population-representative cohort data (N = 15,573), we estimate the causal effect of a home-based hypertension screening intervention on diagnosis, treatment, and BP using a novel application of the Regression Discontinuity Design. Findings:\u0000We find that screening individuals' BP in their homes and providing health information and a referral to those with elevated BP did not meaningfully improve hypertension diagnosis (0.1, p-value: 0.82), treatment (-0.2, p-value: 0.49), or BP levels (systolic: -1.8, p-value: 0.03; diastolic: 0.5, p-value: 0.39). This null effect is robust across subpopulations and alternative specifications. Interpretation:\u0000Our findings suggest that a lack of knowledge of one's hypertension status might not be the primary reason for low diagnosis and treatment rates in India, where other structural and behavioral barriers may be more relevant. Adapting screening efforts to address these additional barriers will be essential for translating India's screening efforts into improved population health.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140004121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-24DOI: 10.1101/2024.02.23.24303259
Piero Ronzani, Wolfgang Stojetz, Nadine Stammel, Maria Boettche, Diego Zardetto, Sarah Fenzl, Maen Salhab, Jessica M. Anderson, Arden Finn, Alia Aghajanian, Tilman Brück
Background Mental health risks are high in conflict settings, but mental health research mostly focuses on non-conflict settings. Survey data from active conflict settings often suffer from low response rates, unrepresentative samples, and a lack of detailed information on the roots and implications of poor mental health. We overcome these challenges by analyzing nationally representative evidence on the prevalence, sources, and socio-economic correlates of depression, a highly disabling and costly public health issue, in an active conflict setting. Methods We analyze nationally and sub-nationally representative geocoded survey data from the Palestinians' Psychological Conditions Survey, collected from 5,877 Palestinian individuals in West Bank and Gaza in 2022. We calculate representative depression statistics, disaggregate by sub-areas and across socio-demographic groups, and estimate the associations with geocoded violent conflict event data as well as survey-based trauma exposure across conflict types and socio-economic outcomes. Findings 58 percent (SE=2.21) of adults in Palestine exhibit depressive symptoms. Prevalence is highest in Gaza (71 percent, SE=2.70), increases with exposure to violent conflict and traumatic events, and is associated with worse socio-economic outcomes. The associated losses for 2022 are equivalent to 732,555 Years Lost in Disability, representing 8.9 percent of Palestine's GDP. Interpretation Those exposed to violence and traumatic events are disproportionately affected by depression in conflict settings, which may fuel poverty and instability. Scalable investments in mental health in conflict settings promise to not only support well-being but also strengthen productivity and social cohesion for a given level of violence. Funding The study received funding by the World Bank's State and Peace Building Trust Fund.
{"title":"Prevalence of Depression and Associated Socio-economic Outcomes during Violent Conflict: A Matched Analysis for Palestine Using Nationally Representative Survey and Conflict Event Data","authors":"Piero Ronzani, Wolfgang Stojetz, Nadine Stammel, Maria Boettche, Diego Zardetto, Sarah Fenzl, Maen Salhab, Jessica M. Anderson, Arden Finn, Alia Aghajanian, Tilman Brück","doi":"10.1101/2024.02.23.24303259","DOIUrl":"https://doi.org/10.1101/2024.02.23.24303259","url":null,"abstract":"Background\u0000Mental health risks are high in conflict settings, but mental health research mostly focuses on non-conflict settings. Survey data from active conflict settings often suffer from low response rates, unrepresentative samples, and a lack of detailed information on the roots and implications of poor mental health. We overcome these challenges by analyzing nationally representative evidence on the prevalence, sources, and socio-economic correlates of depression, a highly disabling and costly public health issue, in an active conflict setting. Methods\u0000We analyze nationally and sub-nationally representative geocoded survey data from the Palestinians' Psychological Conditions Survey, collected from 5,877 Palestinian individuals in West Bank and Gaza in 2022. We calculate representative depression statistics, disaggregate by sub-areas and across socio-demographic groups, and estimate the associations with geocoded violent conflict event data as well as survey-based trauma exposure across conflict types and socio-economic outcomes. Findings\u000058 percent (SE=2.21) of adults in Palestine exhibit depressive symptoms. Prevalence is highest in Gaza (71 percent, SE=2.70), increases with exposure to violent conflict and traumatic events, and is associated with worse socio-economic outcomes. The associated losses for 2022 are equivalent to 732,555 Years Lost in Disability, representing 8.9 percent of Palestine's GDP. Interpretation\u0000Those exposed to violence and traumatic events are disproportionately affected by depression in conflict settings, which may fuel poverty and instability. Scalable investments in mental health in conflict settings promise to not only support well-being but also strengthen productivity and social cohesion for a given level of violence. Funding\u0000The study received funding by the World Bank's State and Peace Building Trust Fund.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139956976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1101/2024.02.20.24303095
Josephine Barnhart, Sondra Vujovich, Brian Piper
Background Gamma hydroxybutyrate (GHB) is a Schedule III drug in the US approved for treatment of cataplexy associated with narcolepsy. Narcolepsy with cateplaxy is a rare disorder with an annual incidence of less than one per one hundred thousand and GHB is a third line treatment. The purpose of this study was to describe the temporal pattern of GHB distribution and cost nationally and between states for Medicaid and Medicare patients. Methods GHB prescriptions were extracted from the State Utilization Data Tool from Medicaid.gov and the Medicare part D Prescribers by Provider and Drug Dataset from CMS.gov. GHB prescriptions were examined by state when corrected for population. States outside a 95 percent confidence interval were considered statistically significant. GHB cost analyses were performed between 2017−2021. GHB prescribers were identified for Medicare in 2019. Results There was a steady increase in prescriptions (±88.5 percent) from 2019 to 2021 and spending (±39.6 percent) from 2017 to 2020 for Medicaid. Specialists other than somnologists, were found to prescribe the highest number of GHB prescriptions to Medicare Part D enrollees. In 2019, two states (Hawaii and North Dakota) did not prescribe GHB to Medicare patients versus twenty states for Medicaid patients. Marylands prescribing to Medicare patients was significantly elevated (269.2 per 100K). Conclusion GHB prescribing has increased to Medicaid and Medicare patients. Further research is necessary to understand how the COVID19 pandemic and off label prescribing (e.g. for excessive daytime sleepiness) may have affected these findings including the origins of the pronounced state level disparities.
{"title":"Increase but pronounced regional disparities in gamma-hydroxybutyrate (GHB) prescriptions among Medicaid and Medicare patients","authors":"Josephine Barnhart, Sondra Vujovich, Brian Piper","doi":"10.1101/2024.02.20.24303095","DOIUrl":"https://doi.org/10.1101/2024.02.20.24303095","url":null,"abstract":"Background Gamma hydroxybutyrate (GHB) is a Schedule III drug in the US approved for treatment of cataplexy associated with narcolepsy. Narcolepsy with cateplaxy is a rare disorder with an annual incidence of less than one per one hundred thousand and GHB is a third line treatment. The purpose of this study was to describe the temporal pattern of GHB distribution and cost nationally and between states for Medicaid and Medicare patients. Methods GHB prescriptions were extracted from the State Utilization Data Tool from Medicaid.gov and the Medicare part D Prescribers by Provider and Drug Dataset from CMS.gov. GHB prescriptions were examined by state when corrected for population. States outside a 95 percent confidence interval were considered statistically significant. GHB cost analyses were performed between 2017−2021. GHB prescribers were identified for Medicare in 2019. Results There was a steady increase in prescriptions (±88.5 percent) from 2019 to 2021 and spending (±39.6 percent) from 2017 to 2020 for Medicaid. Specialists other than somnologists, were found to prescribe the highest number of GHB prescriptions to Medicare Part D enrollees. In 2019, two states (Hawaii and North Dakota) did not prescribe GHB to Medicare patients versus twenty states for Medicaid patients. Marylands prescribing to Medicare patients was significantly elevated (269.2 per 100K). Conclusion GHB prescribing has increased to Medicaid and Medicare patients. Further research is necessary to understand how the COVID19 pandemic and off label prescribing (e.g. for excessive daytime sleepiness) may have affected these findings including the origins of the pronounced state level disparities.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139956185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1101/2024.02.20.24303111
Joachim Worthington, Emily He, Michael Caruana, Stephen Wade, Barbara de Graaff, Anh Le Tuan Nguyen, Jacob George, Karen Canfell, Eleonora Feletto
Introduction: Liver cancer is the only cancer in Australia for which mortality rates have consistently risen, despite tests to identify high-risk individuals. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Curative treatment for HCC is typically only available if detected early. Australian clinical guidelines recommend routine 6-monthly ultrasound surveillance, with or without serum alpha-fetoprotein, for individuals with liver cirrhosis. This study assesses the health and economic implications of this recommendation, utilizing novel modeling techniques. Methods: We designed the sojourn time density model mathematical framework to develop a model of the evolving risk of HCC, liver disease, and death based on time since diagnosis, incorporating data on liver decompensation, HCC incidence, and HCC survival, and the impact of surveillance on cancer stage and survival. Results: We estimated that adherence to 6-monthly ultrasound, with or without alpha-fetoprotein, can increase early-stage diagnosis rates, reducing HCC mortality by 22%. We estimate a cost-effectiveness ratio of $33,850 per quality-adjusted life-year (QALY) saved for 6-monthly ultrasound HCC surveillance, under the $50,000/QALY cost-effectiveness threshold. HCC surveillance was also estimated to be cost-effective at any interval from 3-24 months. Conclusions: These findings support the current clinical guideline recommendation for 6-monthly ultrasound surveillance, affirming its health benefits and cost-effectiveness, and show that alternative surveillance intervals would remain beneficial and cost-effective. Our model may be used to refine surveillance recommendations for other at-risk population subgroups and inform evidence-based clinical practice recommendations, and the framework can be adapted for other epidemiological modelling. Supporting the clinical guidelines and their ongoing development as evidence evolves may be key to reversing increasing HCC mortality rates in Australia, which are predicted to increase by more than 20% by 2040.
{"title":"An economic evaluation of routine hepatocellular carcinoma surveillance for high-risk patients using a novel approach to modelling competing risks","authors":"Joachim Worthington, Emily He, Michael Caruana, Stephen Wade, Barbara de Graaff, Anh Le Tuan Nguyen, Jacob George, Karen Canfell, Eleonora Feletto","doi":"10.1101/2024.02.20.24303111","DOIUrl":"https://doi.org/10.1101/2024.02.20.24303111","url":null,"abstract":"Introduction:\u0000Liver cancer is the only cancer in Australia for which mortality rates have consistently risen, despite tests to identify high-risk individuals. Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Curative treatment for HCC is typically only available if detected early. Australian clinical guidelines recommend routine 6-monthly ultrasound surveillance, with or without serum alpha-fetoprotein, for individuals with liver cirrhosis. This study assesses the health and economic implications of this recommendation, utilizing novel modeling techniques. Methods:\u0000We designed the sojourn time density model mathematical framework to develop a model of the evolving risk of HCC, liver disease, and death based on time since diagnosis, incorporating data on liver decompensation, HCC incidence, and HCC survival, and the impact of surveillance on cancer stage and survival. Results:\u0000We estimated that adherence to 6-monthly ultrasound, with or without alpha-fetoprotein, can increase early-stage diagnosis rates, reducing HCC mortality by 22%. We estimate a cost-effectiveness ratio of $33,850 per quality-adjusted life-year (QALY) saved for 6-monthly ultrasound HCC surveillance, under the $50,000/QALY cost-effectiveness threshold. HCC surveillance was also estimated to be cost-effective at any interval from 3-24 months. Conclusions:\u0000These findings support the current clinical guideline recommendation for 6-monthly ultrasound surveillance, affirming its health benefits and cost-effectiveness, and show that alternative surveillance intervals would remain beneficial and cost-effective. Our model may be used to refine surveillance recommendations for other at-risk population subgroups and inform evidence-based clinical practice recommendations, and the framework can be adapted for other epidemiological modelling. Supporting the clinical guidelines and their ongoing development as evidence evolves may be key to reversing increasing HCC mortality rates in Australia, which are predicted to increase by more than 20% by 2040.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139956321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1101/2024.02.20.24303104
Jia Li, Shuzhang Du, Chengqun Chen, Ziping Ye
Mapping can translate utility values from other health-related quality-of-life scales, giving researchers and policymakers more comprehensive information. The primary objective of the study is to develop mapping algorithms that convert scores from the Oswestry Disability Index (ODI) to the 5-level EuroQol-5 Dimension (EQ-5D-5L). Data for this analysis was sourced from 272 patients suffering from low back pain. The development of the mapping algorithms involved the application of three distinct regression methods across four different settings: ordinary least squares regression, beta regression, and multivariate ordered probit regression. To evaluate the internal validity of these algorithms, we adopted a 'hold-out' approach for predictive performance assessment. Furthermore, to discern the most effective model, three goodness-of-fit tests were employed: the mean absolute error (MAE), the root-mean-square error (RMSE), and the Spearman rank correlation coefficients between the predicted and observed utilities. The study successfully developed several models capable of accurately predicting health utilities in the specified context. The best performing models for ODI to EQ-5D-5L mapping were beta regressions. Mapping algorithms developed in this study enable the estimation of utility values from the ODI. The algorithms formulated in this study facilitate the estimation of utility values based on the ODI, providing a valuable empirical foundation for estimating health utilities in scenarios where EQ-5D data is unavailable.
映射可以转换其他健康相关生活质量量表的效用值，为研究人员和决策者提供更全面的信息。这项研究的主要目的是开发映射算法，将奥斯韦特里残疾指数（Oswestry Disability Index，ODI）的得分转换为五级欧洲量表（EuroQol-5 Dimension，EQ-5D-5L）的得分。本次分析的数据来自 272 名腰背痛患者。映射算法的开发涉及在四种不同的环境中应用三种不同的回归方法：普通最小二乘法回归、贝塔回归和多变量有序概率回归。为了评估这些算法的内部有效性，我们采用了 "保持 "法进行预测性能评估。此外，为了找出最有效的模型，我们采用了三种拟合优度测试：平均绝对误差（MAE）、均方根误差（RMSE）以及预测效用和观测效用之间的斯皮尔曼等级相关系数。这项研究成功开发出了几个能够在特定情况下准确预测健康效用的模型。从 ODI 到 EQ-5D-5L 映射的最佳模型是贝塔回归。本研究开发的映射算法能够根据 ODI 估算效用值。本研究制定的算法有助于根据 ODI 估算效用值，为在没有 EQ-5D 数据的情况下估算健康效用值提供了宝贵的经验基础。
{"title":"Mapping ODI onto EQ-5D-5L in Chinese Low Back Pain Patients","authors":"Jia Li, Shuzhang Du, Chengqun Chen, Ziping Ye","doi":"10.1101/2024.02.20.24303104","DOIUrl":"https://doi.org/10.1101/2024.02.20.24303104","url":null,"abstract":"Mapping can translate utility values from other health-related quality-of-life scales, giving researchers and policymakers more comprehensive information. The primary objective of the study is to develop mapping algorithms that convert scores from the Oswestry Disability Index (ODI) to the 5-level EuroQol-5 Dimension (EQ-5D-5L). Data for this analysis was sourced from 272 patients suffering from low back pain. The development of the mapping algorithms involved the application of three distinct regression methods across four different settings: ordinary least squares regression, beta regression, and multivariate ordered probit regression. To evaluate the internal validity of these algorithms, we adopted a 'hold-out' approach for predictive performance assessment. Furthermore, to discern the most effective model, three goodness-of-fit tests were employed: the mean absolute error (MAE), the root-mean-square error (RMSE), and the Spearman rank correlation coefficients between the predicted and observed utilities. The study successfully developed several models capable of accurately predicting health utilities in the specified context. The best performing models for ODI to EQ-5D-5L mapping were beta regressions. Mapping algorithms developed in this study enable the estimation of utility values from the ODI. The algorithms formulated in this study facilitate the estimation of utility values based on the ODI, providing a valuable empirical foundation for estimating health utilities in scenarios where EQ-5D data is unavailable.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139956362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-18DOI: 10.1101/2024.02.16.24302926
Juan Pablo Diaz Martinez, Therese Aubry de Maraumont, Elly Natty Sánchez, Luis Miguel Camacho Cordero, Eric Yeh
Introduction: This study aims to assess the cost effectiveness of romosozumab versus teriparatide, both sequenced to denosumab, for the treatment of severe postmenopausal osteoporosis at very high risk of fractures in Mexican women. Methods: A Markov model was used to assess the relative cost effectiveness of 1 year of romosozumab versus 2 years of teriparatide, both sequenced to denosumab for a total treatment duration of 5 years. Outcomes for a cohort of women with a mean age of 74 years, a T-score -2.5 and a previous fragility fracture were simulated over a lifetime horizon. The analysis was conducted from the perspective of the Mexican healthcare system and used a discount rate of 5% per annum. To inform relative fracture incidence, the bone mineral density (BMD) advantage of romosozumab over teriparatide was translated into relative risks of fracture, using relationships provided by a meta-regression of osteoporosis therapy trials. Outcomes were assessed in terms of lifetime costs (2023 Mexican pesos), quality-adjusted life years (QALYs) and life-years gained (LYs). Results: Base case results showed that, compared with teriparatide/ denosumab, romosozumab/ denosumab reduced costs by $51,363 MXN per patient and yielded 0.03 additional QALYs and 0.01 LYs. Scenario analyses and probabilistic sensitivity analyses confirmed that results are robust to uncertainty in model assumptions and inputs. Conclusions: Results show that romosozumab/ denosumab produces greater health benefits at a lower total cost than teriparatide/ denosumab.
{"title":"Cost-effectiveness of romosozumab for severe postmenopausal osteoporosis at very high risk of fracture in Mexico.","authors":"Juan Pablo Diaz Martinez, Therese Aubry de Maraumont, Elly Natty Sánchez, Luis Miguel Camacho Cordero, Eric Yeh","doi":"10.1101/2024.02.16.24302926","DOIUrl":"https://doi.org/10.1101/2024.02.16.24302926","url":null,"abstract":"Introduction: This study aims to assess the cost effectiveness of romosozumab versus teriparatide, both sequenced to denosumab, for the treatment of severe postmenopausal osteoporosis at very high risk of fractures in Mexican women. Methods: A Markov model was used to assess the relative cost effectiveness of 1 year of romosozumab versus 2 years of teriparatide, both sequenced to denosumab for a total treatment duration of 5 years. Outcomes for a cohort of women with a mean age of 74 years, a T-score -2.5 and a previous fragility fracture were simulated over a lifetime horizon. The analysis was conducted from the perspective of the Mexican healthcare system and used a discount rate of 5% per annum. To inform relative fracture incidence, the bone mineral density (BMD) advantage of romosozumab over teriparatide was translated into relative risks of fracture, using relationships provided by a meta-regression of osteoporosis therapy trials. Outcomes were assessed in terms of lifetime costs (2023 Mexican pesos), quality-adjusted life years (QALYs) and life-years gained (LYs). Results: Base case results showed that, compared with teriparatide/ denosumab, romosozumab/ denosumab reduced costs by $51,363 MXN per patient and yielded 0.03 additional QALYs and 0.01 LYs. Scenario analyses and probabilistic sensitivity analyses confirmed that results are robust to uncertainty in model assumptions and inputs. Conclusions: Results show that romosozumab/ denosumab produces greater health benefits at a lower total cost than teriparatide/ denosumab.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139904244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-15DOI: 10.1101/2024.02.14.24302706
Sylviane Defres, Patricia Navvuga, Hayley E Hardwick, Ava Easton, Benedict Michael, Rachel Kneen, Michael Griffiths, Antonieta Medina-Lara, Tom Solomon, ENCEPH UK study group
Objective: Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis health outcomes have improved. This paper evaluates the costs and the health-related quality of life implications of these guidelines. Design and setting: A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015. Study participants: Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months. Primary and secondary outcome measures: Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS), and the EuroQoL; health care costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Scare perspective. Results: A total of 49 patients were included, 35 treated within 48 hours ″early″ (median [IQR] 8.25 [3.7-20.5]) and 14 treated after 48 hours (median [IQR] 93.9 [66.7 - 100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0-3) compared to 4 (29%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, £23,086 (95% CI: £15,186 to £30,987) vs £42,405 (95% CI: £25,457 to £59,354) [p<0.04]. A -£20,218 (95% CI: -£52,173 to £11,783) cost difference was observed at 12-month follow-up post discharge. Conclusions: This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.
{"title":"Health economic impact of early versus delayed treatment of herpes simplex virus encephalitis in the UK","authors":"Sylviane Defres, Patricia Navvuga, Hayley E Hardwick, Ava Easton, Benedict Michael, Rachel Kneen, Michael Griffiths, Antonieta Medina-Lara, Tom Solomon, ENCEPH UK study group","doi":"10.1101/2024.02.14.24302706","DOIUrl":"https://doi.org/10.1101/2024.02.14.24302706","url":null,"abstract":"Objective: Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis health outcomes have improved. This paper evaluates the costs and the health-related quality of life implications of these guidelines. Design and setting: A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015. Study participants: Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months. Primary and secondary outcome measures: Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS), and the EuroQoL; health care costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life years (QALYs) were calculated from the EQ-5D utility scores. Cost-utility analysis was performed using the NHS and Social Scare perspective. Results: A total of 49 patients were included, 35 treated within 48 hours ″early″ (median [IQR] 8.25 [3.7-20.5]) and 14 treated after 48 hours (median [IQR] 93.9 [66.7 - 100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0-3) compared to 4 (29%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p<0.000). After adjusting for age and symptom duration at admission, early treatment incurred a lower average cost at discharge, £23,086 (95% CI: £15,186 to £30,987) vs £42,405 (95% CI: £25,457 to £59,354) [p<0.04]. A -£20,218 (95% CI: -£52,173 to £11,783) cost difference was observed at 12-month follow-up post discharge. Conclusions: This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1101/2024.02.10.24302634
Leila Freidoony, Dina Goodman-Palmer, Fred Barker, Mamdou Bountogo, Pascal Geldsetzer, Guy Harling, Lisa R HIrschhorn, Jennifer Manne-Goehler, Mark J Siedner, Stefan T Trautmann, Yilong Xu, Miles Witham, Justine Davies
Background: To ensure resources invested into services are commensurate with benefit, economists utilise various methods to assess value of life. Understanding the performance of these methods in older populations is crucial, particularly in low-and-middle-income countries (LMICs), where the majority of older people will live by 2030. Value of Statistical Life Years (VSLY) is widely used in cost-benefit analyses but rarely been in LMICs or in older people. Objective: This study aimed to investigate the hypothesis that frailty would be associated with a lower VSLY in participants in rural Burkina Faso, when controlling for factors found in other studies likely to affect VSLY, such as socio-demographics, multimorbidity, quality of life, and disability. Methods: The study included 3,988 adults aged 40 years and older from a population-representative household survey done in Nouna, Burkina Faso. Data were collected on sociodemographic characteristics, chronic medical conditions, quality of life, disability, physical performance, and VSLY. Frailty status was derived using Fried's frailty phenotype. Bivariate analyses investigated the association between quintiles of VSLY and frailty. To explore modification of associations by other variables, we built sequential binary logistic regression models comparing each quintile of VSLY with the first (lowest) quintile. Models included frailty category, age, sex, marital status, educational attainment, and wealth. We sequentially added quality of life, multimorbidity, and disability. Results: Of 2,761 survey participants included in this analysis, 51.4% were female. Average age was 54.5 years (with 70.0% aged 40-59 years), 24.8% of respondents reported being alone, and 84.5% had not completed education. In bivariate analyses, we found a significant negative association between higher VSLY and frailty, increasing age, disability, and quality of life. Conversely, being male, married, and educated were positively associated with higher VSLY. The negative association between VSLY and frailty remained significant after adjusting for age, gender, education, wealth, quality of life, disability, and multimorbidity (odds of being frail for VSLY quintile 5 vs quintile 1 was 0.48, 95% CI 0.37-0.64 for the fully adjusted model). Furthermore, effect of age, education, and wealth on VSLY became non-significant once frailty was included in the model. Conclusion: There is a strong relationship between the value that older people place on their lives and their frailty status. Frailty status is important to consider when assessing VSLY, especially in LMICs in which there is a rapidly growing older population.
{"title":"The association between the value of a statistical life and frailty in Burkina Faso","authors":"Leila Freidoony, Dina Goodman-Palmer, Fred Barker, Mamdou Bountogo, Pascal Geldsetzer, Guy Harling, Lisa R HIrschhorn, Jennifer Manne-Goehler, Mark J Siedner, Stefan T Trautmann, Yilong Xu, Miles Witham, Justine Davies","doi":"10.1101/2024.02.10.24302634","DOIUrl":"https://doi.org/10.1101/2024.02.10.24302634","url":null,"abstract":"Background: To ensure resources invested into services are commensurate with benefit, economists utilise various methods to assess value of life. Understanding the performance of these methods in older populations is crucial, particularly in low-and-middle-income countries (LMICs), where the majority of older people will live by 2030. Value of Statistical Life Years (VSLY) is widely used in cost-benefit analyses but rarely been in LMICs or in older people. Objective: This study aimed to investigate the hypothesis that frailty would be associated with a lower VSLY in participants in rural Burkina Faso, when controlling for factors found in other studies likely to affect VSLY, such as socio-demographics, multimorbidity, quality of life, and disability.\u0000Methods: The study included 3,988 adults aged 40 years and older from a population-representative household survey done in Nouna, Burkina Faso. Data were collected on sociodemographic characteristics, chronic medical conditions, quality of life, disability, physical performance, and VSLY. Frailty status was derived using Fried's frailty phenotype. Bivariate analyses investigated the association between quintiles of VSLY and frailty. To explore modification of associations by other variables, we built sequential binary logistic regression models comparing each quintile of VSLY with the first (lowest) quintile. Models included frailty category, age, sex, marital status, educational attainment, and wealth. We sequentially added quality of life, multimorbidity, and disability.\u0000Results: Of 2,761 survey participants included in this analysis, 51.4% were female. Average age was 54.5 years (with 70.0% aged 40-59 years), 24.8% of respondents reported being alone, and 84.5% had not completed education. In bivariate analyses, we found a significant negative association between higher VSLY and frailty, increasing age, disability, and quality of life. Conversely, being male, married, and educated were positively associated with higher VSLY. The negative association between VSLY and frailty remained significant after adjusting for age, gender, education, wealth, quality of life, disability, and multimorbidity (odds of being frail for VSLY quintile 5 vs quintile 1 was 0.48, 95% CI 0.37-0.64 for the fully adjusted model). Furthermore, effect of age, education, and wealth on VSLY became non-significant once frailty was included in the model.\u0000Conclusion: There is a strong relationship between the value that older people place on their lives and their frailty status. Frailty status is important to consider when assessing VSLY, especially in LMICs in which there is a rapidly growing older population.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1101/2024.02.12.24302677
Gerard Dunleavy, Neeladri Verma, Radha Raghupathy, Shivangi Jain, Joao Hofmeister, Rob Cook, Marko Vujicic, Moritz Kebschull, Iain Chapple, Nicola West, Nigel Pitts
Background The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions. Methods A cohort simulation model was developed to estimate direct costs of over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group. Results The population level direct costs of caries from 12 to 65 years of age varied between US10.2bn in Italy to US$36.2bn in Brazil. The highest per-person costs were in the UK at US$22,910 and the lowest in Indonesia at US$7,414. The per-person direct costs were highest in the most deprived group across Brazil, France, Italy and the UK. With the uniform application of preventive measures across all deprivation groups, the greatest reduction in per-person costs for caries management was seen in the most deprived group across all countries except Indonesia. With a levelling-up approach, cost reductions in the most deprived group ranged from US$3,948 in Indonesia to US$17,728 in the UK. Conclusion Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be primarily aimed at reducing early childhood caries, but also applied across all ages.
{"title":"Inequalities in oral health: Estimating the longitudinal economic burden of dental caries by deprivation status in six countries","authors":"Gerard Dunleavy, Neeladri Verma, Radha Raghupathy, Shivangi Jain, Joao Hofmeister, Rob Cook, Marko Vujicic, Moritz Kebschull, Iain Chapple, Nicola West, Nigel Pitts","doi":"10.1101/2024.02.12.24302677","DOIUrl":"https://doi.org/10.1101/2024.02.12.24302677","url":null,"abstract":"Background\u0000The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions. Methods\u0000A cohort simulation model was developed to estimate direct costs of over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group. Results The population level direct costs of caries from 12 to 65 years of age varied between US10.2bn in Italy to US$36.2bn in Brazil. The highest per-person costs were in the UK at US$22,910 and the lowest in Indonesia at US$7,414. The per-person direct costs were highest in the most deprived group across Brazil, France, Italy and the UK. With the uniform application of preventive measures across all deprivation groups, the greatest reduction in per-person costs for caries management was seen in the most deprived group across all countries except Indonesia. With a levelling-up approach, cost reductions in the most deprived group ranged from US$3,948 in Indonesia to US$17,728 in the UK. Conclusion\u0000Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be primarily aimed at reducing early childhood caries, but also applied across all ages.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-11DOI: 10.1101/2024.02.09.24302563
David Knapp, Arie Kapteyn, Alessandro Giambrone, Tabasa Ozawa
The widely cited Lancet Commission concluded that 40% of dementia cases may be preventable through interventions targeting what they refer to as modifiable risk factors. These risk factors have been widely studied individually, but rarely investigated collectively and across many countries. If these factors are “true” (i.e., impactful) modifiable risk factors, then their independent relationship should be robust across countries and comorbidities. We analyze the cross-country consistency of relationships between these modifiable risk factors and episodic memory, a common predictor of cognition and dementia. Using internationally comparable aging studies in 31 countries including the United States, England and Europe, we estimate regressions of combined immediate and delayed word recall with modifiable risk factors and demographic characteristics. Cross-country differences in culture, policies, economy, and other collective experiences lead to significant variation in lifecycle outcomes, including cognitive decline and modifiable risk factors. Our approach does not conclusively affirm a causal relationship but can identify relationships that are weak or nonexistent. We find a limited number of robust relations: education, depression, and hearing loss show clear, consistent associations with our cognition measure. The evidence for other factors, including obesity, smoking, diabetes, and hypertension is weaker and becomes almost non-existent when correcting for multiple hypotheses testing. The inconsistent relationships across countries between episodic memory and obesity, smoking, diabetes, and hypertension suggest the lack of a causal mechanism leading to cognitive decline – a necessary condition for these risk factors to be modifiable and effective targets for policy interventions aimed at controlling dementia prevalence and cost.
{"title":"A cross-country analysis of episodic memory and (potentially) modifiable risk factors of dementia","authors":"David Knapp, Arie Kapteyn, Alessandro Giambrone, Tabasa Ozawa","doi":"10.1101/2024.02.09.24302563","DOIUrl":"https://doi.org/10.1101/2024.02.09.24302563","url":null,"abstract":"The widely cited Lancet Commission concluded that 40% of dementia cases may be preventable through interventions targeting what they refer to as modifiable risk factors. These risk factors have been widely studied individually, but rarely investigated collectively and across many countries. If these factors are “true” (i.e., impactful) modifiable risk factors, then their independent relationship should be robust across countries and comorbidities. We analyze the cross-country consistency of relationships between these modifiable risk factors and episodic memory, a common predictor of cognition and dementia. Using internationally comparable aging studies in 31 countries including the United States, England and Europe, we estimate regressions of combined immediate and delayed word recall with modifiable risk factors and demographic characteristics. Cross-country differences in culture, policies, economy, and other collective experiences lead to significant variation in lifecycle outcomes, including cognitive decline and modifiable risk factors. Our approach does not conclusively affirm a causal relationship but can identify relationships that are weak or nonexistent. We find a limited number of robust relations: education, depression, and hearing loss show clear, consistent associations with our cognition measure. The evidence for other factors, including obesity, smoking, diabetes, and hypertension is weaker and becomes almost non-existent when correcting for multiple hypotheses testing. The inconsistent relationships across countries between episodic memory and obesity, smoking, diabetes, and hypertension suggest the lack of a causal mechanism leading to cognitive decline – a necessary condition for these risk factors to be modifiable and effective targets for policy interventions aimed at controlling dementia prevalence and cost.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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