Pub Date : 2024-02-09DOI: 10.1101/2024.02.08.24302524
David Chipanta, Silas Amo-Agyei, Lucas Hertzog, Ahmad Reza Hosseinpoor, Michael J Smith, Caitlin Mahoney, Juan Gonzalo Jaramillo Meija, Olivia Keiser, Janne Estill
Inequality in access to services is a global problem mainly impacting the poorest populations. The role of social protection in reducing inequalities is recognized, but few studies have investigated whether social protection benefits people facing considerable socioeconomic inequalities. We assessed inequalities in receiving social protection among the public, men and women living with human immunodeficiency virus (PLHIV), and adolescent girls and young women (AGYW), using population-based data from 13 African countries. We constructed concentration curves and computed concentration indices (CIX) for each country and population group. We also conducted a desk review of social protection in the studied countries where information was available on the characteristics of social protection programs and their access by the general population, PLHIV, and AGYW. The sample size ranged from 10,197 in Eswatini to 29,577 in Tanzania. Women comprised 60% or more of PLHIV in the surveyed countries. 50%–70% of the respondents were unemployed, except in Cameroon, Kenya, and Uganda, where less than 50% were unemployed. Generally, the proportion of respondents from wealth quintile one (Q1), the poorest 20% of households, was like that from Q2–Q5. The proportion of the general population receiving social protection varied from 5.2% (95% Confidence Interval 4.5%–6.0%) in Ethiopia to 39.9% (37.0%–42.8%) in Eswatini. Among PLHIV, the proportion receiving social protection varied from 6.9% (5.7%–8.4%) among men living with HIV in Zambia to 45.0% (41.2–49.0) among women living with HIV in Namibia. Among AGYW, the proportion varied from 4.4% (3.6–5.3) in Ethiopia to 44.6% (40.8–48.5) in Eswatini. In general, 15% or less of the respondents from Q1 reported receiving social protection in eight countries (i.e., Cameroon, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Tanzania, Uganda, and Zambia), with 10% or less in three countries (Cameroon, Côte d'Ivoire, and Ethiopia); 15%–20% in Rwanda, 30% in Zimbabwe, 40% in Lesotho, and more than 50% in Eswatini and Namibia. Among the wealthiest quintiles (Q5), the proportion receiving social protection ranged from 3.6% (2.6%–5.0%) in Ethiopia to 19.7% (16.25–23.8%) in Namibia. Only in countries with higher social protection coverage did the proportion of the poorest wealth quintile households reached also high. Socioeconomic inequalities in receiving social protection favored the poor in 11 out of 13 countries and the rich in Cameroon and were undefined in Côte d'Ivoire. The CIX values for socioeconomic inequalities in receiving social protection in these 11 countries ranged from −0.080 (p=0.002) among the general population in Malawi to −0.372 (p< 0.001) among WLHIV in Zimbabwe. However, in 8 countries (Cameroon, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Tanzania, Uganda, and Zambia) of these 11 countries, 15% or less of the population from the poorest wealth quintile received social protection. In the countries surveyed, access to soc
{"title":"Missing the vulnerable – Inequalities in social protection among the general population, people living with HIV, and adolescent girls and young women in 13 sub-Saharan African countries: Analysis of population-based surveys","authors":"David Chipanta, Silas Amo-Agyei, Lucas Hertzog, Ahmad Reza Hosseinpoor, Michael J Smith, Caitlin Mahoney, Juan Gonzalo Jaramillo Meija, Olivia Keiser, Janne Estill","doi":"10.1101/2024.02.08.24302524","DOIUrl":"https://doi.org/10.1101/2024.02.08.24302524","url":null,"abstract":"Inequality in access to services is a global problem mainly impacting the poorest populations. The role of social protection in reducing inequalities is recognized, but few studies have investigated whether social protection benefits people facing considerable socioeconomic inequalities. We assessed inequalities in receiving social protection among the public, men and women living with human immunodeficiency virus (PLHIV), and adolescent girls and young women (AGYW), using population-based data from 13 African countries. We constructed concentration curves and computed concentration indices (CIX) for each country and population group. We also conducted a desk review of social protection in the studied countries where information was available on the characteristics of social protection programs and their access by the general population, PLHIV, and AGYW. The sample size ranged from 10,197 in Eswatini to 29,577 in Tanzania. Women comprised 60% or more of PLHIV in the surveyed countries. 50%–70% of the respondents were unemployed, except in Cameroon, Kenya, and Uganda, where less than 50% were unemployed. Generally, the proportion of respondents from wealth quintile one (Q1), the poorest 20% of households, was like that from Q2–Q5. The proportion of the general population receiving social protection varied from 5.2% (95% Confidence Interval 4.5%–6.0%) in Ethiopia to 39.9% (37.0%–42.8%) in Eswatini. Among PLHIV, the proportion receiving social protection varied from 6.9% (5.7%–8.4%) among men living with HIV in Zambia to 45.0% (41.2–49.0) among women living with HIV in Namibia. Among AGYW, the proportion varied from 4.4% (3.6–5.3) in Ethiopia to 44.6% (40.8–48.5) in Eswatini. In general, 15% or less of the respondents from Q1 reported receiving social protection in eight countries (i.e., Cameroon, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Tanzania, Uganda, and Zambia), with 10% or less in three countries (Cameroon, Côte d'Ivoire, and Ethiopia); 15%–20% in Rwanda, 30% in Zimbabwe, 40% in Lesotho, and more than 50% in Eswatini and Namibia. Among the wealthiest quintiles (Q5), the proportion receiving social protection ranged from 3.6% (2.6%–5.0%) in Ethiopia to 19.7% (16.25–23.8%) in Namibia. Only in countries with higher social protection coverage did the proportion of the poorest wealth quintile households reached also high. Socioeconomic inequalities in receiving social protection favored the poor in 11 out of 13 countries and the rich in Cameroon and were undefined in Côte d'Ivoire. The CIX values for socioeconomic inequalities in receiving social protection in these 11 countries ranged from −0.080 (p=0.002) among the general population in Malawi to −0.372 (p< 0.001) among WLHIV in Zimbabwe. However, in 8 countries (Cameroon, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Tanzania, Uganda, and Zambia) of these 11 countries, 15% or less of the population from the poorest wealth quintile received social protection. In the countries surveyed, access to soc","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756916","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 : 2024-02-08DOI: 10.1101/2024.02.07.24302381
Milena Suarez Castillo, David Benatia, Christine Le Thi, Vianney Costemalle
This paper examines the differential impacts of early childhood exposure to air pollution on children’s health care use across parental income groups and vulnerability factors using French administrative data. Our quasi-experimental study reveals significant impacts on emergency admissions and respiratory medication in young children, attributed to air pollution shocks from thermal inversions. Using causal machine learning, we identify these health impacts as predominantly affecting 10% of infants, characterized by poor health indicators at birth and lower parental income. Our results suggest that intervention strategies focusing on vulnerability metrics may be more effective than those based solely on exposure levels.
{"title":"Air Pollution and Children’s Health Inequalities","authors":"Milena Suarez Castillo, David Benatia, Christine Le Thi, Vianney Costemalle","doi":"10.1101/2024.02.07.24302381","DOIUrl":"https://doi.org/10.1101/2024.02.07.24302381","url":null,"abstract":"This paper examines the differential impacts of early childhood exposure to air pollution on children’s health care use across parental income groups and vulnerability factors using French administrative data. Our quasi-experimental study reveals significant impacts on emergency admissions and respiratory medication in young children, attributed to air pollution shocks from thermal inversions. Using causal machine learning, we identify these health impacts as predominantly affecting 10% of infants, characterized by poor health indicators at birth and lower parental income. Our results suggest that intervention strategies focusing on vulnerability metrics may be more effective than those based solely on exposure levels.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756850","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 : 2024-02-08DOI: 10.1101/2024.02.06.24302436
Amadou Oury Toure, Tapsoba Yanne, Fadima Yaya Bocoum, Seni Kouanda
End-stage renal disease (ESRD) is a late diagnosis. Its prevalence is rapidly increasing worldwide. Although various management techniques exist, they all require access routes. The arteriovenous fistula (AVF) is the vascular access of choice for regular and prolonged hemodialysis sessions. Studies have shown that an AVF saves patients money. In our context, we found no data in the literature on the cost of AVF and the lump-sum cost. The aim of this study was to determine the average costs of AVF and lump-sum costs, and to describe patients’ coping strategies in relation to these costs.
{"title":"The cost of arteriovenous fistula placement in patients with chronic end-stage renal disease in Ouagadougou (Burkina Faso) 2020","authors":"Amadou Oury Toure, Tapsoba Yanne, Fadima Yaya Bocoum, Seni Kouanda","doi":"10.1101/2024.02.06.24302436","DOIUrl":"https://doi.org/10.1101/2024.02.06.24302436","url":null,"abstract":"End-stage renal disease (ESRD) is a late diagnosis. Its prevalence is rapidly increasing worldwide. Although various management techniques exist, they all require access routes. The arteriovenous fistula (AVF) is the vascular access of choice for regular and prolonged hemodialysis sessions. Studies have shown that an AVF saves patients money. In our context, we found no data in the literature on the cost of AVF and the lump-sum cost. The aim of this study was to determine the average costs of AVF and lump-sum costs, and to describe patients’ coping strategies in relation to these costs.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756921","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}
Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This study takes a problem-driven political economy analysis (PEA) approach to investigate the challenges and opportunities surrounding health tax implementation, with a particular focus on sub-national government in Indonesia, where the decentralization context of health tax remains understudied. Employing a qualitative methodology by collecting data from a total of twelve focus group discussions (FGDs) conducted in three provinces—Lampung, Special Region of/Daerah Istimewa (DI) Yogyakarta, and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs), and alcoholic beverages—we explore the multifaceted dynamics of health tax policies. These FGDs involved 117 participants, representing governmental institutions, non-governmental organizations (NGOs), and consumers. Our findings reveal that while health tax policies have the potential to contribute significantly to public health, challenges such as a lack of consumer awareness, bureaucratic complexities, and decentralized governance hinder implementation. Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardized packaging. Addressing these challenges is critical for realizing the full potential of health tax policies.
{"title":"Political Economy Analysis of Health Taxes (Tobacco, Alcohol Drink, and Sugar Sweteened Beverage): Case Study of Three Provinces in Indonesia","authors":"Abdillah Ahsan, Nadira Amalia, Krisna Puji Rahmayanti, Nadhila Adani, Nur Hadi Wiyono, Althof Endawansa, Maulida Gadis Utami, Adela Miranti Yuniar, Erika Valentina Anastasia, Yuyu Buono Ayuning Pertiwi","doi":"10.1101/2024.01.31.24302078","DOIUrl":"https://doi.org/10.1101/2024.01.31.24302078","url":null,"abstract":"Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This study takes a problem-driven political economy analysis (PEA) approach to investigate the challenges and opportunities surrounding health tax implementation, with a particular focus on sub-national government in Indonesia, where the decentralization context of health tax remains understudied. Employing a qualitative methodology by collecting data from a total of twelve focus group discussions (FGDs) conducted in three provinces—Lampung, Special Region of/Daerah Istimewa (DI) Yogyakarta, and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs), and alcoholic beverages—we explore the multifaceted dynamics of health tax policies. These FGDs involved 117 participants, representing governmental institutions, non-governmental organizations (NGOs), and consumers. Our findings reveal that while health tax policies have the potential to contribute significantly to public health, challenges such as a lack of consumer awareness, bureaucratic complexities, and decentralized governance hinder implementation. Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardized packaging. Addressing these challenges is critical for realizing the full potential of health tax policies.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139657586","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 : 2024-01-31DOI: 10.1101/2024.01.30.24302015
Tianyu Sun, Linwei Li, Katherine Mues, Mihaela Georgieva, Brenna Kirk, James Mansi, Nicolas Van de Velde, Ekkehard Beck
Recent data have shown elevated infection rates in several subpopulations at risk of SARS-CoV-2 infection and COVID-19, including immunocompromised (IC) individuals. Previous research suggests that IC persons have reduced risks of hospitalization and medically-attended COVID-19 with 2 doses of mRNA-1273 (SpikeVax; Moderna) compared to two doses of BNT162b2 (Comirnaty; Pfizer/BioNTech). The main objective of this retrospective cohort study was to compare real-world effectiveness of third doses of mRNA-1273 versus BNT162b2 at multiple time points on occurrence of COVID-19 hospitalization and medically-attended COVID-19 among IC adults in the US. The HealthVerity (HV) medical and pharmacy claims database, which contains data from >330 million patients, was the data source. Both subgroup and sensitivity analyses were conducted in addition to the core comparisons noted. In propensity score-adjusted analyses, receiving mRNA-1273 vs BNT162b2 as third dose was associated with 32% (relative risk [RR] 0.68; 95% confidence interval [CI] 0.51-0.89) , 29% (0.71; 0.57-0.86), and 23% (0.77; 0.62-0.93) lower risk of COVID-19 hospitalization after 90, 180, and 270 days, respectively. Corresponding reductions in medically-attended COVID-19 were 8% (0.92; 0.86-0.98), 6% (0.94; 0.90-0.98), and 2% (0.98; 0.94-1.02), respectively. Our findings suggest a third dose of mRNA-1273 is more effective than a third dose of BNT162b2 in preventing COVID-19 hospitalization and breakthrough medically-attended COVID-19 among IC adults in the US.
{"title":"Real-World Effectiveness of a Third Dose of mRNA-1273 versus BNT162b2 on Inpatient and Medically Attended COVID-19 among Immunocompromised Adults in the United States","authors":"Tianyu Sun, Linwei Li, Katherine Mues, Mihaela Georgieva, Brenna Kirk, James Mansi, Nicolas Van de Velde, Ekkehard Beck","doi":"10.1101/2024.01.30.24302015","DOIUrl":"https://doi.org/10.1101/2024.01.30.24302015","url":null,"abstract":"Recent data have shown elevated infection rates in several subpopulations at risk of SARS-CoV-2 infection and COVID-19, including immunocompromised (IC) individuals. Previous research suggests that IC persons have reduced risks of hospitalization and medically-attended COVID-19 with 2 doses of mRNA-1273 (SpikeVax; Moderna) compared to two doses of BNT162b2 (Comirnaty; Pfizer/BioNTech). The main objective of this retrospective cohort study was to compare real-world effectiveness of third doses of mRNA-1273 versus BNT162b2 at multiple time points on occurrence of COVID-19 hospitalization and medically-attended COVID-19 among IC adults in the US. The HealthVerity (HV) medical and pharmacy claims database, which contains data from >330 million patients, was the data source. Both subgroup and sensitivity analyses were conducted in addition to the core comparisons noted. In propensity score-adjusted analyses, receiving mRNA-1273 vs BNT162b2 as third dose was associated with 32% (relative risk [RR] 0.68; 95% confidence interval [CI] 0.51-0.89) , 29% (0.71; 0.57-0.86), and 23% (0.77; 0.62-0.93) lower risk of COVID-19 hospitalization after 90, 180, and 270 days, respectively. Corresponding reductions in medically-attended COVID-19 were 8% (0.92; 0.86-0.98), 6% (0.94; 0.90-0.98), and 2% (0.98; 0.94-1.02), respectively. Our findings suggest a third dose of mRNA-1273 is more effective than a third dose of BNT162b2 in preventing COVID-19 hospitalization and breakthrough medically-attended COVID-19 among IC adults in the US.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139657499","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 : 2024-01-13DOI: 10.1101/2024.01.12.24301234
Akshay Swaminathan, Wasan Kumar, Benjamin Jacobson, Lathan Liou, Ivan Lopez, Caroline Yao, Sarthak Shah
Introduction Access to affordable health coverage for individuals aged 51 and older, particularly those transitioning out of employer-sponsored insurance or with existing health conditions, is challenging in the United States. This study investigates the potential impact of lowering the Medicare eligibility age on healthcare utilization, focusing on elective procedures among late middle-aged individuals. Previous studies indicate significant increases in healthcare utilization around the Medicare eligibility threshold, but a national-level analysis is needed to understand the implications of policy changes in Medicare eligibility.
{"title":"The Association Between Medicare Eligibility on Elective Procedures and Hospital Transfers: A regression discontinuity design applied to the National Inpatient Sample","authors":"Akshay Swaminathan, Wasan Kumar, Benjamin Jacobson, Lathan Liou, Ivan Lopez, Caroline Yao, Sarthak Shah","doi":"10.1101/2024.01.12.24301234","DOIUrl":"https://doi.org/10.1101/2024.01.12.24301234","url":null,"abstract":"<strong>Introduction</strong> Access to affordable health coverage for individuals aged 51 and older, particularly those transitioning out of employer-sponsored insurance or with existing health conditions, is challenging in the United States. This study investigates the potential impact of lowering the Medicare eligibility age on healthcare utilization, focusing on elective procedures among late middle-aged individuals. Previous studies indicate significant increases in healthcare utilization around the Medicare eligibility threshold, but a national-level analysis is needed to understand the implications of policy changes in Medicare eligibility.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139483092","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 : 2023-12-12DOI: 10.1101/2023.12.10.23299653
Donald S. Shepard, Aung K. Lwin, Sunish I. Pulikkottil, Mariapillai Kalimuthu, Natarajan Arunachalam, Brij K. Tyagi, Graham B. White
Background/Methodology: Despite progress using mass drug administration (MDA), lymphatic filariasis (LF) remains a major public health issue in India. Vector control (VC) is hypothesized as a potentially useful addition to MDA towards LF elimination. We conducted cost-effectiveness analysis of MDA alone and augmented by VC single (VCS) or integrated VC approaches (VCI). Data came from historical controls and a 3-arm cluster randomized trial of 36 villages at risk of LF transmission in Tamil Nadu, India. The arms were: MDA alone (the standard of care); VCS (MDA plus expanded polystyrene beads for covering the water surface in wells and cesspits to suppress the filariasis vector mosquito Culex quinquefasciatus), and VCI (VCS plus insecticidal pyrethroid impregnated curtains over windows, doors, and eaves). Economic costs in 2010 US$ combined government and community inputs from household to state levels. Outcomes were controlled microfilaria prevalence (MfP) and antigen prevalence (AgP) to conventional elimination targets (MfP<1% and AgP<2%) from 2010 to 2013, and disability adjusted life years (DALYs) averted. Principal Findings: The estimated annual economic cost per resident was US$0.53 for MDA alone, US$1.02 for VCS, and US$1.83 for VCI. With MDA offered in all arms, all reduced LF prevalence substantially and significantly from 2010 to 2013. MDA proved highly cost effective at $112 per DALY, a very small (8%) share of India's then per capita GDP. Progress towards elimination was comparable across all three study arms. Conclusions: The well-functioning MDA was effective and very cost-effective for eliminating LF, leaving little scope for further improvement. Supplementary VC demonstrated no statistically significant additional benefit in this trial.
{"title":"Cost-effectiveness of vector control strategies for supplementing mass drug administration for eliminating lymphatic filariasis in India","authors":"Donald S. Shepard, Aung K. Lwin, Sunish I. Pulikkottil, Mariapillai Kalimuthu, Natarajan Arunachalam, Brij K. Tyagi, Graham B. White","doi":"10.1101/2023.12.10.23299653","DOIUrl":"https://doi.org/10.1101/2023.12.10.23299653","url":null,"abstract":"Background/Methodology: Despite progress using mass drug administration (MDA), lymphatic filariasis (LF) remains a major public health issue in India. Vector control (VC) is hypothesized as a potentially useful addition to MDA towards LF elimination. We conducted cost-effectiveness analysis of MDA alone and augmented by VC single (VCS) or integrated VC approaches (VCI). Data came from historical controls and a 3-arm cluster randomized trial of 36 villages at risk of LF transmission in Tamil Nadu, India. The arms were: MDA alone (the standard of care); VCS (MDA plus expanded polystyrene beads for covering the water surface in wells and cesspits to suppress the filariasis vector mosquito Culex quinquefasciatus), and VCI (VCS plus insecticidal pyrethroid impregnated curtains over windows, doors, and eaves). Economic costs in 2010 US$ combined government and community inputs from household to state levels. Outcomes were controlled microfilaria prevalence (MfP) and antigen prevalence (AgP) to conventional elimination targets (MfP<1% and AgP<2%) from 2010 to 2013, and disability adjusted life years (DALYs) averted.\u0000Principal Findings: The estimated annual economic cost per resident was US$0.53 for MDA alone, US$1.02 for VCS, and US$1.83 for VCI. With MDA offered in all arms, all reduced LF prevalence substantially and significantly from 2010 to 2013. MDA proved highly cost effective at $112 per DALY, a very small (8%) share of India's then per capita GDP. Progress towards elimination was comparable across all three study arms.\u0000Conclusions: The well-functioning MDA was effective and very cost-effective for eliminating LF, leaving little scope for further improvement. Supplementary VC demonstrated no statistically significant additional benefit in this trial.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138628872","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 : 2023-12-10DOI: 10.1101/2023.12.09.23299763
Padraig Dixon, Emma Louise Anderson
BACKGROUND Alzheimer`s disease and other dementias are progressive neurodegenerative disorders with profound impacts on cognitive function. There is a shortage of economic evidence relating to the impact Alzheimer`s disease on healthcare costs and quality-adjusted life-years (QALYs). METHODS. We employed two study designs to model the association between Alzheimer`s disease and healthcare costs and QALYs. We first estimated conventional multivariable models of the association between Alzheimer`s disease and these core economic outcomes. However, these types of model may be confounded by diseases, processes, or traits that independently affect Alzheimer`s disease and either or both of healthcare costs and QALYs. We therefore also explored a complementary approach using germline genetic variation as instrumental variables in a Mendelian randomization analysis. We used single nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies of Alzheimer`s disease as instruments. We studied outcome data on inpatient hospital costs and QALYs in the UK Biobank cohort. RESULTS Data from up to 310,838 individuals were analyzed. N=55 cases of Alzheimer`s disease were reported at or before recruitment into UK Biobank. A further N=284 incident cases were identified over follow-up. Multivariable observational analysis of the prevalent cases suggested significant impacts on costs (GBP1,140 in cases, 95% Confidence Interval (CI): GBP825 to GBP1,456) and QALYs (-25%, 95% CI: -28% to -21%). Mendelian randomization estimates were very imprecise for costs (GBP3,082, 95% CI: -GBP7,183 to GBP13,348) and QALYs (-32%, 95% CI: -149% to 85%), likely due to the small proportion of variance (0.9%) explained in Alzheimer`s disease status by the most predictive set of SNPs. IMPLICATIONS Conventional multivariable models suggested important impacts of Alzheimer`s disease on inpatient hospital costs and QALYs, although this finding was based on very few cases which may have included instances of early-onset dementia. Mendelian randomization was very imprecise. Larger GWAS of clinical cases, improved understanding of the architecture of the disease, and the follow-up of cohorts until old age and death will help overcome these challenges.
{"title":"Associations of Alzheimer's disease with inpatient hospital costs and with quality-adjusted life years: Evidence from conventional and Mendelian randomization analyses in the UK Biobank","authors":"Padraig Dixon, Emma Louise Anderson","doi":"10.1101/2023.12.09.23299763","DOIUrl":"https://doi.org/10.1101/2023.12.09.23299763","url":null,"abstract":"BACKGROUND Alzheimer`s disease and other dementias are progressive neurodegenerative disorders with profound impacts on cognitive function. There is a shortage of economic evidence relating to the impact Alzheimer`s disease on healthcare costs and quality-adjusted life-years (QALYs). METHODS. We employed two study designs to model the association between Alzheimer`s disease and healthcare costs and QALYs. We first estimated conventional multivariable models of the association between Alzheimer`s disease and these core economic outcomes. However, these types of model may be confounded by diseases, processes, or traits that independently affect Alzheimer`s disease and either or both of healthcare costs and QALYs. We therefore also explored a complementary approach using germline genetic variation as instrumental variables in a Mendelian randomization analysis. We used single nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies of Alzheimer`s disease as instruments. We studied outcome data on inpatient hospital costs and QALYs in the UK Biobank cohort. RESULTS Data from up to 310,838 individuals were analyzed. N=55 cases of Alzheimer`s disease were reported at or before recruitment into UK Biobank. A further N=284 incident cases were identified over follow-up. Multivariable observational analysis of the prevalent cases suggested significant impacts on costs (GBP1,140 in cases, 95% Confidence Interval (CI): GBP825 to GBP1,456) and QALYs (-25%, 95% CI: -28% to -21%). Mendelian randomization estimates were very imprecise for costs (GBP3,082, 95% CI: -GBP7,183 to GBP13,348) and QALYs (-32%, 95% CI: -149% to 85%), likely due to the small proportion of variance (0.9%) explained in Alzheimer`s disease status by the most predictive set of SNPs. IMPLICATIONS Conventional multivariable models suggested important impacts of Alzheimer`s disease on inpatient hospital costs and QALYs, although this finding was based on very few cases which may have included instances of early-onset dementia. Mendelian randomization was very imprecise. Larger GWAS of clinical cases, improved understanding of the architecture of the disease, and the follow-up of cohorts until old age and death will help overcome these challenges.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138565894","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 : 2023-12-09DOI: 10.1101/2023.12.08.23292892
Alexandra Guttentag, Haider J Warraich, Jeroen van Meijgaard
There is a growing need for understanding and addressing the issue of healthcare cost literacy (HCL) in the United States. We conducted a survey in partnership with YouGov targeting a representative sample of 1500 American adults (median age 47, 51.4% female, 62.8% white) to help develop a novel tool to assess the prevalence of HCL, and to estimate levels of HCL and health literacy across various sociodemographic and health-related variables. An exploratory factor analysis revealed that the HCL questions mapped to three factors: 1) knowledge on health insurance terminology/interpretation, 2) ability to estimate healthcare costs ahead of time, and 3) confidence in performing cost comparisons between healthcare plans and deductibles. An understanding of Americans’ levels of HCL will help policymakers and various stakeholders in the healthcare system to develop targeted plans to educate consumers on financial planning and evaluation in the healthcare system.
{"title":"Healthcare Cost Literacy: Exploration of Concept and Initial Development of a Novel Tool in a Representative U.S. Adult Population","authors":"Alexandra Guttentag, Haider J Warraich, Jeroen van Meijgaard","doi":"10.1101/2023.12.08.23292892","DOIUrl":"https://doi.org/10.1101/2023.12.08.23292892","url":null,"abstract":"There is a growing need for understanding and addressing the issue of healthcare cost literacy (HCL) in the United States. We conducted a survey in partnership with YouGov targeting a representative sample of 1500 American adults (median age 47, 51.4% female, 62.8% white) to help develop a novel tool to assess the prevalence of HCL, and to estimate levels of HCL and health literacy across various sociodemographic and health-related variables. An exploratory factor analysis revealed that the HCL questions mapped to three factors: 1) knowledge on health insurance terminology/interpretation, 2) ability to estimate healthcare costs ahead of time, and 3) confidence in performing cost comparisons between healthcare plans and deductibles. An understanding of Americans’ levels of HCL will help policymakers and various stakeholders in the healthcare system to develop targeted plans to educate consumers on financial planning and evaluation in the healthcare system.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138576207","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 : 2023-12-07DOI: 10.1101/2023.12.06.23299601
Oliver Carlile, Andrew Briggs, Alasdair Henderson, Ben Butler-Cole, John Tazare, Laurie Tomlinson, Michael Marks, Mark Jit, Liang-Yu Lin, Chris Bates, John Parry, Sebastian Bacon, Iain Dillingham, William Dennison, Ruth Costello, Alex Walker, William J Hulme, Ben Goldacre, Amir Mehrkar, Brian MacKenna, The OpenSAFELY Collaborative, Emily Herrett, Rosalind Eggo
Background Long COVID is a major problem affecting patient health, the health service, and the workforce. To optimise the design of future interventions against COVID-19, and to better plan and allocate health resources, it is critical to quantify the health and economic burden of this novel condition. Methods With the approval of NHS England, we developed OpenPROMPT, a UK cohort study measuring the impact of long COVID on health-related quality-of-life (HRQoL). OpenPROMPT invited responses to Patient Reported Outcome Measures (PROMs) using a smartphone application and recruited between November 2022 and October 2023. We used the validated EuroQol EQ-5D questionnaire with the UK Value Set to develop disutility scores (1-utility) for respondents with and without Long COVID using linear mixed models, and we calculated subsequent Quality-Adjusted Life-Months (QALMs) for long COVID. Results We used data from 6,070 participants where 24.7% self-reported long COVID. In multivariable regressions, long COVID had a consistent impact on HRQoL, showing a high probability of reporting loss in quality-of-life (OR: 22, 95% CI:12.35-39.29) compared with people who did not report long COVID. Reporting a disability was the largest predictor of losses of HRQoL (OR: 60.2, 95% CI: 27.79-130.57) across survey responses. Self-reported long COVID was associated with an 0.37 QALM loss. Conclusions We found substantial impacts on quality-of-life due to long COVID, representing a major burden on patients and the health service. We highlight the need for continued support and research for long COVID, as HRQoL scores compared unfavourably to patients with conditions such as multiple sclerosis, heart failure, and renal disease.
{"title":"The impact of Long COVID on Health-Related Quality-of-life using OpenPROMPT","authors":"Oliver Carlile, Andrew Briggs, Alasdair Henderson, Ben Butler-Cole, John Tazare, Laurie Tomlinson, Michael Marks, Mark Jit, Liang-Yu Lin, Chris Bates, John Parry, Sebastian Bacon, Iain Dillingham, William Dennison, Ruth Costello, Alex Walker, William J Hulme, Ben Goldacre, Amir Mehrkar, Brian MacKenna, The OpenSAFELY Collaborative, Emily Herrett, Rosalind Eggo","doi":"10.1101/2023.12.06.23299601","DOIUrl":"https://doi.org/10.1101/2023.12.06.23299601","url":null,"abstract":"Background\u0000Long COVID is a major problem affecting patient health, the health service, and the workforce. To optimise the design of future interventions against COVID-19, and to better plan and allocate health resources, it is critical to quantify the health and economic burden of this novel condition.\u0000Methods\u0000With the approval of NHS England, we developed OpenPROMPT, a UK cohort study measuring the impact of long COVID on health-related quality-of-life (HRQoL). OpenPROMPT invited responses to Patient Reported Outcome Measures (PROMs) using a smartphone application and recruited between November 2022 and October 2023. We used the validated EuroQol EQ-5D questionnaire with the UK Value Set to develop disutility scores (1-utility) for respondents with and without Long COVID using linear mixed models, and we calculated subsequent Quality-Adjusted Life-Months (QALMs) for long COVID.\u0000Results\u0000We used data from 6,070 participants where 24.7% self-reported long COVID. In multivariable regressions, long COVID had a consistent impact on HRQoL, showing a high probability of reporting loss in quality-of-life (OR: 22, 95% CI:12.35-39.29) compared with people who did not report long COVID. Reporting a disability was the largest predictor of losses of HRQoL (OR: 60.2, 95% CI: 27.79-130.57) across survey responses. Self-reported long COVID was associated with an 0.37 QALM loss.\u0000Conclusions\u0000We found substantial impacts on quality-of-life due to long COVID, representing a major burden on patients and the health service. We highlight the need for continued support and research for long COVID, as HRQoL scores compared unfavourably to patients with conditions such as multiple sclerosis, heart failure, and renal disease.","PeriodicalId":501072,"journal":{"name":"medRxiv - Health Economics","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138555296","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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