Pub Date : 2023-12-01Epub Date: 2023-06-02DOI: 10.1007/s12070-023-03915-x
Chethana R, Prasun Mishra, Shivani Dixit, Rakhee Raghavan, S S Pranaya Deepika
Nasal mucociliary clearance (NMC) plays an important role in removal of inhaled particles. The aim of this study was to assess the normal nasal mucociliary clearance time in Indian adult population in age group 18-60 years. A cross sectional, descriptive, observational study was performed. Two hundred participants in the age group 18-60 years were included in this study. Saccharin transit test was performed in these subjects. Saccharin particle was placed 0.5 cm away from the inferior turbinate from its anterior part. The participants were asked to inform the appearance of sweet taste. Duration between placement of particle and the appearance of taste was noted in minutes. Mean saccharin transit time was 9.44?2.73 minutes. There was no statistically significant difference in saccharin transit time between males & females. Nasal mucociliary clearance time between < 40 years & ≥40 years was compared and there was no significant difference between the 2 groups. The normal mucociliary clearance value in healthy adult Indian population-based on saccharin transit time is 9.44 ± 2.73 min. The earliest change in respiratory defense mechanism is change in nasal mucociliary clearance time and saccharin test is a simple, easy test to detect this.
Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-03915-x.
{"title":"Measurement of Nasal Mucociliary Clearance in Indian Adults: Normative Data.","authors":"Chethana R, Prasun Mishra, Shivani Dixit, Rakhee Raghavan, S S Pranaya Deepika","doi":"10.1007/s12070-023-03915-x","DOIUrl":"10.1007/s12070-023-03915-x","url":null,"abstract":"<p><p>Nasal mucociliary clearance (NMC) plays an important role in removal of inhaled particles. The aim of this study was to assess the normal nasal mucociliary clearance time in Indian adult population in age group 18-60 years. A cross sectional, descriptive, observational study was performed. Two hundred participants in the age group 18-60 years were included in this study. Saccharin transit test was performed in these subjects. Saccharin particle was placed 0.5 cm away from the inferior turbinate from its anterior part. The participants were asked to inform the appearance of sweet taste. Duration between placement of particle and the appearance of taste was noted in minutes. Mean saccharin transit time was 9.44?2.73 minutes. There was no statistically significant difference in saccharin transit time between males & females. Nasal mucociliary clearance time between < 40 years & ≥40 years was compared and there was no significant difference between the 2 groups. The normal mucociliary clearance value in healthy adult Indian population-based on saccharin transit time is 9.44 ± 2.73 min. The earliest change in respiratory defense mechanism is change in nasal mucociliary clearance time and saccharin test is a simple, easy test to detect this.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12070-023-03915-x.</p>","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"48 2 1","pages":"2990-2992"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10645800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90557662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acknowledgments.","authors":"","doi":"10.1111/1468-0009.12550","DOIUrl":"https://doi.org/10.1111/1468-0009.12550","url":null,"abstract":"","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"114 1","pages":"1198-1206"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79246590","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}
{"title":"In the December 2019 Issue of the\u0000 Quarterly","authors":"A. Cohen","doi":"10.1111/1468-0009.12434","DOIUrl":"https://doi.org/10.1111/1468-0009.12434","url":null,"abstract":"","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85828599","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}
{"title":"Acknowledgments","authors":"","doi":"10.1111/1468-0009.12445","DOIUrl":"https://doi.org/10.1111/1468-0009.12445","url":null,"abstract":"","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84300766","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}
• Lawrence Gostin’s assessment of the World Health Organization’s Global Action Plan to promote the health of refugees and migrants reveals serious inadequacies and inequities among nations. He calls for member states to share the burden of providing needed services on a more equal and fair basis. • A stated goal of the new “Primary Cares Initiative” of the Centers for Medicare and Medicaid Services (CMS) is the transformation of primary care delivery from a fee-for-service driven enterprise to one involving value-based payment. In a guest opinion, K. John McConnell appraises the initiative’s two-part design—Primary Care First and Direct Contracting—and raises questions regarding its ability to catalyze wide reform. • In addition to focusing on primary care, CMS also has tried to transform hospital care by promoting patient safety in its hospital payment policies. Yet, despite efforts to penalize hospitals for poor safety performance, Gail Wilensky notes that patient safety issues continue to plague American hospitals, and she ponders whether low-scoring hospitals are receiving the assistance they need to improve their performance. • Paula Lantz examines the recent spate of state laws restricting abortion and urges policymakers to document the impact of such laws, arguing that it is in society’s best interests to produce nonbiased, valid estimates of the death and morbidity toll from these policies. • Harold Pollack poignantly describes the plight of pregnant and parenting women struggling with opioid addiction, and cautions against repeating the harmful, stigmatizing media coverage that marked the crack epidemic 25 years ago. He argues that
{"title":"In the September 2019 Issue of the Quarterly.","authors":"A. Cohen","doi":"10.1111/1468-0009.12415","DOIUrl":"https://doi.org/10.1111/1468-0009.12415","url":null,"abstract":"• Lawrence Gostin’s assessment of the World Health Organization’s Global Action Plan to promote the health of refugees and migrants reveals serious inadequacies and inequities among nations. He calls for member states to share the burden of providing needed services on a more equal and fair basis. • A stated goal of the new “Primary Cares Initiative” of the Centers for Medicare and Medicaid Services (CMS) is the transformation of primary care delivery from a fee-for-service driven enterprise to one involving value-based payment. In a guest opinion, K. John McConnell appraises the initiative’s two-part design—Primary Care First and Direct Contracting—and raises questions regarding its ability to catalyze wide reform. • In addition to focusing on primary care, CMS also has tried to transform hospital care by promoting patient safety in its hospital payment policies. Yet, despite efforts to penalize hospitals for poor safety performance, Gail Wilensky notes that patient safety issues continue to plague American hospitals, and she ponders whether low-scoring hospitals are receiving the assistance they need to improve their performance. • Paula Lantz examines the recent spate of state laws restricting abortion and urges policymakers to document the impact of such laws, arguing that it is in society’s best interests to produce nonbiased, valid estimates of the death and morbidity toll from these policies. • Harold Pollack poignantly describes the plight of pregnant and parenting women struggling with opioid addiction, and cautions against repeating the harmful, stigmatizing media coverage that marked the crack epidemic 25 years ago. He argues that","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"95 1","pages":"627-630"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82151470","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}
O n March 19, 2019, the firmament of expertise on the improvement of quality in complex systems lost one of its brightest stars with the death of Tom Nolan, PhD. A protégé of Dr. W. Edwards Deming, Nolan worked in many industries, but in the last two decades of his life, his primary focus was on improving health care, to the benefit of countless patients, families, and communities worldwide. Nolan contributed many important concepts and frameworks to the health care quality movement, but one of his most important was also one of the simplest. “What are the necessary and sufficient conditions for improvement in large systems?” he asked. His answer was threefold: “Will, ideas, and execution.” He regarded the assurance of these conditions as a fair description of the duties of boards, executives, and senior leaders who wished to foster change at scale.1 Providing will refers to the tasks of fostering discomfort with the status quo and attractiveness for the as-yet-unrealized future. Providing ideas means assuring access to alternative designs and ideas worth testing, as opposed to continuing legacy systems. And execution was his term for embedding learning activities and change in the day-to-day work of everyone, beginning with leaders. Nolan’s simple framework launched never-ending debates among aficionados of improvement as to which of the three conditions is toughest to supply. Of course, all three are. But, in my experience, the sleeper, apparently easy, but really not easy at all, is ideas. Without change, there is no improvement. Therefore, here is the task: to find or create new models of a system that can outperform the existing system, and then to offer those models to the people without whom they cannot be put to use—the workforce. In health care, ideas can come from a fire hose of suppliers. One is the vast published medical
{"title":"Reflections on the Chronic Care Model-23 Years Later.","authors":"D. Berwick","doi":"10.1111/1468-0009.12414","DOIUrl":"https://doi.org/10.1111/1468-0009.12414","url":null,"abstract":"O n March 19, 2019, the firmament of expertise on the improvement of quality in complex systems lost one of its brightest stars with the death of Tom Nolan, PhD. A protégé of Dr. W. Edwards Deming, Nolan worked in many industries, but in the last two decades of his life, his primary focus was on improving health care, to the benefit of countless patients, families, and communities worldwide. Nolan contributed many important concepts and frameworks to the health care quality movement, but one of his most important was also one of the simplest. “What are the necessary and sufficient conditions for improvement in large systems?” he asked. His answer was threefold: “Will, ideas, and execution.” He regarded the assurance of these conditions as a fair description of the duties of boards, executives, and senior leaders who wished to foster change at scale.1 Providing will refers to the tasks of fostering discomfort with the status quo and attractiveness for the as-yet-unrealized future. Providing ideas means assuring access to alternative designs and ideas worth testing, as opposed to continuing legacy systems. And execution was his term for embedding learning activities and change in the day-to-day work of everyone, beginning with leaders. Nolan’s simple framework launched never-ending debates among aficionados of improvement as to which of the three conditions is toughest to supply. Of course, all three are. But, in my experience, the sleeper, apparently easy, but really not easy at all, is ideas. Without change, there is no improvement. Therefore, here is the task: to find or create new models of a system that can outperform the existing system, and then to offer those models to the people without whom they cannot be put to use—the workforce. In health care, ideas can come from a fire hose of suppliers. One is the vast published medical","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84580550","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}
chronic illnesses. well-trained, hard-working clin-icians (like us) unable to deliver proven services reliably or achieve tar-geted levels of blood pressure, HbA1c, or other disease control indicators for our patients? competing multipound paper in designed systems of care, evolved ago to respond to acute illnesses and injuries. for care to designed
{"title":"Organizing Care for Patients With Chronic Illness Revisited.","authors":"E. Wagner","doi":"10.1111/1468-0009.12416","DOIUrl":"https://doi.org/10.1111/1468-0009.12416","url":null,"abstract":"chronic illnesses. well-trained, hard-working clin-icians (like us) unable to deliver proven services reliably or achieve tar-geted levels of blood pressure, HbA1c, or other disease control indicators for our patients? competing multipound paper in designed systems of care, evolved ago to respond to acute illnesses and injuries. for care to designed","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88682672","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}
Sydney R Rooney, Elaine L Shelton, Ida Aka, Christian M Shaffer, Ronald I Clyman, John M Dagle, Kelli Ryckman, Tamorah R Lewis, Jeff Reese, Sara L Van Driest, Prince J Kannankeril
Aims: To identify clinical andgenetic factors associated with indomethacin treatment failure in preterm neonates with patent ductus arteriosus (PDA). Patients & Methods: This is a multicenter cohort study of 144 preterm infants (22-32 weeks gestational age) at three centers who received at least one treatment course of indomethacin for PDA. Indomethacin failure was defined as requiring subsequent surgical intervention. Results: In multivariate analysis, gestational age (AOR 0.76, 95% CI 0.60-0.96), surfactant use (AOR 9.77, 95% CI 1.15-83.26), and CYP2C9*2 (AOR 3.74; 95% CI 1.34-10.44) were each associated with indomethacin failure. Conclusion: Age, surfactant use, and CYP2C9*2 influence indomethacin treatment outcome in preterm infants with PDA. This combination of clinical and genetic factors may facilitate targeted indomethacin use for PDA.
目的：确定与吲哚美辛治疗早产儿动脉导管未闭（PDA）失败相关的临床和遗传因素。患者和方法：这是一项多中心队列研究，在三个中心对 144 名早产儿（胎龄 22-32 周）进行了研究，这些早产儿至少接受过一个疗程的吲哚美辛治疗 PDA。吲哚美辛治疗失败的定义是随后需要手术干预。结果在多变量分析中，胎龄（AOR 0.76，95% CI 0.60-0.96）、表面活性物质的使用（AOR 9.77，95% CI 1.15-83.26）和 CYP2C9*2 （AOR 3.74；95% CI 1.34-10.44）均与吲哚美辛失败有关。结论年龄、表面活性物质的使用和 CYP2C9*2 会影响 PDA 早产儿的吲哚美辛治疗效果。临床和遗传因素的结合可能有助于有针对性地使用吲哚美辛治疗 PDA。
{"title":"<i>CYP2C9*2</i> is associated with indomethacin treatment failure for patent ductus arteriosus.","authors":"Sydney R Rooney, Elaine L Shelton, Ida Aka, Christian M Shaffer, Ronald I Clyman, John M Dagle, Kelli Ryckman, Tamorah R Lewis, Jeff Reese, Sara L Van Driest, Prince J Kannankeril","doi":"10.2217/pgs-2019-0079","DOIUrl":"10.2217/pgs-2019-0079","url":null,"abstract":"<p><p><b>Aims:</b> To identify clinical andgenetic factors associated with indomethacin treatment failure in preterm neonates with patent ductus arteriosus (PDA). <b>Patients & Methods:</b> This is a multicenter cohort study of 144 preterm infants (22-32 weeks gestational age) at three centers who received at least one treatment course of indomethacin for PDA. Indomethacin failure was defined as requiring subsequent surgical intervention. <b>Results:</b> In multivariate analysis, gestational age (AOR 0.76, 95% CI 0.60-0.96), surfactant use (AOR 9.77, 95% CI 1.15-83.26), and <i>CYP2C9*2</i> (AOR 3.74; 95% CI 1.34-10.44) were each associated with indomethacin failure. <b>Conclusion:</b> Age, surfactant use, and <i>CYP2C9*2</i> influence indomethacin treatment outcome in preterm infants with PDA. This combination of clinical and genetic factors may facilitate targeted indomethacin use for PDA.</p>","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"36 1 1","pages":"939-946"},"PeriodicalIF":1.9,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90531583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T here has been a significant focus on patient safety issues over the past two decades. This began with the release of To Err is Human in late 1999,1 but has included numerous other reports indicating the substantial number of deaths and injuries due to medical errors. Despite the focus on this topic by hospital associations, medical groups, and various professional organizations, such as the ECRI Institute, a recent report indicates serious challenges remain.2 Johns Hopkins researchers recently published a study based on the latest available statistics estimating that 161,000 avoidable deaths occur each year.2 While the good news is that this number is down from the 206,000 preventable deaths estimated in the original study from 2016, 160,000 or more avoidable deaths remains a large number of people who are dying from preventable errors in the delivery of health care and it is clear that serious safety challenges persist. It is also likely that this latest estimate may only be the proverbial “tip of the iceberg” because the number is likely to be an underestimate—there are no ICD codes for human and system errors—and because the estimate ignores other medical mishaps and morbidities that do not result in deaths. Medicare is trying to reinforce the importance of patient safety in its payment policies by reducing payments to hospitals that have demonstrated reasons for there to be concerns about the safety of patients. Between October 2018 and September 2019, 800 hospitals will have had their reimbursements reduced for patients discharged because of such concerns, with the penalties applied when hospitals submit their claims. Under the program, a hospital is given a total score based on performance according to six quality measures: Hospitals that fall in the worst-performing quartile will lose 1% of their Medicare payments for Medicare beneficiaries who were discharged in the year in which the safety concerns occurred.
{"title":"Patient Safety Issues Continue to Plague American Hospitals.","authors":"G. Wilensky","doi":"10.1111/1468-0009.12406","DOIUrl":"https://doi.org/10.1111/1468-0009.12406","url":null,"abstract":"T here has been a significant focus on patient safety issues over the past two decades. This began with the release of To Err is Human in late 1999,1 but has included numerous other reports indicating the substantial number of deaths and injuries due to medical errors. Despite the focus on this topic by hospital associations, medical groups, and various professional organizations, such as the ECRI Institute, a recent report indicates serious challenges remain.2 Johns Hopkins researchers recently published a study based on the latest available statistics estimating that 161,000 avoidable deaths occur each year.2 While the good news is that this number is down from the 206,000 preventable deaths estimated in the original study from 2016, 160,000 or more avoidable deaths remains a large number of people who are dying from preventable errors in the delivery of health care and it is clear that serious safety challenges persist. It is also likely that this latest estimate may only be the proverbial “tip of the iceberg” because the number is likely to be an underestimate—there are no ICD codes for human and system errors—and because the estimate ignores other medical mishaps and morbidities that do not result in deaths. Medicare is trying to reinforce the importance of patient safety in its payment policies by reducing payments to hospitals that have demonstrated reasons for there to be concerns about the safety of patients. Between October 2018 and September 2019, 800 hospitals will have had their reimbursements reduced for patients discharged because of such concerns, with the penalties applied when hospitals submit their claims. Under the program, a hospital is given a total score based on performance according to six quality measures: Hospitals that fall in the worst-performing quartile will lose 1% of their Medicare payments for Medicare beneficiaries who were discharged in the year in which the safety concerns occurred.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81515802","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}
B. Collins, C. Kypridemos, J. Pearson-Stuttard, Yue Huang, P. Bandosz, P. Wilde, R. Kersh, S. Capewell, D. Mozaffarian, L. Whitsel, R. Micha, M. O’Flaherty
Policy Points The World Health Organization has recommended sodium reduction as a “best buy” to prevent cardiovascular disease (CVD). Despite this, Congress has temporarily blocked the US Food and Drug Administration (FDA) from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years. We modeled the health and economic impact of meeting the two‐year and ten‐year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036. Benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD‐related health gains and cost savings are together greater than the government and industry costs of reformulation. Context The US Food and Drug Administration (FDA) set draft voluntary targets to reduce sodium levels in processed foods. We aimed to determine cost effectiveness of meeting these draft sodium targets, from the perspective of US food system workers. Methods We employed a microsimulation cost‐effectiveness analysis using the US IMPACT Food Policy model with two scenarios: (1) short term, achieving two‐year FDA reformulation targets only, and (2) long term, achieving 10‐year FDA reformulation targets. We modeled four close‐to‐reality populations: food system “ever” workers; food system “current” workers in 2017; and subsets of processed food “ever” and “current” workers. Outcomes included cardiovascular disease cases prevented and postponed as well as incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained from 2017 to 2036. Findings Among food system ever workers, achieving long‐term sodium reduction targets could produce 20‐year health gains of approximately 180,000 QALYs (95% uncertainty interval [UI]: 150,000 to 209,000) and health cost savings of approximately $5.2 billion (95% UI: $3.5 billion to $8.3 billion), with an incremental cost‐effectiveness ratio (ICER) of $62,000 (95% UI: $1,000 to $171,000) per QALY gained. For the subset of processed food industry workers, health gains would be approximately 32,000 QALYs (95% UI: 27,000 to 37,000); cost savings, $1.0 billion (95% UI: $0.7bn to $1.6bn); and ICER, $486,000 (95% UI: $148,000 to $1,094,000) per QALY gained. Because many health benefits may occur in individuals older than 65 or the uninsured, these health savings would be shared among individuals, industry, and government. Conclusions The benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, with the value of health gains and health care cost savings outweighing the costs of reformulation, although not for the processed food industry.
{"title":"FDA Sodium Reduction Targets and the Food Industry: Are There Incentives to Reformulate? Microsimulation Cost‐Effectiveness Analysis","authors":"B. Collins, C. Kypridemos, J. Pearson-Stuttard, Yue Huang, P. Bandosz, P. Wilde, R. Kersh, S. Capewell, D. Mozaffarian, L. Whitsel, R. Micha, M. O’Flaherty","doi":"10.1111/1468-0009.12402","DOIUrl":"https://doi.org/10.1111/1468-0009.12402","url":null,"abstract":"Policy Points The World Health Organization has recommended sodium reduction as a “best buy” to prevent cardiovascular disease (CVD). Despite this, Congress has temporarily blocked the US Food and Drug Administration (FDA) from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years. We modeled the health and economic impact of meeting the two‐year and ten‐year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036. Benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD‐related health gains and cost savings are together greater than the government and industry costs of reformulation. Context The US Food and Drug Administration (FDA) set draft voluntary targets to reduce sodium levels in processed foods. We aimed to determine cost effectiveness of meeting these draft sodium targets, from the perspective of US food system workers. Methods We employed a microsimulation cost‐effectiveness analysis using the US IMPACT Food Policy model with two scenarios: (1) short term, achieving two‐year FDA reformulation targets only, and (2) long term, achieving 10‐year FDA reformulation targets. We modeled four close‐to‐reality populations: food system “ever” workers; food system “current” workers in 2017; and subsets of processed food “ever” and “current” workers. Outcomes included cardiovascular disease cases prevented and postponed as well as incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained from 2017 to 2036. Findings Among food system ever workers, achieving long‐term sodium reduction targets could produce 20‐year health gains of approximately 180,000 QALYs (95% uncertainty interval [UI]: 150,000 to 209,000) and health cost savings of approximately $5.2 billion (95% UI: $3.5 billion to $8.3 billion), with an incremental cost‐effectiveness ratio (ICER) of $62,000 (95% UI: $1,000 to $171,000) per QALY gained. For the subset of processed food industry workers, health gains would be approximately 32,000 QALYs (95% UI: 27,000 to 37,000); cost savings, $1.0 billion (95% UI: $0.7bn to $1.6bn); and ICER, $486,000 (95% UI: $148,000 to $1,094,000) per QALY gained. Because many health benefits may occur in individuals older than 65 or the uninsured, these health savings would be shared among individuals, industry, and government. Conclusions The benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, with the value of health gains and health care cost savings outweighing the costs of reformulation, although not for the processed food industry.","PeriodicalId":78777,"journal":{"name":"The Milbank Memorial Fund quarterly","volume":"2 1","pages":"858 - 880"},"PeriodicalIF":0.0,"publicationDate":"2019-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84246382","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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