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Cost-effectiveness analysis

Majdi Ashour
BACKGROUND: People living in the Gaza Strip have experienced a protracted political conflict and extreme socioeconomic adversity since 1948. Economic conditions have deteriorated markedly since the onset of the Palestinian Intifada in 1987 and have been exacerbated by the economic siege after 2006. The health system in the Gaza Strip has faced additional challenges. The aim of this study was to assess how Palestinian households in the Gaza Strip experienced health care services during this period of political turmoil, socioeconomic adversity, and challenges to health services...
February 21, 2018: Lancet
Natasha A Lannin, Louise Ada, Coralie English, Julie Ratcliffe, Maria Crotty
Rationale Although clinical practice guidelines recommend that management of moderate to severe spasticity include the use of botulinum toxin-A in conjunction with therapy, there is currently no evidence to support the addition of therapy. Aims To determine the effect and cost-benefit of adding evidence-based movement training to botulinum toxin-A. Sample size estimate A total of 136 participants will be recruited in order to be able to detect a between-group difference of seven points on the Goal Attainment Scale T-score with 80% power at a two-tailed significance level of 0...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Sarah M Bartsch, Susan S Huang, James A McKinnell, Kim F Wong, Leslie E Mueller, Loren G Miller, Bruce Y Lee
OBJECTIVE While previous work showed that the Centers for Disease Control and Prevention toolkit for carbapenem-resistant Enterobacteriaceae (CRE) can reduce spread regionally, these interventions are costly, and decisions makers want to know whether and when economic benefits occur. DESIGN Economic analysis SETTING Orange County, California METHODS Using our Regional Healthcare Ecosystem Analyst (RHEA)-generated agent-based model of all inpatient healthcare facilities, we simulated the implementation of the CRE toolkit (active screening of interfacility transfers) in different ways and estimated their economic impacts under various circumstances...
March 19, 2018: Infection Control and Hospital Epidemiology
Victoria E Jackson, Helen Hurst, Sandip Mitra
INTRODUCTION: Arteriovenous fistulae remain the gold standard of vascular access in haemodialysis. There is currently no consensus on standardised methods of monitoring arteriovenous fistulae. Assessment techniques and practice remain widely variable. The purpose of this study is to determine whether existing evidence supports physical assessment as an effective tool and a good predictor of arteriovenous fistulae dysfunction to allow for timely intervention and improve outcomes. METHODS: A literature search was performed using CINAHL, PubMed, Medline and BNI databases and relevant search terms...
March 1, 2018: Journal of Vascular Access
Tammy Toscos, Maria Carpenter, Mindy Flanagan, Kislaya Kunjan, Bradley N Doebbeling
Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These "positive deviant" practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families...
January 2018: Health Services Research and Managerial Epidemiology
Martin Cheung, Hidehito Adaniya, Cathal Cassidy, Masao Yamashita, Kun-Lung Li, Seita Taba, Tsumoru Shintake
For many macromolecular complexes, the inability to uniformly disperse solubilized specimen particles within vitreous ice films precludes their analysis by cryo-electron microscopy (cryo-EM). Here, we introduce a sample preparation process using "perpetually-hydrated" graphene oxide flakes as particle support films, and report vastly improved specimen dispersion. Furthermore, we provide evidence that the presence of graphene oxide flakes in vitreous ice results in a significant reduction in electron beam-induced specimen decomposition...
March 15, 2018: Journal of Structural Biology
Annette Peart, Virginia Lewis, Ted Brown, Grant Russell
OBJECTIVE: Patient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred. SETTING AND PARTICIPANTS: We used the Arksey and O'Malley scoping review method...
March 17, 2018: BMJ Open
Fevzi F Yalniz, Mohammad H Murad, Stephanie J Lee, Steven Z Pavletic, Nandita Khera, Nilay D Shah, Shahrukh K Hashmi
Given the increasing incidence of cGVHD and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost effectiveness analysis (CEA) for the frequently utilized agents in SR-cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis (ECP), pomalidomide and methotrexate...
March 14, 2018: Biology of Blood and Marrow Transplantation
Michelle H Chua, Raksmey Hong, Tytim Rydeth, Iv Vycheth, Sam Nang, Din Vuthy, Kee B Park
INTRODUCTION: In recent years, delivery of cost-effective "essential neurosurgery" in resource-limited communities has been recognized as an indispensable part of health care and a global health priority. The purpose of this study was to review outcomes from operative management of spine trauma at a resource limited government hospital in Phnom Penh, Cambodia, and to provide an epidemiologic report to guide prevention programs. METHODS: A retrospective review of a prospective neurosurgical database was performed to identify risk factors for spine trauma and severe spinal cord injury (ASIA A or ASIA B) and to evaluate the cost-effectiveness of surgery for patients treated at Preah Kossamak Hospital for subaxial and thoracolumbar spine trauma from 2013 to 2016...
March 14, 2018: World Neurosurgery
Li Huang, Calum T Roberts, Brett J Manley, Louise S Owen, Peter G Davis, Kim M Dalziel
OBJECTIVE: To compare the cost-effectiveness of 2 common "noninvasive" modes of respiratory support for infants born preterm. STUDY DESIGN: An economic evaluation was conducted as a component of a multicenter, randomized control trial from 2013 to 2015 enrolling infants born preterm at ≥28 weeks of gestation with respiratory distress, <24 hours old, who had not previously received endotracheal intubation and mechanical ventilation or surfactant. The economic evaluation was conducted from a healthcare sector perspective and the time horizon was from birth until death or first discharge...
March 15, 2018: Journal of Pediatrics
Karthikeyan E Ponnusamy, Edward M Vasarhelyi, Lyndsay Somerville, Richard W McCalden, Jacquelyn D Marsh
BACKGROUND: We estimated the cost-effectiveness of performing total knee arthroplasty (TKA) vs nonoperative management (NM) among 6 body mass index (BMI) cohorts. METHODS: A Markov model was used to compare the cost-utility of TKA and NM in 6 BMI groups (nonobese [BMI 18.5-24.9], overweight [25-29.9], obese [30-34.9], severely obese [35-39.9], morbidly obese [40-49.9], and super-obese [50+] patients) over a 15-year period. Model parameters for transition probability (ie, revision, re-revision, death), utility, and costs were estimated from the literature...
February 14, 2018: Journal of Arthroplasty
Susan Horton, Richard Sullivan, John Flanigan, Kenneth A Fleming, Modupe A Kuti, Lai Meng Looi, Sanjay A Pai, Mark Lawler
Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health...
March 14, 2018: Lancet
Camilla Sortsø, Anastasija Komkova, Annelli Sandbæk, Simon J Griffin, Martha Emneus, Torsten Lauritzen, Rebecca K Simmons
AIMS/HYPOTHESIS: Trials have not demonstrated benefits to the population of screening for type 2 diabetes. However, there may be cost savings for those found to have diabetes. We therefore aimed to compare healthcare costs among individuals with incident type 2 diabetes in a screened group with those in an unscreened group. METHODS: In this register-based, non-randomised controlled trial, eligible individuals were men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392)...
March 16, 2018: Diabetologia
Raghavendra S Hebbar, Arun M Isloor, Balakrishna Prabhu, Inamuddin, Abdullah M Asiri, A F Ismail
Functional surfaces and polymers with branched structures have a major impact on physicochemical properties and performance of membrane materials. With the aim of greener approach for enhancement of permeation, fouling resistance and detrimental heavy metal ion rejection capacity of polyetherimide membrane, novel grafting of poly (4-styrenesulfonate) brushes on low cost, natural bentonite was carried out via distillation-precipitation polymerisation method and employed as a performance modifier. It has been demonstrated that, modified bentonite clay exhibited significant improvement in the hydrophilicity, porosity, and water uptake capacity with 3 wt...
March 16, 2018: Scientific Reports
Jorge Vilar-Palop, Ildefonso Hernandez-Aguado, María Pastor-Valero, José Vilar, Isabel González-Alvarez, Blanca Lumbreras
OBJECTIVES: To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. DESIGN: Cross-sectional retrospective study. SETTING: Two Spanish public tertiary hospitals. PARTICIPANTS: 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded...
March 16, 2018: BMJ Open
Jana Pöttgen, Rona Moss-Morris, Janina-Maria Wendebourg, Lena Feddersen, Stefanie Lau, Sascha Köpke, Björn Meyer, Tim Friede, Iris-Katharina Penner, Christoph Heesen, Stefan M Gold
OBJECTIVE: Fatigue is a major disabling symptom in many chronic diseases including multiple sclerosis (MS), but treatment options are limited.Here, we tested the effectiveness of a self-guided , interactive, online fatigue management programme (ELEVIDA) based on principles of cognitive behavioural therapy (CBT) and related psychotherapeutic approaches (eg, mindfulness) for reducing fatigue in MS. METHODS: Patients with MS and self-reported fatigue were recruited via the website of the German MS Society and assigned via an automated randomisation generator (1:1, no blocking or stratification) to a 12-week online intervention (ELEVIDA, n=139, 82% female, mean age 40...
March 16, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Laura Desveaux, James Shaw, Marianne Saragosa, Charlene Soobiah, Husayn Marani, Jennifer Hensel, Payal Agarwal, Nike Onabajo, R Sacha Bhatia, Lianne Jeffs
BACKGROUND: The increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure)...
March 16, 2018: Journal of Medical Internet Research
Francisco I Salgado García, Karen J Derefinko, Zoran Bursac, Sarah Hand, Robert C Klesges
Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed...
March 13, 2018: Contemporary Clinical Trials
Guo-Qiang Zhang, Guangming Xing, Licong Cui
One of the basic challenges in developing structural methods for systematic audition on the quality of biomedical ontologies is the computational cost usually involved in exhaustive sub-graph analysis. We introduce ANT-LCA, a new algorithm for computing all non-trivial lowest common ancestors (LCA) of each pair of concepts in the hierarchical graph induced by an ontology. The computation of LCA is a fundamental step for non-lattice approach for ontology quality assurance. Distinct from existing approaches, ANT-LCA only computes LCAs for non-trivial pairs, those having at least one common ancestor...
March 13, 2018: Journal of Biomedical Informatics
Yusuke Okubo, Nobuaki Michihata, Naho Morisaki, Kazuhiro Uda, Isao Miyairi, Yuichi Ogawa, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia/bronchitis in children, and macrolide-resistant strains are increasing in East Asian countries. Recent practice patterns, especially for antibiotic selection, and benefits of corticosteroid treatment in pediatric Mycoplasma pneumoniae infections remain unclear. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database, we analyzed recent trends in antibiotic selection and corticosteroid use for pediatric Mycoplasma pneumoniae-related respiratory infections, using multivariable mixed effects logistic regressions...
March 2018: Respiratory Investigation
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