Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review

ObjectivesTo systematically review the literature on the unit cost and cost-effectiveness of malaria control.MethodsTen databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider and household, or societal perspective were included.ResultsWe identified 103 costing studies. The majority of studies focused on individual rather than combined interventions, notably insecticide-treated bed nets and treatment, and commonly took a provider perspective. A third of all studies took place in 3 countries. The median provider economic cost of protecting 1 person per year ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed with rapid diagnostic tests was $6.06 and per case treated $9.31 or $89.93 depending on clinical severity. Other interventions did not share enough similarities to be summarized. Cost drivers were rarely reported. Cost-effectiveness of malaria control was reiterated, but care in methodological and reporting standards is required to enhance data transferability.ConclusionsImportant information that can support resource allocation was reviewed. Given the variability in methods and reporting, global efforts to follow existing standards are required for the evidence to be most useful outside their study context, supplemented by guidance on options for transferring existing data across settings.     

Anticholinergic Drug Burden and Delirium: A Systematic Review

ObjectivesTo investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity.DesignSystematic review.Setting and ParticipantsAll available studies.MethodsA systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, and Google Scholar. Studies evaluating the association between ADB (measured as a total score) and delirium or delirium severity, published in English, were eligible for inclusion.ResultsSixteen studies, including 148,756 persons, were included. Fifteen studies investigated delirium. ADB was measured with the Anticholinergic Risk Scale (ARS, n = 5), the Anticholinergic Cognitive Burden Scale (ACB, n = 6), the list of Chew (n = 1), the Anticholinergic Drug Scale (ADS, n = 5), a modified version of the ARS (n = 1), and a modified version of the ACB (n = 1). A high ADB, measured with the ARS, was associated with delirium (5/5). Also with the modified version of the ARS and ACB, an association was found between a high ADB and delirium during 3-month (1/1) and 1-year follow-up (1/1), respectively. When ADB was assessed with other scales, the results were inconclusive, with only 1 positive association for the ACB (1/6) and ADS (1/5) each. The possible association between ADB and delirium severity has also been investigated (ADS n = 2, Summers Drug Risk Number n = 1). One study found an association between a high ADB, measured with the ADS, and an increase in severity of delirium.Conclusions and ImplicationsADB assessed with the ARS is consistently associated with delirium. The association found between the modified versions of the ARS and ACB and delirium needs confirmation. When ADB was assessed with other scales, the findings were inconclusive. The current findings suggest that the ARS might be a useful tool to identify patients at increased risk for delirium.     

A Systematic Review of Osteoporosis Medication Adherence and Osteoporosis-Related Fracture Costs in Men

Background and objective

Male osteoporosis is an increasingly important public health concern. Although several medications are approved for the treatment of osteoporosis, medication non-adherence and the associated consequences are not well documented in male populations. Our objective was to identify and summarize the current knowledge related to osteoporotic medication adherence, the potential implications of non-adherence to the medication, and the cost of osteoporosis-related fractures and health-resource utilization in men.

Methods

Two separate systematic searches were conducted concurrently: one to identify literature reporting male-specific adherence to anti-osteoporotic medication and the clinical consequence of non-adherence in men, and the other to identify literature reporting the cost and resource burden of osteoporosis-related fractures in men. The PubMed, MEDLINE, EMBASE, and Cochrane databases were searched using a date range of 1 January 1998 to 30 June 2012, and citations were screened based on pre-defined criteria.

Results

The percentage of males adherent to bisphosphonates [medication possession ratio (MPR) >0.8] over a 1-year period ranged from 32 % to 64 %. The data imply worse clinical outcomes with treatment non-adherence. Costs and resource use associated with osteoporosis-related fractures in men are high, with hip fractures generating the most cost.

Conclusions

One-third to two-thirds of men are not adherent to bisphosphonates. Non-adherence is associated with increased fracture risk. Estimates of direct and indirect osteoporosis-related fracture costs are also substantial in men, and may even be more costly than in women. More robust data would better inform disease management initiatives that could improve adherence to medication and outcomes in men with osteoporosis.     

The Estimation and Inclusion of Presenteeism Costs in Applied Economic Evaluation: A Systematic Review

Objective

Given the significant costs of reduced productivity (presenteeism) in comparison to absenteeism, and overall societal costs, presenteeism has a potentially important role to play in economic evaluations. However, these costs are often excluded. The objective of this study is to review applied cost of illness studies and economic evaluations to identify valuation methods used for, and impact of including presenteeism costs in practice.

Interventions for Young Bereaved Children: A Systematic Review and Implications for School Mental Health Providers

Background

Many young children experience the death of a family member and they may be at risk for developing psychological and behavioral problems, but not much is known about how to help young children cope with such a stressful and painful experience.

Objective

The purposes of this study are to identify the interventions for bereaved young children and examine the effectiveness of the interventions.

Methods

A systematic review of the literature was performed to investigate the effects of interventions for preschool-age children (3–5 years) who experience the death of a family member.

Results

Seventeen studies that met the inclusion criteria for the purpose of this review were identified. All of the studies involved a small sample, and majority of the studies mixed preschool children with other older children in the sample. Play-based therapies were the most common interventions for grieving young children. Involving parents in the interventions, regardless of their therapeutic orientation, was a critical ingredient.

Conclusions

Limited empirical evidence of positive intervention outcomes for preschool-age bereaved children was available. Surviving parents were seen as an important agent to help young children grieve and cope with the experience of loss. Implications for school mental health practice and research are provided.

     

Free-Living Dietary Intake in Tactical Personnel and Implications for Nutrition Practice: A Systematic Review

Tactical personnel (including military, law enforcement, and fire and rescue) are responsible for ensuring national and public safety. Dietary intake is an important consideration to support optimal health and performance. The aims of this systematic review were to: (1) describe the reported free-living dietary intake (energy and macronutrients) of tactical personnel, and (2) describe the practical implications of reported dietary intakes to support the physical and dietary requirements of tactical personnel. A systematic search of databases (MEDLINE, EMBASE, CINAHL and Web of Science) was conducted following the PRISMA guidelines. English and full text research articles were identified and screened against inclusion and exclusion criteria. Demographic and dietary intake data were extracted, tabulated, and synthesized narratively. The quality of the studies was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Twenty-two studies (15 military, 4 law enforcement, and 2 fire and rescue) were eligible to inform this review. The volume of evidence suggested that tactical personnel met dietary protein and exceeded dietary fat recommendations but failed to meet energy and carbohydrate recommendations. Therefore, practical approaches to support optimized energy, fat and carbohydrate intake in tactical personnel is important.     

Systematic Review of Psychotropic Adverse Drug Event Monitoring Tools for Use in Long-Term Care Facilities

ObjectivesTo evaluate properties of psychotropic adverse drug event (ADE) monitoring tools intended for use in long-term care facilities.DesignSystematic review.Setting and ParticipantsAdults aged 18 years and older in nursing homes and other long-term care facilities.MethodsMedline, CINAHL, Embase, and PsycInfo were searched from inception to August 2022 for studies reporting the development, validation, or application of tools to monitor psychotropic ADEs. Screening, data extraction, and quality assessment were performed independently by 2 authors. Each tool was assessed under the domains of test-retest reliability, interrater reliability, content validity, and construct validity.ResultsEight studies that described 6 tools were included. Tools were developed in Wales (n = 2), United States (n = 1), Ireland (n = 1), Canada (n = 1), and Singapore (n = 1). Tools monitored 4 to 95 items related to antipsychotics (n = 6 tools), antidepressants (n = 4), benzodiazepines or hypnotics (n = 4), antiepileptics (n = 4), and dementia medications (n = 1). Tools commonly monitored sedation, tiredness, or sleepiness (n = 6), falls (n = 4), and tremor or extrapyramidal symptoms (n = 4). Tools were designed for application by nurses (n = 4), during family conferences (n = 1), and by general medical practitioners before repeat prescribing (n = 1). Two tools were reported to require 10 to 60 minutes to administer. Four tools were determined to have adequate content validity and 2 tools adequate interrater reliability. No tools reported test-retest reliability or construct validity.Conclusions and ImplicationsSix published psychotropic ADE monitoring tools are heterogeneous in design and intended application. Existing tools are predominately designed for application by nurses with or without direct involvement of the wider multidisciplinary team. Further research is needed into models of care that facilitate psychotropic ADE monitoring in the long-term care facility setting, and the extent to which application of specific tools is associated with reduced medication-related harm.     

Cost-Utility Analyses in Diabetes: A Systematic Review and Implications from Real-World Evidence

ObjectivesTo systematically review the cost-effectiveness of diabetes interventions, identify high-value diabetes services, and estimate potential gains from increasing their utilization.MethodsThe study consisted of two steps. First, we reviewed cost-utility analyses (CUAs) related to diabetes published through the end of 2012, using the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org). We used logistic regression to examine factors independently associated with favorable cost-effective ratios. Second, we used the Humedica electronic medical records to estimate potential savings and health benefits gained by shifting patients currently receiving low-value services to high-value alternatives.ResultsWe identified 196 diabetes CUAs, of which 55% examined pharmaceuticals. Most (70%) diabetes CUAs focused on treatment rather than prevention. Most used a health care payer perspective and were industry-sponsored. Of the 497 published cost-utility ratios, 82% examined an intervention recommended by diabetes guidelines. Approximately 73% of the interventions were cost-saving or below $50,000 per quality-adjusted life-year. Logistic regression analysis showed that higher-quality CUAs, CUAs conducted from the US perspective, surgical interventions, and guideline-recommended interventions were more likely to report favorable ratios. Of the 7907 eligible patients with diabetes in our sample, up to 7117 could in principle be shifted to cost-saving treatments, reducing costs by $12.5 million and gaining more than 1938 quality-adjusted life-years over a lifetime.ConclusionsMost diabetes interventions evaluated by CUAs are recommended by practice guidelines and may provide good value for money. Our results indicate that patients with diabetes and the health care system could potentially benefit from shifting to the greater use of high-value services.     

Drug Utilization and Costs for Patients with Acute Myocardial Infarction

The study of drug experience of patients with acute myocardial infarction is part of a series studying factors that influence drug utilization in the hospital. The medical care field is more than ever aware of the associations between use of drugs, hospital costs, and quality of care. Aspects of utilization studied included variety, number, route, purpose, and cost of drugs; use of generic names in prescribing; and timing of drug orders during a patient's stay. In some of these aspects large teaching hospitals differ from small hospitals. It is especially striking that timing of drug orders differed between public and voluntary sectors; this was affected by the greater severity of disease and lower survival rate among city hospital patients. Direct costs of the drugs are low, in general, and so make up a small portion of hospital care costs. Each hospital showed a different pattern for principal purposes of medications used.

Future trends in utilization depend on interactions among social, technical, and administrative developments. Equalizing conditions of admission would smooth out contrasts in drug use between public and voluntary hospitals. Staff review of drugs in use could reduce needless variety. Cardiac monitoring devices can set up new patterns for use of intravenous drugs. Hospitals that must account for drugs under public reimbursement schemes could simplify their tasks by applying a group averaging system to most drugs.

     

Comparing Methods for Estimating Direct Costs of Adverse Drug Events

Objectives

To estimate how direct health care costs resulting from adverse drug events (ADEs) and cost distribution are affected by methodological decisions regarding identification of ADEs, assigning relevant resource use to ADEs, and estimating costs for the assigned resources.

欧洲国家控制药物费用的主要政策措施简介

在欧洲,药品开支在医疗费用扮演了重要的角色,许多政策措施被用于控制药品开支。在这篇文章中,综述了欧盟国家采取的控制药物费用的主要政策措施,以期对我国的药物政策带来借鉴意义。