Estimation of the cost of treatment by chemotherapy for early breast cancer in Morocco

Background

Physical inactivity is a major risk factor for many chronic diseases including diabetes, cardiovascular diseases and some cancers. It is estimated that, in Australia, physical inactivity contributes to 13,500 annual deaths and incurs an annual cost of AU$ 21 billion to the health care system. The cost of physical inactivity to the Western Australian (WA) economy is estimated to be about AU$ 2.1 billion. Increased burden of physical inactivity has motivated health professionals to seek cost effective intervention to promote physical activity. One such strategy is encouraging general practitioners (GPs) to advocate physical activity to the patients who are at high risk of developing chronic diseases associated with physical inactivity. This study intends to investigate the cost-effectiveness of a subsidy program for GP advice to promote physical activity.

Methodology

The percentage of population that could potentially move from insufficiently active to sufficiently active, on GP advice was drawn from the Western Australian (WA) Premier's Physical Activity Taskforce (PATF) survey in 2006. Population impact fractions (PIF) for diseases attributable to physical inactivity together with disability adjusted life years (DALYs) and health care expenditure were used to estimate the net cost of intervention for varying subsidies. Cost-effectiveness of subsidy programs were evaluated in terms of cost per DALY saved at different compliance rates.

Results

With a 50% adherence to GP advice, an annual health care cost of AU$ 24 million could be potentially saved to the WA economy. A DALY can be saved at a cost of AU $ 11,000 with a AU$ 25 subsidy at a 50% compliance rate. Cost effectiveness of such a subsidy program decreases at higher subsidy and lower compliance rates.

Conclusion

Implementing a subsidy for GP advice could potentially reduce the burden of physical inactivity. However, the cost-effectiveness of a subsidy program for GP advice depends on the percentage of population who comply with GP advice.     

Targeting Diabetes Prevention to More Disadvantaged Groups Improves Cost-Effectiveness: Implications of Inequality in Type 2 Diabetes From Theoretical Interventions

ObjectivesTo determine the effect of socioeconomic status on efficacy and cost thresholds at which theoretical diabetes prevention policies become cost-effective.MethodsWe designed a life table model using real-world data that captured diabetes incidence and all-cause mortality in people with and without diabetes by socioeconomic disadvantage. The model used data from the Australian diabetes registry for people with diabetes and the Australian Institute of Health and Welfare for the general population. We simulated theoretical diabetes prevention policies and estimated the threshold at which they would be cost-effective and cost saving, overall, and by socioeconomic disadvantage, from the public healthcare perspective.ResultsFrom 2020 to 2029, 653 980 people were projected to develop type 2 diabetes, 101 583 in the least disadvantaged quintile and 166 744 in the most. Theoretical diabetes prevention policies that reduce diabetes incidence by 10% and 25% would be cost-effective in the total population at a maximum per person cost of Australian dollar (AU$) 74 (95% uncertainty interval: 53-99) and AU$187 (133-249) and cost saving at AU$26 (20-33) and AU$65 (50-84). Theoretical diabetes prevention policies remained cost-effective at a higher cost in the most versus least disadvantaged quintile (eg, a policy that reduces type 2 diabetes incidence by 25% would be cost-effective at AU$238 [169-319] per person in the most disadvantaged quintile vs AU$144 [103-192] in the least).ConclusionsPolicies targeted at more disadvantaged populations will likely be cost-effective at higher costs and lower efficacy compared to untargeted policies. Future health economic models should incorporate measures of socioeconomic disadvantage to improve targeting of interventions.     

Cost-Effectiveness of Statins for Primary Prevention in Patients Newly Diagnosed with Type 2 Diabetes in The Netherlands

BackgroundStatins are lipid-lowering drugs that reduce the risk of cardiovascular events in patients with diabetes.ObjectivesThe objective of this study was to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective, taking nonadherence, baseline risk, and age into account.MethodsA cost-effectiveness analysis was performed by using a Markov model with a time horizon of 10 years. The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment (GIANTT) database, using the United Kingdom Prospective Diabetes Study risk engine. Statin adherence was measured as pill days covered in the IADB.nl pharmacy research database. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) from the health care payers’ perspective.ResultsFor an average patient aged 60 years, the base case, statin treatment was highly cost-effective at €2245 per QALY. Favorable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from almost €100,000 per QALY to almost being cost saving. Treating all patients younger than 45 years at diabetes diagnosis was not cost-effective (weighted cost-effectiveness of almost €60,000 per QALY).ConclusionsDespite the nonadherence levels observed in actual practice, statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes. Because of large differences in cost-effectiveness according to different risk and age groups, the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages.     

Is type-2 diabetes mellitus preventable?

The public health burden of type 2 diabetes mellitus has been dramatically increased worldwide. Not only its prevalence rate at present but the increase of its incidence in the near future can create a global health problem. The rapid increase of the total number of newly diagnosed diabetic patients proved to be associated with the increasing prevalence rate of obesity. The metabolic syndrome and type 2 diabetes can contribute to accelerated atherosclerosis and, therefore, the target organ damages can carry a serious problem for the individuals and also for the whole society. It is obvious, that the primary prevention of type 2 diabetes mellitus is of great importance. There is now substantial evidence that type 2 diabetes can be prevented or delayed by lifestyle interventions, i.e. diet and exercise should be the first choice in order to avoid weight gain when preventing diabetes. Pharmacological intervention should not be routinely used to prevent diabetes although results of large clinical trials with metformin and acarbose in subjects with impaired glucose tolerance are available. It is noteworthy that a decrease in the number of newly diagnosed diabetes was observed in prospective, double blind clinical studies evaluating the effect of new antihypertensive drugs (captopril, ramipril, lisinopril, nifedipine GITS, amlodipine, losartan) or lipid-lowering agents (pravastatin) on the cardiovascular morbidity and mortality in high risk patients. In these studies the relative risk reduction of newly diagnosed diabetes was evaluated in comparison to placebo or other drugs in a subgroup of non-diabetic patients at baseline. In addition, the incidence of newly diagnosed type 2 diabetes decreased parallel with weight loss in clinical trials with orlistat, an anti-obesity drug. Although new results were provided by evidence based clinical trials a lot of questions remained to be solved. Further research is necessary to understand better how to facilitate effective primary prevention of type 2 diabetes. Further data are needed to evaluate the clinical significance of currently used antidiabetic drugs and, in addition, the possible role of other drugs (antihypertensives, lipid lowering agents, anti-obesity drugs) should also be investigated in order to identify the optimal primary prevention policy of type 2 diabetes.     

Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America

Objective

To examine the potential for reducing cardiovascular risk factors in the United States of America enough to cause age-adjusted coronary heart disease (CHD) mortality rates to drop by 20% (from 2000 baseline figures) by 2010, as targeted under the Healthy People 2010 initiative.

Methods

Using a previously validated, comprehensive CHD mortality model known as IMPACT that integrates trends in all the major cardiovascular risk factors, stratified by age and sex, we calculated how much CHD mortality would drop between 2000 and 2010 in the projected population of the United States aged 25–84 years (198 million). We did this for three assumed scenarios: (i) if recent risk factor trends were to continue to 2010; (ii) success in reaching all the Healthy People 2010 risk factor targets, and (iii) further drops in risk factors, to the levels already seen in the low-risk stratum.

Findings

If age-adjusted CHD mortality rates observed in 2000 remained unchanged, some 388 000 CHD deaths would occur in 2010. First scenario: if recent risk factor trends continued to 2010, there would be approximately 19 000 fewer deaths than in 2000. Although improved total cholesterol, lowered blood pressure in men, decreased smoking and increased physical activity would account for some 51 000 fewer deaths, these would be offset by approximately 32 000 additional deaths from adverse trends in obesity and diabetes and in blood pressure in women. Second scenario: If Healthy People 2010 cardiovascular risk factor targets were reached, approximately 188 000 CHD deaths would be prevented. Scenario three: If the cardiovascular risk levels of the low-risk stratum were reached, approximately 372 000 CHD deaths would be prevented.

Conclusion

Achievement of the Healthy People 2010 cardiovascular risk factor targets would almost halve the predicted CHD death rates. Additional reductions in major risk factors could prevent or postpone substantially more deaths from CHD.     

Peer Reviewed: Identifying Populations at High Risk for Diabetes With the Behavioral Risk Factor Surveillance System,Rhode Island, 2003

Introduction

We evaluated the feasibility of applying a previously validated diabetes risk score (DRS) to state-based surveillance data from the Behavioral Risk Factor Surveillance System (BRFSS) to assess population risk for developing type 2 diabetes or having undiagnosed type 2 diabetes.

Methods

We conducted a cross-sectional analysis of 1,969 adults aged 30 to 60 years who self-reported never having been diagnosed with diabetes. The Danish DRS was applied to the 2003 Rhode Island BRFSS data by using 6 categorical variables: age, sex, body mass index, known hypertension, leisure-time physical activity, and family history of diabetes. The DRS was the sum of these individual scores, which ranged from 0 to 60; a score of 31 or more was considered high-risk.

Results

We found that 436 study participants, representing 23% of Rhode Island adults aged 30 to 60 years, had a high DRS. In the final model, adults with at least some college education were 43% less likely to have a high DRS, compared to adults with a high school diploma. Adults with no health insurance were 54% more likely to have a high DRS compared with insured adults.

Conclusion

By adding a family history question in odd years to correspond to the hypertension module in the BRFSS, routinely available state-level surveys can be used with a DRS to monitor populations at high risk for developing type 2 diabetes. In Rhode Island, almost one-fourth of adults aged 30 to 60 years were at high risk for having undiagnosed diabetes or developing diabetes. Adults with lower education and without health insurance were at highest risk.     

Peer Reviewed: Reach and Effectiveness of a Weight Loss Intervention in Patients With Prediabetes in Colorado

Introduction

Although lifestyle interventions are effective in delaying the onset of diabetes, translating these lessons to routine health care settings remains a challenge. We investigated the effectiveness of a theory-based, brief, small-group weight loss intervention for diabetes prevention. A secondary purpose was to determine the potential reach of the intervention.

Methods

A total of 14,379 members of an integrated health care organization newly diagnosed with prediabetes were potentially eligible to participate in this matched cohort longitudinal study. Of this group, 1,030 attended a 90-minute, small-group session that targeted personal action planning for healthful eating, physical activity, and weight management. We accessed electronic medical records to select 1 to 2 controls (matched on impaired fasting glucose measurement, sex, age, and body mass index) for each member who attended the small-group session (n = 760). Weight change, as recorded in the medical record, was the primary outcome. Mixed models analyses were used to adjust for matching variables and covariates and to account for individual random effects over time.

Results

Small-group participants lost significantly more weight than did their matched controls. A significantly higher proportion of small-group participants lost at least 5% of their body weight compared with controls.

Conclusion

A brief, small-group weight loss intervention was effective. However, it did not reach broadly into the population that was at risk for diabetes.     

Outcomes of a Latino Community-Based Intervention for the Prevention of Diabetes: The Lawrence Latino Diabetes Prevention Project

Objectives. We tested the effectiveness of a community-based, literacy-sensitive, and culturally tailored lifestyle intervention on weight loss and diabetes risk reduction among low-income, Spanish-speaking Latinos at increased diabetes risk.Methods. Three hundred twelve participants from Lawrence, Massachusetts, were randomly assigned to lifestyle intervention care (IC) or usual care (UC) between 2004 and 2007. The intervention was implemented by trained Spanish-speaking individuals from the community. Each participant was followed for 1 year.Results. The participants’ mean age was 52 years; 59% had less than a high school education. The 1-year retention rate was 94%. Compared with the UC group, the IC group had a modest but significant weight reduction (−2.5 vs 0.63 lb; P = .04) and a clinically meaningful reduction in hemoglobin A1c (−0.10% vs −0.04%; P = .009). Likewise, insulin resistance improved significantly in the IC compared with the UC group. The IC group also had greater reductions in percentage of calories from total and saturated fat.Conclusions. We developed an inexpensive, culturally sensitive diabetes prevention program that resulted in weight loss, improved HbA1c, and improved insulin resistance in a high-risk Latino population.Type 2 diabetes is a serious disorder with many complications and is characterized by insulin resistance and relative insulin deficiency. The prevalence of diabetes in Latino Americans is 1.5 times that in non-Latino Whites.1 Between 1988 to 1994 and 2005 to 2006, the prevalence of diabetes increased from 9.6% to 12.6% in the adult Latino population.2,3 Prediabetes, as defined by impaired glucose tolerance or impaired fasting blood glucose, is often present 5 or more years before the development of type 2 diabetes.4 Several randomized clinical trials have shown that it is possible to prevent or delay the progression of the prediabetic state to clinical type 2 diabetes.5–7The Diabetes Prevention Program (DPP) demonstrated that a lifestyle intervention incorporating dietary modification and increased physical activity produced an average weight loss of 5.6 kilograms at 1 year and by 4 years reduced the incidence of diabetes by 58% versus usual care.7 However, the intervention was intensive and costly, beginning with a 16-session curriculum that was delivered individually over 24 weeks and continuing with a number of follow-up individual and group sessions. The total intervention cost over the first year was $1399 per participant. The participants, although representing diverse American subpopulations, were generally well-educated, literate in English, and of average socioeconomic status.The effectiveness of the DPP lifestyle intervention delivered in a lower cost, lower intensity format to high-risk populations is not known. We hypothesized that a community-based, culturally tailored, literacy-sensitive lifestyle intervention delivered in a primarily group-based format would facilitate weight loss and reduce the risk of type 2 diabetes among low-income Latinos at elevated risk of developing diabetes.     

A Comprehensive Lifestyle Intervention to Prevent Type 2 Diabetes and Cardiovascular Diseases: the German <Emphasis Type="Italic">CHIP</Emphasis> Trial

The prevalence of type 2 diabetes is continuously increasing. This chronic metabolic disorder is difficult to treat and imposes a considerable economic burden on the healthcare system. In view of the fact that type 2 diabetes is primarily caused by behavioral factors, effective preventive strategies are urgently needed. We examined the effects of a holistic lifestyle intervention on clinical and laboratory parameters as well as on the long-term diabetes risk in patients at risk to develop diabetes. We conducted a randomized controlled trial in a primary care setting in Hannover, Germany, with 83 patients diagnosed as (pre)diabetic or at risk for diabetes. CHIP Germany is a 40-hour coaching lifestyle intervention program for the primary and secondary prevention of type 2 diabetes and cardiovascular diseases. The intervention included a comprehensive nutrition and health educational program based on the American CHIP approach. The primary outcome parameter was the body mass index (BMI). Secondary outcome parameters included body weight, blood pressure, fasting glucose, HbA1c, blood lipids, and the FINDRISK score, which assesses long-term diabetes risk. At the final measurement after 12 months, in the intervention group the BMI was reduced by 1.4 versus 0.2 kg/m² in controls (p?=?.119). The mean sustained weight loss after 12 months was ?4.1 kg in the intervention group versus ?0.8 kg in controls. Furthermore, we found a trend toward a stronger reduction in blood pressure, fasting glucose, and HbA1c as well as an improved FINDRISK score in the intervention group, compared to controls. Although failing to reach statistical significance at the final assessment, this comprehensive lifestyle intervention showed a noticeable reduction in several cardiometabolic risk factors which may facilitate the prevention of diabetes.     

Cost-Effectiveness Analysis of Clinically Indicated Versus Routine Replacement of Peripheral Intravenous Catheters

Background

Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72–96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative.

Objectives

To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters.

Methods

A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed.

Results

The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95 % confidence interval [CI] 4.96–10.62) and a non-significant difference in the phlebitis rate of 0.41 % (95 % CI ?1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95 % CI 4.96–10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years.

Conclusion

The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.     

Hypertension and diabetes in Africa: design and implementation of a large population-based study of burden and risk factors in rural and urban Malawi

Background

The emerging burden of cardiovascular disease and diabetes in sub-Saharan Africa threatens the gains made in health by the major international effort to combat infectious diseases. There are few data on distribution of risk factors and outcomes in the region to inform an effective public health response. A comprehensive research programme is being developed aimed at accurately documenting the burden and drivers of NCDs in urban and rural Malawi; to design and test intervention strategies. The programme includes population surveys of all people aged 18 years and above, linking individuals with newly diagnosed hypertension and diabetes to healthcare and supporting clinical services. The successes, challenges and lessons learnt from the programme to date are discussed.

Results

Over 20,000 adults have been recruited in rural Karonga and urban Lilongwe. The urban population is significantly younger and wealthier than the rural population. Employed urban individuals, particularly males, give particular recruitment challenges; male participation rates were 80.3 % in the rural population and 43.6 % in urban, whilst female rates were 93.6 and 75.6 %, respectively. The study is generating high quality data on hypertension, diabetes, lipid abnormalities and risk factors.

Conclusions

It is feasible to develop large scale studies that can reliably inform the public health approach to diabetes, cardiovascular disease and other NCDs in Sub-Saharan Africa. It is essential for studies to capture both rural and urban populations to address disparities in risk factors, including age structure. Innovative approaches are needed to address the specific challenge of recruiting employed urban males.

     

Outcome and cost of a statewide diabetes screening and awareness initiative in New York.

From 1997 through 1999, a total of 365 diabetes screening and awareness events targeting high-risk populations were held throughout New York State. These events were planned and implemented by community-based coalitions that received funding from the state's Diabetes Control Program. The American Diabetes Association's diabetes risk questionnaire was administered, and those individuals identified as high risk received a capillary blood glucose test. Screened individuals with glucose readings above the cut-off value (140 mg/dl or 110 mg/dl if fasting) were referred to a physician for diagnostic testing. A total of 32,954 individuals took the questionnaire, 27,237 received the blood test, and 1,564 were referred to a physician. Among those who were successfully tracked (n = 1,113), 354 were newly diagnosed with diabetes mellitus. Seventy-two percent of participants screened were aged 45 years and older, and 67% had a body mass index of 25 or higher. Only 15% were members of ethnic minorities, and uninsured individuals were also underrepresented at 10%. The entire initiative, including planning, promotion, and administration, required 5,428 person-hours of staff time and a total cost of approximately 262,000 dollars. Fifty-seven percent of the total cost was derived from in-kind support of the coalitions. The cost of detecting each new case was 741 dollars.     

Prevention of type 2 diabetes: what challenges do we have to address?

The worldwide epidemic of type 2 diabetes mellitus is a major challenge for medical care and health-care systems. Type 2 diabetes is a complex metabolic disease developing in genetically susceptible individuals as a result of environmental and lifestyle risk factors. These risk factors are well known: obesity, central adiposity, physical inactivity and an unhealthy diet. To prevent the personal and socioeconomic burden of diabetes, the effort to prevent the disease needs to be started before the its onset and should address all susceptibility factors. Four recent studies have shown that prevention of type 2 diabetes is possible and that reinforced lifestyle intervention/modification can significantly reduce the onset of the disease. The studies showed repeatedly that diabetes was prevented from developing in about 60% of those with an increased diabetes risk compared to a control group. Early pharmacological preventive strategies have yielded a 25–30% risk reduction. These studies have convincingly demonstrated that the primary aim in prevention of type 2 diabetes is the stabilization of glucose tolerance due to improvement of insulin resistance. Based on the results of the studies, the intervention protocol focused on achieving five core goals. With respect to the worldwide burden of diabetes, these studies offer a compelling evidence base for the translation of the research findings into community-based prevention strategies on a national scale. The workgroup Diabetes Prevention at the German Diabetes Association together with the German Diabetes Foundation have developed a concept for a National Diabetes Prevention Programme. To achieve this, a large number of partners are necessary. For the implementation of such a programme at the population level, the intervention is primarily based on reinforced behaviour modification (lifestyle and physical activity). In addition, the pharmacoprevention of type 2 diabetes will be of increasing importance.     

Cost-Effectiveness of Reducing Glycaemic Episodes Through Community Pharmacy Management of Patients with Type 2 Diabetes Mellitus

Accessibility, availability and frequent public contact place community pharmacists in an ideal position to provide medically necessary, intensive health education and preventive health services to diabetes patients, thus reducing physician burden. We assessed the cost-effectiveness of reducing glycaemic episodes in patients with type 2 diabetes mellitus through a pharmacist-led Diabetes Management Education Program (DMEP) compared to standard care. We recruited eight metropolitan community pharmacies in Perth, Western Australia for the study. We paired them based on geographical location and the socioeconomic status of the population served, and then randomly selected one pharmacy in each pair to be in the intervention group, with the other assigned to the control group. We conducted an incremental cost-effectiveness analysis to compare the costs and effectiveness of DMEP with standard pharmacy care. Cost per patient of implementing DMEP was AU$394 (US$356) for the 6-month intervention period. Significantly greater reductions in number of hyperglycaemic and hypoglycaemic episodes occurred in the intervention relative to the control group [OR 0.34 (95 % CI 0.22, 0.52), p = 0.001; OR 0.54 (95 % CI 0.34, 0.86), p = 0.009], respectively, with a net reduction of 1.86 days with glycaemic episodes per patient per month. The cost-effectiveness of DMEP relative to standard pharmacy care was AU$43 (US$39) per day of glycaemic symptoms avoided. Patients with type 2 diabetes in three surveys were willing to pay an average of 1.9 times that amount to avoid a hypoglycaemic day. We conclude that DMEP decreased days with glycaemic symptoms at a reasonable cost. If a larger-scale replication study confirms these findings, widespread adoption of this approach would improve diabetes health without burdening general practitioners.     

Preventing HIV/AIDS among high-risk urban women: the cost-effectiveness of a behavioral group intervention.

OBJECTIVES: A human immunodeficiency virus (HIV) intervention trial for women at high risk for acquired immunodeficiency syndrome and attending an urban clinic was reported previously. The behavioral group intervention was shown to increase condom use behaviors significantly. This study retrospectively assessed the intervention's cost-effectiveness. METHODS: Standard methods of cost and cost-utility analysis were used. RESULTS: The intervention cost was just over $2000 for each quality-adjusted life-year saved; this is favorable compared with other life-saving programs. However, the results are sensitive to changes in some model assumptions. CONCLUSIONS: Under most scenarios, the HIV prevention intervention was cost-effective.     

Adolescent,parent and societal preferences and willingness to pay for meningococcal B vaccine: A Discrete Choice Experiment

ObjectiveMeningococcal B (MenB) vaccines have been licensed in many countries with private purchase the only option until recently, when a funded programme was introduced in the UK. The aim of this study was to explore adolescent/parental values for a variety of salient vaccine attributes (cost, effectiveness, side effect profile) to assess preferences and willingness-to-pay (WTP) for a MenB vaccine.MethodologyA national cross-sectional population study was conducted in Australia using Discrete Choice Experiment methodology to assess adolescent/parent/adult preferences for attributes related to MenB vaccine.Results2003 adults and 502 adolescents completed the survey in 2013. The majority of participants were willing to be vaccinated with MenB vaccine with vaccination opt-out chosen by 11.9% of adolescents and parents, and 18.2% of non-parent adults. A mixed logit regression model examining adolescent/adult preferences indicated consistent findings; the higher the effectiveness, the longer the duration of protection, the less chance of adverse events and the lower the cost, the more likely respondents were to agree to vaccination. For an ideal MenB vaccine, including the most favoured level of each attribute summed together (90% effectiveness, 10 year duration, 1 injection, no adverse events) adolescents would pay AU$251.60 and parents AU$295.10. Adolescents and parents would pay AU$90.70 or AU$127.20 for 90% vaccine effectiveness vs AU$18.50 or AU$16.70 for 70% effectiveness and would want to be financially compensated for 50% effectiveness; pay AU$63.30 or AU$76.40 for 10 years protection; and pay AU$48.50 or AU$49.20 for no vaccine related adverse events. A slight fever post vaccination was a preferred choice with parents and adolescents willing to pay AU$9.60 or AU$12.30 for this attribute.ConclusionsVaccine effectiveness, adverse events and duration of immunity are important drivers for parental and adolescent decisions about WTP for MenB vaccine and should be included in discussions on the benefits, risks and cost.     

膳食因素与2型糖尿病关系的logistic回归分析

目的：研究日常膳食因素与2型糖尿病患病的关系。方法：采用频数匹配病例对照研究设计,随机选择徐州市2型糖尿病新诊断病例185例,医院对照201例和人群对照197例,通过食物频数法膳食调查收集资料。使用logistic回归分析膳食因素与2型糖尿病的关联。结果：经单因素和多因素非条件logistic回归分析,结果显示膳食因素中高主食摄入（OR＝3．40）,经常性肉类摄入（OR＝2．29）,动物内脏摄入（OR＝2．47）,牛奶摄入（OR＝1．97）和甜食摄入（OR＝2．91）与2型糖尿病有显著性关联。结论：膳食中高能量,高脂肪,高糖摄入可能是当地2型糖尿病的危险因素。倡导健康的生活方法,提倡合理的膳食结构,是2型糖尿病防治的重要措施。     

Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care

ObjectiveTo report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice.MethodsAn economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children’s Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios.ResultsOn average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care.ConclusionsThis economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.     

Cost-effectiveness of a preventive counseling and support package for postnatal depression

OBJECTIVES: This study reports the cost-effectiveness of a preventive intervention, consisting of counseling and specific support for the mother-infant relationship, targeted at women at high risk of developing postnatal depression. METHODS: A prospective economic evaluation was conducted alongside a pragmatic randomized controlled trial in which women considered at high risk of developing postnatal depression were allocated randomly to the preventive intervention (n = 74) or to routine primary care (n = 77). The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum. Data on health and social care use by women and their infants up to 18 months postpartum were collected, using a combination of prospective diaries and face-to-face interviews, and then were combined with unit costs ( pound, year 2000 prices) to obtain a net cost per mother-infant dyad. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression. RESULTS: Women in the preventive intervention group were depressed for an average of 2.21 months (9.57 weeks) during the study period, whereas women in the routine primary care group were depressed for an average of 2.70 months (11.71 weeks). The mean health and social care costs were estimated at pounds sterling 2,396.9 per mother-infant dyad in the preventive intervention group and pounds sterling 2,277.5 per mother-infant dyad in the routine primary care group, providing a mean cost difference of pounds sterling 119.5 (bootstrap 95 percent confidence interval [CI], -535.4, 784.9). At a willingness to pay threshold of pounds sterling 1,000 per month of postnatal depression avoided, the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is pounds sterling 383.4 (bootstrap 95 percent CI, - pounds sterling 863.3- pounds sterling 1,581.5). CONCLUSIONS: The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum. Given the negative impact of postnatal depression on later child development, further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women.     

Presence of diabetes related complication at the time of NIDDM diagnosis: An important prognostic factor

We studied the short-term natural history of patients with newly diagnosed non-insulin dependent diabetes mellitus (NIDDM), and the prognostic role of history of NIDDM related complication at the time of first NIDDM diagnosis in relation to the development of a new complication or death. We performed a cohort study using data from the General Practice Research Database in the UK. We identified patients aged 30 to 74 years with a newly diagnosed NIDDM between 1990 and 1992 and followed them from the day of NIDDM diagnosis until June 1995. Among the 1077 patients identified, 437 (41%) developed a NIDDM complication during the follow-up. NIDDM complications were more frequent among males and in the elderly. Sixty-seven percent of the study cohort was initially free of any complication while the remaining 360 patients presented already one or more NIDDM complication at the time of their NIDDM diagnosis. History of diabetic related complication was associated with an increased risk of developing a new NIDDM complication (RR: 1.8; 95% CI: 1.5–2.2). Mortality was also greater among patients with history of NIDDM complication (RR: 1.5; 95% CI: 1.0–2.2). Patients with a history of any disorder related to diabetes before their clinical diagnosis of NIDDM are at increased risk of developing a NIDDM complication after the NIDDM diagnosis, as well as at increased risk of dying compared to diabetic patients with no history.