Lives and Economic Loss in Brazil due to Lack of Radiotherapy Access in Cervical Cancer: A Cost-Effectiveness Analysis

AimsAmong all malignancies, the use of radiotherapy incurs the highest survival benefit within cervical cancers. Radiotherapy, however, remains underutilised for cervical cancers within the Brazilian public health system (BPHS). The objective of this study was to estimate the potential health and monetary benefits for universal access to radiotherapy and chemoradiotherapy (CRT) for untreated cervical cancer patients in the BPHS.Materials and methodsUsing 2016 data on Brazilian cervical cancer incidence and availability of radiotherapy/CRT in the BPHS, the number of cancer deaths due to radiotherapy/CRT underutilisation was estimated. The incremental effectiveness was calculated by life-year gain. The indirect costs from mortality-related productivity loss (MRPL) were estimated based on life expectancy, wage and labour force participation rate. MRPL was compared with direct medical costs after being adjusted to 2016 US dollars. This study was conducted from the payer's perspective; both costs and effectiveness were discounted at a rate of 3%. The incremental cost-effectiveness ratio (ICER) was calculated to determine the cost-effectiveness of radiotherapy for cervical cancer in Brazil. One-way sensitivity analyses were carried out to assess the robustness of the model.ResultsThe total number of life-years lost due to lack of universal access to radiotherapy and CRT per year were 27 199 and 31 627, respectively. The annual cost to match the radiotherapy gap was $10.5 million, with an additional cost of $3 million to close the CRT gap. The mean years of potential life lost per death was 20.5. The cost per life saved was $7942 for radiotherapy alone (ICER $388/life-year) and $8774 for CRT (ICER $429/life-year). MRPL due to shortage of radiotherapy and CRT were $59 million and $69 million, respectively.ConclusionProviding universal access to radiotherapy/CRT for cervical cancer patients in the BPHS is highly cost-effective and should be prioritised as an impactful public health initiative.     

Roles of community pharmacists in improving oral health awareness in Plateau State,Northern Nigeria

Introduction: There is poor oral health awareness in Nigeria because of limited access to correct information on oral health as well as a lack of oral health-care providers. The purpose of this study was to describe the roles of community pharmacists (CPs) in Plateau State, Northern Nigeria, as sources of oral health information in their communities. Methods: A quantitative cross-sectional study on CPs spanning the entire State. Data collection was a survey method using a structured paper-based self-administered questionnaire. Analysis, which included t-tests and binary logistic regression, was carried out using SPSS ver. 23. Results: A one-sample t-test to assess the attitudes of CPs on oral health showed that they had a very good disposition towards engaging in oral health services [advice, referrals, recommendations and basic treatment (e.g. of pain); mean = 4.54, standard deviation = 0.59, t(111) = 27.8, P < 0.001]. Although CPs presently provide some services to patients with oral health problems, 94.7% were willing to do more to advance the cause of oral health care. Training of CPs on oral health (32%), removal of restrictive policies in the health bill (1.8%) and sensitising the public (6.3%) were some suggestions on how to improve these services. Conclusion: The disposition of CPs towards improving oral health could serve as a platform to help propagate oral health care and awareness in their communities. Engaging the CPs might help to reduce oral health disparities by increasing oral health awareness and improving the quality of life via cost-effective delivery of pharmacy-based oral health-care services.Key words: Oral health, community pharmacists, access to oral care, oral health promotion     

Transradial access for coronary diagnostic and interventional procedures: Consensus statement and recommendations for India: Advancing Complex CoronariES Sciences through TransRADIAL intervention in India – ACCESS RADIAL™: Clinical consensus recommendations in collaboration with Cardiological Society of India (CSI)

Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not. An evidence-based review involving various facets of radial procedure for cardiac catheterization, including practical, patient-related and technical issues was conducted by an expert committee that formed a part of Advancing Complex CoronariES Sciences through TransRADIAL intervention (ACCESS RADIAL™) Advisory Board. Emerging challenges in redefining TR management based on evidence supporting practices were discussed to formulate these final recommendations through consensus.     

Addressing rural and remote access disparities for patients with inflammatory arthritis through video‐conferencing and innovative inter‐professional care models

Objective

The aim of the present study was to evaluate whether rheumatoid arthritis (RA) patients followed longitudinally using video‐conferencing and inter‐professional care support have comparable disease control to those followed in traditional in‐person rheumatology clinics.

Methods

This was a randomized controlled trial for 85 RA patients allocated to either traditional in‐person rheumatology follow‐up or video‐conferenced follow‐up with urban‐based rheumatologists and rural in‐person physical therapist examiners. Follow‐up was every 3 months for 9 months. Outcome measures included disease activity metrics (disease activity in 28 joints with CRP measure score [DAS28‐CRP], and RA disease activity index [RADAI]), modified health assessment questionnaire (mHAQ), quality of life (EuroQOL five dimensions questionnaire [EQ5D]) and patient satisfaction (nine‐item visit‐specific satisfaction questionnaire [VSQ9]).

Results

Of 85 participants, 54 were randomized to the video‐conferencing team model and 31 to the traditional clinic (control group). Dropout rates were high, with only 31 (57%) from the video‐conferencing and 23 (74%) from the control group completing the study. The mean age for study participants was 56 years; 20% were male. Mean RA disease duration was 13.9 years. There were no significant between‐group differences in DAS28‐CRP, RADAI, mHAQ or EQ5D scores at baseline or over the study period. Satisfaction rates were high in both groups.

Conclusions

We found no evidence of a difference in effectiveness between inter‐professional video‐conferencing and traditional rheumatology clinic for both the provision of effective follow‐up care and patient satisfaction for established RA patients. High dropout rates reinforce the need for consultation with patients' needs and preferences in developing models of care. While use of video‐conferencing/telehealth technologies may be a distinct advantage for some patients, there may be loss of travel‐related auxiliary benefits for others.