Social support is used to determine transplant eligibility despite lack of an evidence base and vague regulatory guidance. It is unknown how many patients are disqualified from transplantation due to inadequate support, and whether providers feel confident using these subjective criteria to determine eligibility. Transplant providers (n = 551) from 202 centers estimated that, on average, 9.6% (standard deviation = 9.4) of patients evaluated in the prior year were excluded due to inadequate support. This varied significantly by United Network for Organ Sharing region (7.6%-12.2%), and by center (21.7% among top quartile). Significantly more providers used social support in listing decisions than believed it ought to be used (86.3% vs 67.6%). Nearly 25% believed that using social support in listing determinations was unfair or were unsure; 67.3% felt it disproportionately impacted patients of low socioeconomic status. Overall, 42.4% were only somewhat or not at all confident using social support to determine transplant suitability. Compared to surgical/medical transplant providers, psychosocial providers had 2.13 greater odds of supporting the criteria (P = .03). Furthermore, 69.2% supported revised guidelines for use of social support in listing decisions. Social support criteria should be reconsidered in light of the limited evidence, potential for disparities, practice variation, low provider confidence, and desire for revised guidelines.

OBJECTIVES:To examine racial and ethnic differences in knowledge about one's dementia status DESIGN: Prospective cohort study SETTING: 2000-2014 Health and Retirement Study PARTICIPANTS: Our sample included 8,686 person-wave observations representing 4,065 unique survey participants age ≥70 with dementia, as identified by a well-validated statistical prediction model based on individual demographic and clinical characteristics. MEASUREMENTS: Primary outcome measure was knowledge of one's dementia status as reported in the survey. Patient characteristics included race/ethnicity, age, gender, survey year, cognition, function, comorbidity, and whether living in a nursing home.RESULTS: Among subjects identified as having dementia by the prediction model, 43.5%-50.2%, depending on the survey year, reported that they were informed of the dementia status by their doctor. This proportion was lower among Hispanics (25.9%-42.2%) and non-Hispanic blacks (31.4%-50.5%) than among non-Hispanic Whites (47.7%-52.9%). Our fully-adjusted regression model indicated lower dementia awareness among non-Hispanic blacks (OR=0.74 95% CI: 0.58-0.94) and Hispanics (OR=0.60; 95% CI: 0.43-0.85), compared to non-Hispanic whites. Having more IADL limitations (OR=1.65, 95% CI: 1.56-1.75) and living in a nursing home (OR=2.78, 95% CI: 2.32-3.32) were associated with increased odds of subjects reporting being told about dementia by a physician.

Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers' beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.

As economic evaluation becomes increasingly essential to support universal health coverage (UHC), we aim to understand the growth, characteristics, and quality of cost‐effectiveness analyses (CEA) conducted for Africa and to assess institutional capacity and relationship patterns among authors. We searched the Tufts Medical Center CEA Registries and four databases to identify CEAs for Africa. After extracting relevant information, we examined study characteristics, cost‐effectiveness ratios, individual and institutional contribution to the literature, and network dyads at the author, institution, and country levels. The 358 identified CEAs for Africa primarily focused on sub‐Saharan Africa (96%) and interventions for communicable diseases (77%). Of 2,121 intervention‐specific ratios, 8% were deemed cost‐saving, and most evaluated immunizations strategies. As 64% of studies included at least one African author, we observed widespread collaboration among international researchers and institutions. However, only 23% of first authors were affiliated with African institutions. The top producers of CEAs among African institutions are more adherent to methodological and reporting guidelines. Although economic evidence in Africa has grown substantially, the capacity for generating such evidence remains limited. Increasing the ability of regional institutions to produce high‐quality evidence and facilitate knowledge transfer among African institutions has the potential to inform prioritization decisions for designing UHC.

Background The iDSI reference case, originally published in 2014, aims to improve the quality and comparability of cost-effectiveness analyses (CEA). This study assesses whether the development of the guideline is associated with an improvement in methodological and reporting practices for CEAs using disability-adjusted life-years (DALYs). Methods We analyzed the Tufts Medical Center Global Health CEA Registry to identify cost-per-DALY averted studies published from 2011 to 2017. Among each of 11 principles in the iDSI reference case, we translated all methodological specifications and reporting standards into a series of binary questions (satisfied or not satisfied) and awarded articles one point for each item satisfied. We then calculated methodological and reporting adherence scores separately as a percentage of total possible points, measured as normalized adherence score (0% = no adherence; 100% = full adherence). Using the year 2014 as the dissemination period, we conducted a pre-post analysis. We also conducted sensitivity analyses using: 1) optional criteria in scoring, 2) alternate dissemination period (2014–2015), and 3) alternative comparator classification. Results Articles averaged 60% adherence to methodological specifications and 74% adherence to reporting standards. While methodological adherence scores did not significantly improve (59% pre-2014 vs. 60% post-2014, p = 0.53), reporting adherence scores increased slightly over time (72% pre-2014 vs. 75% post-2014, p<0.01). Overall, reporting adherence scores exceeded methodological adherence scores (74% vs. 60%, p<0.001). Articles seldom addressed budget impact (9% reporting, 10% methodological) or equity (7% reporting, 7% methodological). Conclusions The iDSI reference case has substantial potential to serve as a useful resource for researchers and policy-makers in global health settings, but greater effort to promote adherence and awareness is needed to achieve its potential.

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for the COSUMO Working GroupPurpose: To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials.Design: Mixed-methods study design comprising a systematic review and qualitative study followed by a 2-round Delphi exercise and face-to-face consensus meeting.Participants: Key stakeholders including patients diagnosed with NIU-PS, their caregivers, and healthcare professionals involved in decision-making for patients with NIU-PS, including ophthalmologists, nurse practitioners, and policymakers/commissioners.Methods: A long list of outcomes was developed based on the results of (1) a systematic review of clinical trials of NIU-PS and (2) a qualitative study of key stakeholders including focus groups and interviews. The long list was used to generate a 2-round Delphi exercise of stakeholders rating the importance of outcomes on a 9-point Likert scale. The proportion of respondents rating each item was calculated, leading to recommendations of "include," "exclude," or "for discussion" that were taken to a face-to-face consensus meeting of key stakeholders at which they agreed on the final COS.Main Outcome Measure: Items recommended for inclusion in the COS for NIU-PS.Results: A total of 57 outcomes grouped in 11 outcome domains were presented for evaluation in the Delphi exercise, resulting in 9 outcomes directly qualifying for inclusion and 15 outcomes being carried forward to the consensus meeting, of which 7 of 15 were agreed on for inclusion. The final COS contained 16 outcomes organized into 4 outcome domains comprising visual function, health-related quality of life, treatment side effects, and disease control.Conclusions: This study builds on international work across the clinical trials community and our qualitative research to construct the world's first COS for NIU-PS. The COS provides a list of outcomes that represent the priorities of key stakeholders and provides a minimum set of outcomes for use in all future NIU-PS clinical trials. Adoption of this COS can improve the value of future uveitis clinical trials and reduce noninformative research. Some of the outcomes identified do not yet have internationally agreed upon methods for measurement and should be the subject of future international consensus development.

29Background: The iDSI reference case, originally published in 2014, aims to improve the quality 30 and comparability of cost-effectiveness analyses (CEAs). This study assesses whether the 31 development of the guideline has improved the reporting and methodology for CEAs using 32 disability-adjusted life-years (DALYs). 33 Methods: We analyzed the Tufts Medical Center Global Health CEA Registry to identify cost-34 per-DALY averted studies published from 2011 to 2017. Among each of 11 principles in the 35iDSI reference case, we translated all reporting standards and methodological specifications into 36 quantifiable yes/no questions and awarded articles one point for each item satisfied. We then 37 separately calculated reporting and methods scores, measured as percent adherence (0%=no 38 adherence, 100%=full adherence). Using the year 2014 as the dissemination period, we 39 conducted a pre-post analysis. Additionally, we conducted an analysis stratified by the 11 40 principles and examined different scoring strategies and dissemination periods in sensitivity 41 analyses. 42Results: Articles averaged 74% adherence to reporting standards and 60% adherence to 43 methodological specifications. Adherence to reporting standards increased slightly over time 44 (72% pre-2014 vs. 75% post-2014, p<0.01), but methodological adherence did not significantly 45 improve (59% pre-2014 vs. 60% post-2014, p=0.53). Overall, reporting adherence scores 46 exceeded methodology adherence scores (74% vs. 60%, p<0.001). Articles seldom addressed 47 budget impact (9% reporting, 10% methodology) or equity (7% reporting, 7% methodology). 10/1/2018 3 48 Conclusions:The iDSI reference case has substantial potential to serve as a useful resource for 49 researchers and policy-makers in global health settings, but greater effort to promote adherence 50 and awareness is needed to achieve its potential. 10/1/2018 4 51 Background 52 Since the original Panel on Cost-Effectiveness in Health and Medicine proposed the use 53 of a reference case as a benchmark of quality and methodological rigor (1, 2), various guidelines 54 for conducting economic analyses have been proposed (3, 4). Over the last two decades, many 55 countries, particularly high-income ones, have developed their own reference cases to inform 56 decision-making in their health care systems (5-8). In contrast, most low-and middle-income 57 countries (LMICs) have not developed such guidelines, possibly due to their limited capacity to 58 do so (9).Case (10, 11) to convey the breadth of its intended applicability. The iDSI Reference Case fills a 65 major gap in global health economics, as it serves as the only resource of best practices for 66 economic evaluation for many LMICs looking for guidance on resource prioritization. To date, 67 however, no study has examined the extent to which economic evaluations adhere to the iDSI 68 guidelines. We aimed to evaluate whether the development of the iDSI reference case has 69 improved adherence to best practices for economic evaluations in glo...