In this updated analysis, QIV was estimated to be cost-effective compared with TIV in the U.K.
Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, one of seven commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in health care settings? Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in health care workers (HCWs; absolute risk reductions 1%–21%); five reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and two in HIV-positive in-patients (6%–29% reduction). 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated. Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonising study designs and reporting frameworks will permit formal data syntheses and facilitate policymaking.
Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid has the potential to reduce bleeding and a large randomized controlled trial of its effect on maternal health outcomes in women with PPH (The WOMAN trial) is ongoing. We will examine the effect of tranexamic acid on fibrinolysis and coagulation in a subset of WOMAN trial participants. Methods. Adult women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion in the WOMAN trial. In a sub-group of trial participants, blood samples will be collected at baseline and 30 minutes after the first dose of tranexamic acid or matching placebo. Our primary objective is to evaluate the effect of tranexamic acid on fibrinolysis. Fibrinolysis will be assessed by measuring D-dimers and by rotational thromboelastometry (ROTEM). Secondary outcomes are international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, haemoglobin and platelets. We aim to include about 180 women from the University College Hospital, Ibadan in Nigeria. Discussion: This sub-study of WOMAN trial participants should provide information on the mechanism of action of tranexamic acid in women with postpartum haemorrhage. We present the trial protocol and statistical analysis plan. The trial protocol was registered prior to the start of patient recruitment. The statistical analysis plan was completed before un-blinding. Trial registration: The trial was registered: ClinicalTrials.gov, Identifier NCT00872469 https://clinicaltrials.gov/ct2/show/NCT00872469; ISRCTN registry, Identifier ISRCTN76912190 http://www.isrctn.com/ISRCTN76912190 (Registration date: 22/03/2012).
Immunizing healthy children for influenza is more costly, yet more effective than no immunization in preventing cases in the sample. At a cost of $164.12 to prevent a case of influenza, immunizing healthy children to protect all community members may be considered costeffective. Estimated results are conservative as the influenza season was mild and the sample population was healthy. In a more severe season with a less healthy population the ICER is expected to decrease.
Objectives: Untreated hepatitis C virus (HCV) infection results in chronic liver disease. The prevalence in The Netherlands is estimated at 0.1-0.4% with 50% of patients having HCV genotype 1 (GT1). Sofosbuvir (SOF), a novel Direct Antiviral Agent (DAA), reached high rates of sustained virological response (SVR) when given with pegylated interferon-α and ribavirin (PegIFN-α /RBV) in chronic HCV (all genotypes). This study compares the costs per successfully treated patient with sofosbuvir compared to current standard of care (SoC) in the Netherlands in treatment-naïve GT1 patients. MethOds: A Markov transition cost-utility model was used, reflecting efficacy and safety data from published RCTs with SOF+PegIFNα /RBV, PegIFN-α /RBV, telaprevir (TVR) +PegIFN-α /RBV and boceprevir (BOC) +PegIFN-α /RBV. Medical resource use is based on clinical guidelines and expert opinion. Costs include treatment costs, monitoring costs, costs for treatment of complications and adverse events. The model has a lifetime horizon and costs are discounted with 4% and outcomes with 1.5%. Successfully treated patients are defined as having an SVR. Results are presented for a treatment-naïve GT1 population. Results: The SVR rate for SOF ranged from 91.7% in non-cirrhotic patients to 80.1% in cirrhotic patients. This was 43.6% and 23.6% for PegIFN-α , 75.4% and 61.9% in TVR and 64.1% and 55% for BOC. Total treatment costs ranged from € 55,376 to € 70,336 for SOF (non-cirrhotic and cirrhotic), € 22,240 and € 44,751 for PegIFN-α , € 42,593 to € 60,071 for TVR and € 39,634 to € 57,647 for BOC. The costs per SVR varied from € 60.388 to € 87,050 for SOF (non-cirrhotic and cirrhotic), € 51,009 to € 189,623 for PegIFN-α , € 56,489 to € 97,045 for TVR and € 61,832 to € 104,813 for BOC. cOnclusiOns: The costs per successfully treated patient with sofosbuvir are comparable to current standard of care in GT1 treatment naive patients without cirrhosis and are lower than SoC in cirrhotic patients in The Netherlands.
costs in intraoperative changes of the surgical plan and reductions in unnecessary surgery associated with the use of PV-MRI. Results from the previous study VALUE, which showed that no patient with PV required additional imaging tests as part of a Phase IV, confirm the results obtained in the present analysis (resulting in even slightly lower cost than the total cost of diagnosis using PV-MRI).OBJECTIVES: Cervical cancer incidence in Serbia has been identified as one of the highest in Europe, showing slow but steady increase during the last decade. Despite the National Programme for Prevention of Cervical Cancer that has recently been established, an organised Pap screening is far from full implementation. This study aims to assess the effectiveness and cost effectiveness of absolute adherence to the proposed policy compared to the current practice. METHODS: A Markov model simulating the natural history of cervical cancer was developed. Calibration was performed using country specific data, sourcing incidence and mortality from Serbian cancer registries. Accordingly, the screening algorithm incorporated in the model was based on the local guidelines. We followed a hypothetical cohort of 100,000 15-year old girls until the end of their lifetime. Subsequently, the actual cytological screening practice covering only 20% of the targeted population was compared to a scenario of absolute adherence to the national screening programme. A discount rate of 1.5% for health and 4% for cost outcomes was applied. RESULTS: The natural history model showed that limited benefit is currently being achieved from cytological screening. The hypothetical cohort analysis indicated that absolute guidelines adherence would result in 422 deaths averted and an incremental cost effectiveness ratio (ICER) of 3272 €/LYG. The ICER estimate did not exceed the national annual GDP (3857 €/capita) -a commonly used informal threshold. CONCLUSIONS: This research identified that full adherence to the screening policy is very likely to be cost effective. In general, the low screening coverage that has been observed appeared as the most serious obstacle to the prevention of cervical cancer. The new methods in cervical cancer prevention, however, such as HPV vaccination and HPV testing, require further pharmacoeconomic assessment.
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