While the economic burden of influenza infection is well described among adults aged 65 and older, less is known about younger adults. A systematic literature review was conducted to describe the economic burden of seasonal influenza in adults aged 18 to 64 years, to identify the main determinants of direct and indirect costs, and to highlight any gaps in the existing published evidence. MEDLINE and Embase were searched from 2007 to February 7, 2020, for studies reporting primary influenzarelated cost data (direct or indirect) or absenteeism data. Of the 2613 publications screened, 51 studies were included in this review. Half of them were conducted in the United States, and 71% of them described patients with influenza-like illness rather than laboratory-confirmed disease. Only 12 studies reported cost data specifically for at-risk populations. Extracted data highlighted that within the 18-to 64-year-old group, up to 88% of the economic burden of influenza was attributable to indirect costs, and up to 75% of overall direct costs were attributable to hospitalizations. Furthermore, within the 18-to 64-year-old group, influenza-related costs increased with age and underlying medical conditions. The reported cost of influenza-related hospitalizations was found to be up to 2.5 times higher among atrisk populations compared with not-at-risk populations. This review documents the considerable economic impact of influenza among adults aged 18 to 64. In this age group, most of the influenza costs are indirect, which are generally not recognized by decision makers. Future studies should focus on at-risk subgroups, lab-confirmed cases, and European countries.
Overall, RCT evidence strongly supported omalizumab efficacy and safety as add-on treatment in children 6 to 11 years old with moderate-to-severe persistent allergic asthma. RWS data confirmed these findings in an extended patient population of children and adolescents that is more generalizable to the actual day-to-day management of these patients.
BackgroundThis study investigated the relationship between changes in lung function (as measured by forced expiratory volume in one second [FEV1]) and the St. George’s Respiratory Questionnaire (SGRQ) and economically significant outcomes of exacerbations and health resource utilization, with an aim to provide insight into whether the effects of COPD treatment on lung function and health status relate to a reduced risk for exacerbations.MethodsA systematic literature review was conducted in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials of adult COPD patients published in English since 2002 in order to relate mean change in FEV1 and SGRQ total score to exacerbations and hospitalizations. These predictor/outcome pairs were analyzed using sample-size weighted regression analyses, which estimated a regression slope relating the two treatment effects, as well as a confidence interval and a test of statistical significance.ResultsSixty-seven trials were included in the analysis. Significant relationships were seen between: FEV1 and any exacerbation (time to first exacerbation or patients with at least one exacerbation, p = 0.001); between FEV1 and moderate-to-severe exacerbations (time to first exacerbation, patients with at least one exacerbation, or annualized rate, p = 0.045); between SGRQ score and any exacerbation (time to first exacerbation or patients with at least one exacerbation, p = 0.0002) and between SGRQ score and moderate-to-severe exacerbations (time to first exacerbation or patients with at least one exacerbation, p = 0.0279; annualized rate, p = 0.0024). Relationships between FEV1 or SGRQ score and annualized exacerbation rate for any exacerbation or hospitalized exacerbations were not significant.ConclusionsThe regression analysis demonstrated a significant association between improvements in FEV1 and SGRQ score and lower risk for COPD exacerbations. Even in cases of non-significant relationships, results were in the expected direction with few exceptions. The results of this analysis offer health care providers and payers a broader picture of the relationship between exacerbations and mean change in FEV1 as well as SGRQ score, and will help inform clinical and formulary-making decisions while stimulating new research questions for future prospective studies.
With major depressive disorder (MDD) associated with significant clinical, economic and health-related quality of life impact, we sought to systematically review and synthesize information relevant to the burden of MDD in Africa and the Middle East, from which published evidence is slim. Our literature search identified 54 publications assessing epidemiological (43), humanistic (5), clinical/treatment (7) or economic outcomes (2). General population MDD prevalence and that among chronic disease populations were similar in Africa and the Middle East. No MDD-related economic literature specific to Africa or the Middle East was identified. Five studies of humanistic outcomes were identified; four African studies documented significant reduction of health-related quality of life related to MDD. The frequency of certain risk factors for MDD, such as disease, trauma and associated stress, as well as patterns of MDD treatment, suggest the potential for a higher burden of disease in Africa and the Middle East than in western countries.
compared the gene expression of these markers in GVHD to that in LE, using fixed skin biopsy specimens. Logistical regression diagnostic models were developed. Results: We included 49 cases of GVHD and 14 cases of LE, all showing vacuolar interface inflammation. Both entities showed robust expression of genes induced by interferon, as well as those encoding proteins involved in antigen processing and presentation, cell signaling, and tissue repair. Expression of these genes was significantly higher in LE than in GVHD, despite equivalent histopathologic grades of vacuolar interface changes between the groups. We developed four models that offered perfect diagnostic differentiation on samples tested (receiver operating characteristic area-undercurve: 1.0). Conclusions:This study confirms type I interferon influence on gene expression in the skin in both acute GVHD and LE, with LE affected to a significantly higher degree. Similar changes were noted with genes relating to antigen presentation, supporting the general pathogenic mechanisms of these processes. Finally, this study demonstrates the feasibility of distinguishing between microscopically similar inflammatory dermatoses using tissue-based molecular techniques.
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