Background: Polypharmacy, the concomitant use of 5 or more medications, is highly prevalent among older adults and individuals with multimorbid conditions and has been linked to suboptimal clinical outcomes in various diseases. However, little is known about the impact of polypharmacy on clinical outcomes among coronavirus disease 2019 (COVID-19) patients. Objective: This systematic review summarizes the available literature on the association between polypharmacy and specific drug classes, and clinical outcomes among COVID-19 patients. Methods: We conducted an electronic database search on Embase, Medline, Cochrane, Scopus, Google Scholar, clinicaltrials.gov, LITCOVID, PubMed, PubMed Central (PMC), and China national knowledge infrastructure for studies on Polypharmacy among COVID-19 patients using relevant combinations of the keywords. Only studies published between November 2019 to September 2020 were included. Seven articles out of 1502 unique articles met the inclusion criteria and were used for the current study. We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in conducting and reporting this systematic review. Results: The total sample size of all studies was 474,342, out of which 10,519 patients were COVID-19 positive, and 4818 COVID-19 positive patients experienced polypharmacy. Five out of the 7 included studies found associations between polypharmacy and negative clinical outcomes among COVID-19 patients. Polypharmacy was associated with increase in the relative risk of a positive COVID-19 test result (P < 0.01), death among male COVID-19 patients (P < 0.001), increase in the rate of acute kidney injury (P ¼ 0.003), and adverse drug reactions (P < 0.001). Antipsychotic drugs were associated with severe COVID-19 morbidity (OR ¼ 2.79; 95% CI 2.23e3.49) and increased risk of death among COVID-19 infected men (OR ¼ 1.71; 95% CI 1.18e2.48) and women (OR ¼ 1.96; 95% CI 1.41e2.73). Conclusion: Polypharmacy and selected drug classes are associated with increased risk of adverse clinical outcomes among COVID-19 patients. Understanding these relationships can enhance risk stratification and evidence-based decision-making that may improve care and clinical outcomes of COVID-19 patients.
Objectives: Globally, rotaviruses are the most frequent causes of severe diarrhea in children under five years of age. China has experienced significant morbidity and mortality associated with rotavirus, creating a large economic burden. The domestic monovalent rotavirus vaccine and the universal pentavalent rotavirus vaccine are available in China. To determine the public health impact of a national rotavirus vaccination program, we performed a cost-effectiveness study from the perspective of the health care system. Methods: A Markov model was designed to perform a cost-effectiveness analysis that reflects key features of rotavirus history in China. Parameters of the model were assessed by field study or developed through literature searches and published data. Outcome measures included direct cost, indirect cost, the incidence of rotavirus infection, vaccine-induced intussusception risk, the mortality of the intensive care unit (ICU), quality-adjusted life-years (QALYs) lost, and incremental cost per QALY saved (ICER). Moreover, we considered the first and subsequent rotavirus infections and the protection against subsequent rotavirus infections and disease. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the incremental cost-effectiveness ratios (ICERs). Results: In a base case analysis, vaccine arms showed cost-saving ICERs. the ICER of the universal pentavalent rotavirus vaccine arm was -1518USD/QALY and the domestic monovalent rotavirus vaccine arm was -1514USD/QALY compared to no vaccine. One-way sensitivity analysis demonstrated that intensive care unit (ICU) mortality due to rotavirus infection was the most influential parameter for the ICER of each vaccine strategy. In a probabilistic sensitivity analysis, two kinds of vaccines saved QALYs in 100% of simulations and were cost-saving 97% of the time. Conclusions: Two rotavirus vaccines strategies were cost-saving preventive measures in our analysis.
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