Objective The coronavirus disease 2019 (COVID-19) pandemic has imposed significant costs on economies. Safe and effective vaccines are a key tool to control the pandemic; however, vaccination programs can be costly. Are the benefits they bestow worth the costs they incur? The relative value of COVID-19 vaccines has not been widely assessed. In this study, a cost-effectiveness analysis was performed to provide evidence of the economic value of vaccines in Hong Kong. Method We developed a Markov model of COVID-19 infections using a susceptible–infected–recovered structure over a 1-year time horizon from a Hong Kong healthcare sector perspective to measure resource utilization, economic burden, and disease outcomes. The model consisted of two arms: do nothing and implement a vaccination program. We assessed effectiveness using units of quality-adjusted life years (QALYs) to measure the incremental cost-effectiveness at a HKD 1,000,000/QALY threshold. Results The vaccination program, which has reached approximately 72% of the population of Hong Kong with two vaccine doses, was found to have a cost of HKD 22,339,700 per QALY gained from February 2021 to February 2022. At a willingness-to-pay threshold, the vaccination program was not cost-effective in the context of the low prevalence of COVID-19 cases before the Omicron wave. However, the cost-effectiveness of a COVID-19 vaccine is sensitive to the infection rate. Hong Kong is now experiencing the fifth wave of the Omicron. It is estimated that the ICER of the vaccination program from February 2022 to February 2023 was HKD 310,094. The vaccination program in Hong Kong was cost-effective in the context of the Omicron. Conclusions Vaccination programs incur a large economic burden, and we therefore need to acknowledge their limitations in the short term. This will help relevant departments implement vaccination programs. From a longer-term perspective, the vaccination program will show great cost-effectiveness once infection rates are high in a regional outbreak. Compared with other age groups, it is suggested that the elderly population should be prioritized to improve the vaccine coverage rate.
Background The rate of undetected dementia is high in China. However, the performance of dementia screening tools may differ in the Chinese population due to the lower education level and cultural diversity. This study aimed to evaluate the diagnostic accuracy of dementia screening tools in the Chinese population. Methods Eleven electronic databases were searched for studies evaluating the diagnostic accuracy of dementia screening tools in older Chinese adults. The overall diagnostic accuracy was estimated using bivariate random-effects models, and the area under the summary receiver operating characteristic curve was presented. Results One hundred sixty-seven studies including 81 screening tools were identified. Only 134 studies qualified for the meta-analysis. The Mini-Mental State Examination (MMSE) was the most commonly studied tool, with a combined sensitivity (SENS) and specificity (SPEC) of 0.87 (95%CI 0.85–0.90) and 0.89 (95%CI 0.86–0.91), respectively. The Addenbrooke’s Cognitive Examination-Revised (ACE-R) (SENS: 0.96, 95%CI 0.89–0.99; SPEC: 0.96, 95%CI 0.89–0.98) and Montreal Cognitive Assessment (MoCA) (SENS: 0.93, 95%CI 0.88–0.96; SPEC: 0.90, 95%CI 0.86–0.93) showed the highest performance. The General Practitioner Assessment of Cognition (GPCOG), Hasegawa’s Dementia Scale and Cognitive Abilities Screening Instrument had performances comparable to that of the MMSE. The cut-off scores ranged widely across studies, especially for the MMSE (range: 15–27) and MoCA (range: 14–26). Conclusions A number of dementia screening tools were validated in the Chinese population after cultural and linguistical adaptations. The ACE-R and MoCA had the best diagnostic accuracy, whereas the GPCOG, with an administration time < 5 minutes, could be considered as a rapid screening tool.
Digital drawing tests have been proposed for cognitive screening over the past decade. However, the diagnostic performance is still to clarify. The objective of this study was to evaluate the diagnostic performance among different types of digital and paper-and-pencil drawing tests in the screening of mild cognitive impairment (MCI) and dementia. Diagnostic studies evaluating digital or paper-and-pencil drawing tests for the screening of MCI or dementia were identified from OVID databases, included Embase, MEDLINE, CINAHL, and PsycINFO. Studies evaluated any type of drawing tests for the screening of MCI or dementia and compared with healthy controls. This study was performed according to PRISMA and the guidelines proposed by the Cochrane Diagnostic Test Accuracy Working Group. A bivariate random-effects model was used to compare the diagnostic performance of these drawing tests and presented with a summary receiver-operating characteristic curve. The primary outcome was the diagnostic performance of clock drawing test (CDT). Other types of drawing tests were the secondary outcomes. A total of 90 studies with 22,567 participants were included. In the screening of MCI, the pooled sensitivity and specificity of the digital CDT was 0.86 (95% CI = 0.75 to 0.92) and 0.92 (95% CI = 0.69 to 0.98), respectively. For the paper-and-pencil CDT, the pooled sensitivity and specificity of brief scoring method was 0.63 (95% CI = 0.49 to 0.75) and 0.77 (95% CI = 0.68 to 0.84), and detailed scoring method was 0.63 (95% CI = 0.56 to 0.71) and 0.72 (95% CI = 0.65 to 0.78). In the screening of dementia, the pooled sensitivity and specificity of the digital CDT was 0.83 (95% CI = 0.72 to 0.90) and 0.87 (95% CI = 0.79 to 0.92). The performances of the digital and paper-and-pencil pentagon drawing tests were comparable in the screening of dementia. The digital CDT demonstrated better diagnostic performance than paper-and-pencil CDT for MCI. Other types of digital drawing tests showed comparable performance with paper-and-pencil formats. Therefore, digital drawing tests can be used as an alternative tool for the screening of MCI and dementia.
This review aimed to systematically review and meta-analyze the effects of interventions in improving bracing compliance among adolescent idiopathic scoliosis (AIS) patients. Eight databases were searched from their inception to April 2022. The eligibility criteria included controlled studies that used any type of intervention to enhance bracing compliance in braced AIS patients. Two researchers independently screened articles and extracted data based on the PICO (participant, intervention, comparator, and outcome) framework. Quality appraisal of included studies was performed using GRADE (overall assessment), and the risk of bias was assessed with Cochrane RoB Tool 2 for randomized controlled trials (RCT) and ROBINS-I for non-RCT studies. The primary outcome was bracing compliance and secondary outcomes included Cobb Angle and measurements for quality of life. Six eligible studies involving 523 participants were included. All studies were evaluated as low or very low quality with a high risk of bias. Four types of interventions were identified, including sensor monitoring (n = 2, RCTs), auto-adjusted brace (n = 1, RCT), more intensive or collaborated medical care (n = 2), and psychosocial intervention (n = 1). A meta-analysis of 215 patients from the three RCTs suggested that the compliance-enhancing intervention group had 2.92 more bracing hours per day than the usual care control (95%CI [1.12, 4.72], P = 0.001). In subgroup analysis, sensor monitoring significantly improved bracing wearing quantity compared to usual care (3.47 hours/day, 95%CI [1.48, 5.47], P = 0.001), while other aforementioned interventions did not show a significant superiority. Compliance-enhancing interventions may be favorable in preventing curve progression and promoting quality of life, but the improvements cannot be clarified according to limited evidence. In conclusion, although the results of this study suggested that sensor monitoring may be the most promising approach, limited high-quality evidence precludes reliable conclusions. Future well-designed RCTs are required to confirm the actual benefit of compliance-improving interventions in clinical practice.
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