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32 p., ill., Een fabrikant van implantaten of invasieve medische hulpmiddelen moet, als hij wenst dat zijn product wordt terugbetaald, een dossier indienen bij de ziekteverzekering (RIZIV). Daarbij moet hij, onder andere, de jaarlijkse impact van de terugbetaling inschatten op het budget van alle betalers van gezondheidszorg, in een zogenaamde budget impact analyse (BIA). Op vraag van het RIZIV ging het Federaal Kenniscentrum voor de Gezondheidszorg na hoe real-world data (RWD) uit de Belgische nationale databanken hierbij kunnen worden gebruikt. RWD blijken waardevolle informatie te bevatten, maar vaak ontbreken bepaalde gegevens of zijn ze onvolledig; en daarom dienen ze met de nodige omzichtigheid te worden gebruikt. Voor het bepalen van het behandeleffect blijven andere vormen van studies de voorkeur genieten., VOORWOORD 1 -- SYNTHESE 3 -- 1. INLEIDING 5 -- 1.1. WAT IS EEN IMPLANTAAT OF INVASIEF MEDISCH HULPMIDDEL? 5 -- 1.2. WANNEER WORDT EEN BUDGET IMPACT ANALYSE UITGEVOERD? 5 -- 1.3. WELKE INFORMATIE MOET EEN BIA BEVATTEN? 6 -- 1.3.1. Directe zorgkosten of besparingen met mogelijkheid tot bijkomende analyses 6 -- 1.3.2. Vanuit het oogpunt van alle zorgbetalers: een transversale aanpak 7 -- 1.4. DOEL VAN DE STUDIE 7 -- 1.4.1. Onderzoeksvragen 7 -- 2. DE BESCHIKBARE BELGISCHE DATABANKEN EN HUN TOEGANGSMOGELIJKHEDEN 8 -- 2.1. DE DATABANK VAN HET INTERMUTUALISTISCH AGENTSCHAP (IMA) 10 -- 2.2. DE PERMANENTE STEEKPROEF VAN HET IMA (EPS) 10 -- 2.3. DE MINIMALE ZIEKENHUISGEGEVENS (MZG) 11 -- 2.4. DE ZIEKENHUISFACTURATIEGEGEVENS (AZV/ADH) 11 -- 2.5. DE GEKOPPELDE MZG/EPS DATA 11 -- 2.6. DE DATABANK VAN DE TECHNISCHE CEL (TCT) 12 -- 2.7. RIZIV DOC. N 12 -- 2.8. RIZIV DOC. P 12 -- 2.9. RIZIV DOC. PH 12 -- 2.10. FARMANET 13 -- 3. TOEKOMSTIGE INITIATIEVEN 14 -- 3.1. AGENTSCHAP GEZONDHEIDS(ZORG)DATA IN OPRICHTING 14 -- 3.2. DE EUROPESE UDI EN EUDAMED DATABANK 14 -- 4. DE ONDERDELEN VAN EEN BUDGET IMPACT ANALYSE EN DE DATABANKEN DIE HIERVOOR KUNNEN WORDEN GEBRUIKT 15 -- 4.1. DE OMVANG VAN DE DOELPOPULATIE 17 -- 4.2. DE KOSTPRIJS VAN HET GEBRUIK VAN HET HULPMIDDEL EN DE COMPARATOR 18 -- 4.3. OVERIGE KOSTEN VERBONDEN AAN DE INITIËLE HOSPITALISATIE 18 -- 4.4. HET BEHANDELINGSEFFECT (IMPACT OP AANTAL EN ERNST VAN HEROPNAMES, OPVOLGING, REVALIDATIE, COMPLICATIES) 19 -- 4.5. DE EENHEIDSKOSTEN VAN GEBEURTENISSEN NA DE INITIËLE INGREEP 20 -- 4.6. BEPERKINGEN VAN DE NATIONALE DATABANKEN 20 -- 4.6.1. Kwaliteit van de informatie 20 -- 4.6.2. Patiëntkenmerken slechts in beperkte mate aanwezig 20 -- 4.6.3. Elke databank heeft zijn eigen kenmerken en beperkingen 21 -- AANBEVELINGEN 23

109 p., ill., 1 INTRODUCTION 11 -- 1.1 CONTEXT 11 -- 1.2 AIM OF THE STUDY 13 -- 1.2.1 Research questions .13 -- 1.3 METHODS 14 -- 1.3.1 Two case studies 14 -- 1.3.2 Data sources analyzed 14 -- 1.3.3 Methods for the data analysis .15 -- 1.4 REPORT OUTLINE .17 -- 2 BACKGROUND 17 -- 2.1 THE GLOBAL AND PARTIAL BUDGETS OF THE FEDERAL RIZIV-INAMI HEALTH INSURANCE BUDGET .17 -- 2.2 THE CTIIMH – CRIDMI AND THE REIMBURSEMENT DECISION PROCEDURE FOR IMPLANTS AND INVASIVE MEDICAL DEVICES 21 -- 2.2.1 Definitions .21 -- 2.2.2 The CTIIMH – CRIDMI 22 -- 2.2.3 The list and the nominative lists .24 -- 2.2.4 The procedure .28 -- 2.3 THE HEALTH CARE RESPONSIBILITIES OF AND DATA TRANSMISSION BY THE FEDERATED INSTANCES .32 -- 3 RETROSPECTIVE ANALYSIS OF TWO CASES 33 -- 3.1 THE CASE OF MECHANICAL THROMBECTOMY 33 -- 3.1.1 Background information .33 -- 3.1.2 PICO of the reimbursement request 33 -- 3.1.3 Overview of inputs from the budget impact analyses .34 -- 3.2 THE CASE OF TAVI 41 -- 3.2.1 Background information .41 -- 3.2.2 PICO of the reimbursement request 43 -- 3.2.3 Overview of inputs from the budget impact analyses .43 -- 3.2.4 Inputs 43 -- 4 OVERVIEW OF NATIONAL DATABASES THAT CAN POTENTIALLY BE USED FOR BIA AND ACCESS POSSIBILITIES 58 -- 4.1 OVERVIEW .58 -- 4.2 LIMITATIONS OF THE NATIONAL DATABASES 72 -- 4.3 OVERVIEW OF ELEMENTS IN A BIA AND WHICH NATIONAL DATABASES CAN BE USED FOR THEM 74 -- 5 DISCUSSION .76 -- 5.1 CAUTION WHEN USING NATIONAL DATABASES FOR DEMONSTRATING EFFECTIVENESS 76 -- 5.2 (TRANSVERSAL) BUDGET IMPACT – INFORMATION NEEDED FOR DIFFERENT ELEMENTS .77 -- 5.3 (PROBLEM OF) IDENTIFYING THE RELATIVE TREATMENT EFFECT 80 -- 5.3.1 RCTs versus observational data: large-scale evidence .80 -- 5.3.2 (Lack of) comparative evidence for implants and invasive medical devices 84 -- 5.4 OPPORTUNITIES UNDER THE NEW HTA REGULATION: JOINT SCIENTIFIC CONSULTATIONS AND JOINT CLINICAL ASSESSMENTS 85 -- 5.5 LEARNING FROM MANAGED ENTRY AGREEMENTS .86 -- 5.6 FUTURE OPPORTUNITIES FOR DATA ENHANCEMENTS 8

32 p., ill., S’ils souhaitent que leur produit soit remboursé, les producteurs d’implants ou de dispositifs médicaux invasifs doivent introduire un dossier auprès de l’assurance maladie (INAMI). Dans ce cadre, ils doivent notamment réaliser une estimation de l’impact d’un éventuel remboursement sur le budget de tous les payeurs des soins de santé par le biais d’une « analyse d’impact budgétaire » (AIB). À la demande de l’INAMI, le Centre Fédéral d’Expertise des Soins de Santé (KCE) a examiné comment les données de vie réelle (real-world data ou RWD) en provenance des bases de données nationales belges peuvent être utilisées dans le cadre de telles analyses. Il semble que ces RWD contiennent des informations extrêmement précieuses, mais il arrive fréquemment que certaines données manquent ou qu’elles présentent des lacunes. Elles doivent donc être traitées avec toute la prudence nécessaire. D’autres types d’études restent à privilégier pour déterminer l’effet du traitement., PRÉFACE 1 -- SYNTHÈSE 3 -- 1. INTRODUCTION 5 -- 1.1. QU’ENTEND-ON PAR IMPLANT OU DISPOSITIF MÉDICAL INVASIF ? 5 -- 1.2. QUAND RÉALISE-T-ON UNE ANALYSE D’IMPACT BUDGÉTAIRE ? 5 -- 1.3. QUELLES SONT LES INFORMATIONS QUI DOIVENT FIGURER DANS UNE AIB ? 6 -- 1.3.1. Économies ou coûts de santé directs, avec possibilité d’analyses complémentaires 6 -- 1.3.2. Du point de vue des payeurs des soins : une approche transversale 7 -- 1.4. OBJECTIF DE L’ÉTUDE 7 -- 1.4.1. Questions de recherche 7 -- 1.5. COMMENT LES CHERCHEURS DU KCE ONT-ILS PROCÉDÉ ? 8 -- 2. LES BASES DE DONNÉES DISPONIBLES EN BELGIQUE ET LEURS POSSIBILITÉS D’ACCÈS 8 -- 2.1. LA BASE DE DONNEES DE L’AGENCE INTERMUTUALISTE (AIM) 10 -- 2.2. L’ÉCHANTILLON PERMANENT DE L’AIM (EPS) 10 -- 2.3. LE RÉSUMÉ HOSPITALIER MINIMUM (RHM) 10 -- 2.4. LES DONNÉES DE FACTURATION HOSPITALIÈRE (SHA/HJA) 11 -- 2.5. LES DONNÉES COUPLÉES RHM/EPS 12 -- 2.6. LA BASE DE DONNÉES DE LA CELLULE TECHNIQUE (TCT) 12 -- 2.7. INAMI – DOC. N 12 -- 2.8. INAMI – DOC. P 12 -- 2.9. INAMI DOC. PH 13 -- 2.10. PHARMANET 13 -- 3. INITIATIVES FUTURES 14 -- 3.1. LA FUTURE AGENCE DES DONNÉES DE (SOINS DE) SANTÉ 14 -- 3.2. L’IUD EUROPÉEN ET LA BASE DE DONNÉES EUDAMED 14 -- 4. ÉLÉMENTS D’UNE ANALYSE D’IMPACT BUDGÉTAIRE ET BASES DE DONNÉES POUVANT ÊTRE UTILISÉES POUR L’ALIMENTER 15 -- 4.1. LE VOLUME DE LA POPULATION CIBLE 17 -- 4.2. LE COÛT DE L’UTILISATION DU DISPOSITIF MÉDICAL ET DU COMPARATEUR 18 -- 4.3. AUTRES COÛTS LIÉS À L’HOSPITALISATION INITIALE 18 -- 4.4. L’IMPACT DU TRAITEMENT SUR LE NOMBRE ET LA GRAVITÉ DES RÉADMISSIONS, LE SUIVI, LA REVALIDATION, LES COMPLICATIONS 19 -- 4.5. LE COÛT UNITAIRE DES ÉVÉNEMENTS QUI SUIVENT L’INTERVENTION INITIALE 20 -- 4.6. LIMITATIONS DES BASES DE DONNÉES NATIONALES 20 -- 4.6.1. Qualité de l’information 20 -- 4.6.2. Les caractéristiques des patients présentes de façon limitée 21 -- 4.6.3. Chaque base de données a ses propres caractéristiques et limitations 21 -- RECOMMANDATIONS 23

The COVID-19 Vaccines Global Access (COVAX) is a World Health Organization (WHO) initiative that aims for an equitable access of COVID-19 vaccines. Despite potential heterogeneous infection levels across a country, countries receiving allotments of vaccines may follow WHO's allocation guidelines and distribute vaccines based on a jurisdictions' relative population size. Utilizing economic-epidemiological modeling, we benchmark the performance of this pro rata allocation rule by comparing it to an optimal one that minimizes the economic damages and expenditures over time, including a penalty representing the social costs of deviating from the pro rata strategy. The pro rata rule performs better when the duration of naturally- and vaccine-acquired immunity is short, when there is population mixing, when the supply of vaccine is high, and when there is minimal heterogeneity in demographics. Despite behavioral and epidemiological uncertainty diminishing the performance of the optimal allocation, it generally outperforms the pro rata vaccine distribution rule.

ObjectiveTo explore the population health impact of treating all US adults eligible for the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) with icosapent ethyl (IPE), we estimated (1) the number of ASCVD events and healthcare costs that could be prevented; and (2) medication costs.MethodsWe derived REDUCE-IT eligible cohorts in (1) the National Health and Nutrition Examination Surveys (NHANES) 2009-2014 and (2) the Optum Research Database (ORD). Population sizes were obtained from NHANES and observed first event rates (composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, unstable angina requiring hospitalization, or coronary revascularization) were estimated from the ORD. Hazard ratios from REDUCE-IT USA estimated events prevented with IPE therapy. The National Inpatient Sample estimated event costs (facility and professional) and daily IPE treatment cost was approximated at $4.59.ResultsWe estimate 3.6 million US adults to be REDUCE-IT eligible, and the observed five-year first event rate without IPE of 19.0% (95% confidence interval [CI] 16.6%-19.5%) could be lowered to 13.1% (95% CI 12.8%-13.5%) with five years of IPE treatment, preventing 212,000 (uncertainty range 163,000-262,000) events. We projected the annual IPE treatment cost for all eligible persons to be $6.0 billion (95% CI $4.7-$7.5 billion), but saving $1.8 billion annually due to first events prevented (net annual cost $4.3 billion). The total five-year event rate (first and recurrent) could be reduced from 42.5% (95% CI 39.6%-45.4%) to 28.9% (95% CI 26.9-30.9%) with five years of IPE therapy, preventing 490,000 (uncertainty range 370,000-609,000) events (net annual cost $2.6 billion).ConclusionsTreating all REDUCE-IT eligible US adults has substantial medication costs but could prevent a substantial number of ASCVD events and associated direct costs. Indirect cost savings by preventing events could outweigh much of the incurred d

Reference pricing (RP) is an insurance design that can be used to incentivize patients to use low-price settings. While RP is not intended to affect overall utilization, it could unintentionally reduce utilization. We examined whether utilization was reduced when a large employer adopted RP for selected elective surgeries, including inpatient joint replacement surgery and outpatient cataract surgery, colonoscopy, and arthroscopic surgery. Data included a treatment group subject to RP implementation and a comparison group that was not. We applied autoregressive integrated moving average analysis as comparison-population interrupted time-series analysis to determine whether there were procedure reductions following RP implementation. We find no evidence of short-term decreases (within 3 months of RP implementation). However, we find very modest declines of approximately 14 (20%) fewer arthroscopic knee surgeries 6 months after RP implementation and 129 (17.2%) fewer colonoscopies 8 months after RP implementation. There were no declines in the other procedures examined.

Objective. To estimate the productivity reduction costs associated to self-reported voice symptoms, low sleep quality, and high stress levels among college professors during homeworking in times of COVID-19 pandemic. Methods. This cross-sectional study included fifty-eight college professors who reported their reduction in productivity at work due to self-perceived stress levels, sleep quality, and voice symptoms. Results. High stress levels were reported by 24% of the participants, whereas 19% reported voice symptoms, and 3% low sleep quality. Costs associated with the three conditions were calculated for twenty-nine subjects. Productivity costs associated with high stress levels were higher (COP$32.345.925) than those for voice symptoms (COP$1.872.703) and low sleep quality (COP$319.733). Conclusion: Productivity reduction costs were higher for professors who reported high levels of stress followed by participants with self-reported voice symptoms and low sleep quality, which highlight the importance of prioritizing activities to reduce stress levels and voice symptoms in workplace health promotion programs implemented in educational settings., Objetivo. Estimar los costos de reducción de productividad asociados con los síntomas de voz, la baja calidad del sueño y los altos niveles de estrés entre los profesores universitarios durante el trabajo en casa en tiempos de COVID-19. Métodos. Este estudio transversal incluyó la participación de 58 docentes universitarios, los cuales reportaron la reducción de la productividad en el trabajo relacionada con sus percepciones de los niveles de estrés, la calidad del sueño y los síntomas de voz . Resultados. El 24% de los participantes informó altos niveles de estrés, mientras que el 19% informó síntomas de voz y el 3% mala calidad del sueño. Los costos asociados con las tres condiciones se calcularon para 29 sujetos. Los costos de productividad asociados a altos niveles de estrés fueron mayores (COP$32.345.925) en comparación con los síntomas de voz (COP$1.872.703) y la mala calidad del sueño (COP$319.733). Conclusiones: Los costos asociados a la reducción en la productividad fueron altos en docentes que reportaron altos niveles de estrés, seguidos de los que reportaron síntomas de voz y baja calidad del sueño. Lo anterior resalta la importancia de priorizar actividades dirigidas a reducir los niveles de estrés y los síntomas vocales en los programas de promoción de la salud en los lugares de trabajo que se implementan en las instituciones educativas.

Introduction: Many cannabis dispensaries market and sell their products online through websites designed to attract and maintain customers; often, these websites incorporate a variety of product claims and other marketing tactics. This study evaluated website content, product pricing and discounts on dispensary websites in California and Nevada, states that legalized recreational cannabis in 2016. Methods: We content coded product availability, marketing claims and discounts on cannabis dispensary websites in the San Francisco Bay Area (N = 34) and Reno (N = 15) from March to June 2020 using a web crawler to scrape pricing information for four product types. We conducted bivariate analyses comparing both locations. Results: Prices were significantly lower for flower, edibles, and concentrates in Reno compared to the Bay Area, but not cartridges. In both areas, a range of marketing claims were made regarding the health effects of certain products. The most common were that cannabis products treated pain, nausea/vomiting, spasms, anxiety, insomnia, and depression. Products were also said to promote creativity and euphoria. Other marketing claims related to potency, pleasure enhancement, and improved social interactions. Discounts targeted to senior citizens and veterans were found on over half of all websites. Conclusions: Dispensary websites in the Bay Area and Reno frequently make health-related claims which should not be allowed in absence of scientific evidence. Non-health related claims are similar to those used for selling e-cigarettes and other tobacco products. Monitoring cannabis dispensary websites provides insight into local sales tactics and may help identify subpopulations for research on behavioral impacts of cannabis marketing activities.

Introduction: Many cannabis dispensaries market and sell their products online through websites designed to attract and maintain customers; often, these websites incorporate a variety of product claims and other marketing tactics. This study evaluated website content, product pricing and discounts on dispensary websites in California and Nevada, states that legalized recreational cannabis in 2016. Methods: We content coded product availability, marketing claims and discounts on cannabis dispensary websites in the San Francisco Bay Area (N = 34) and Reno (N = 15) from March to June 2020 using a web crawler to scrape pricing information for four product types. We conducted bivariate analyses comparing both locations. Results: Prices were significantly lower for flower, edibles, and concentrates in Reno compared to the Bay Area, but not cartridges. In both areas, a range of marketing claims were made regarding the health effects of certain products. The most common were that cannabis products treated pain, nausea/vomiting, spasms, anxiety, insomnia, and depression. Products were also said to promote creativity and euphoria. Other marketing claims related to potency, pleasure enhancement, and improved social interactions. Discounts targeted to senior citizens and veterans were found on over half of all websites. Conclusions: Dispensary websites in the Bay Area and Reno frequently make health-related claims which should not be allowed in absence of scientific evidence. Non-health related claims are similar to those used for selling e-cigarettes and other tobacco products. Monitoring cannabis dispensary websites provides insight into local sales tactics and may help identify subpopulations for research on behavioral impacts of cannabis marketing activities.

ObjectiveModels such as family-based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent-based treatment (PBT; or parent-only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models.MethodsA total of 150 children with overweight and obesity and their parents were randomized to one of two 6-month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial-based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective.ResultsResults suggest that PBT, compared with FBT, had lower costs per parent-child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279).ConclusionsThese findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.

IntroductionThe dementia experience is not a monolithic phenomenon-and while core elements of dementia are considered universal-people living with dementia experience the disorder differently. Understanding the patterning of Alzheimer's disease and related dementias (ADRD) in the population with regards to incidence, risk factors, impacts on dementia care, and economic costs associated with ADRD can provide clues to target risk and protective factors for all populations as well as addressing health disparities.MethodsWe discuss information presented at the 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers, Theme 1: Impact of Dementia. In this article, we describe select population trends, care interventions, and economic impacts, health disparities and implications for future research from the perspective of our diverse panel comprised of academic stakeholders, and persons living with dementia, and care partners.ResultsDementia incidence is decreasing yet the advances in population health are uneven. Studies examining the educational, geographic and race/ethnic distribution of ADRD have identified clear disparities. Disparities in health and healthcare may be amplified by significant gaps in the evidence base for pharmacological and non-pharmacological interventions. The economic costs for persons living with dementia and the value of family care partners' time are high, and may persist into future generations.ConclusionsSignificant research gaps remain. Ensuring that ADRD healthcare services and long-term care services and supports are accessible, affordable, and effective for all segments of our population is essential for health equity. Policy-level interventions are in short supply to redress broad unmet needs and systemic sources of disparities. Whole of society challenges demand research producing whole of society solutions. The urgency, complexity, and scale merit a "whole of government" approach invo

BACKGROUND: Upper tract urothelial carcinoma (UTUC) is a heterogeneous disease that presents a clinical management challenge for the urologic surgeon. We assessed treatment patterns, costs, and survival outcomes among patients with nonmetastatic UTUC. METHODS: We identified 4114 patients diagnosed with nonmetastatic UTUC from 2004 to 2013 in the Survival Epidemiology, and End Results-Medicare population-based database. Patients were stratified into low- or high-risk disease groups. Median total costs from 30 days prior to diagnosis through 365 days after diagnosis were compared between groups. Overall and cancer-specific survival were evaluated using Cox proportional hazards regression. All statistical tests were 2-sided. RESULTS: After risk stratification, 1027 (24.9%) and 3087 (75.0%) patients were classified into low- vs high-risk UTUC groups. Most patients underwent at least 1 surgical intervention (95.1%); 68.4% underwent at least 1 endoscopic intervention. Patients diagnosed with high- vs low-risk UTUC were more likely to undergo nephroureterectomy (83.6% vs 72.0%; P < .001); few patients with low-risk disease were exclusively managed endoscopically (16.9%). At 365 days after diagnosis, costs of care for high- vs low-risk UTUC were statistically significantly higher ($108 520 vs $91 233; median difference $16 704, 95% confidence interval [CI] = $11 619 to $21 778; P < .001). Those with high-risk UTUC had worse cancer-specific and overall survival compared with patients with low-risk UTUC (cancer-specific survival hazard ratio [HR] = 4.14, 95% CI = 3.19 to 5.37; overall survival HR = 1.78, 95% CI = 1.62 to 1.96). CONCLUSIONS: UTUC continues to be managed primarily with nephroureterectomy, regardless of risk stratification, and patients with high-risk UTUC have worse overall and cancer-specific survival. Substantial costs are associated with management of low- and high-risk UTUC, with the latter being more costly up to 1 year from

BackgroundPublic health initiatives must look for ways to cost-effectively scale critical interventions to achieve high coverage. Private sector distribution channels, can potentially distribute preventive healthcare products to hard-to-reach populations, decongest public healthcare systems, and increase the sustainability of programs by getting customers to share costs. However, little is known about how sellers set prices for new products. By introducing a new product, HIV self-test kits, to local drug shops, we observed whether shops experimented with pricing, charged different buyers different prices, and whether prices converged within the local market over our study period.MethodsFrom August to December 2019, we provided free HIV self-test kits, a new product, to 26 drug shops in Shinyanga, Tanzania to sell to the local community. We measured sales volume, price, customer age and sex using shop records. Using a multiple linear regression model, we conducted F-tests to determine whether shop, age, sex, and time (week) respectively were associated with price. We measured willingness-to-pay to restock test kits at the end of the study.Results514 test kits were sold over 18 weeks; 69% of buyers were male, 40% were aged 25-34 and 32% aged 35-44. Purchase prices ranged from 1000 to 6000 Tsh (median 3000 Tsh; ~$1.30 USD). Within shops, prices were 11.3% higher for 25-34 and 12.7% higher for 45+ year olds relative to 15-19-year olds (p = 0.029) and 13.5% lower for men (p = 0.023) on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Mean maximum willingness-to-pay to restock was 2000 Tsh per kit.ConclusionsShopkeepers charged buyers different prices depending on buyers' age and sex. There was limited variation in prices within shops over time and low demand among shopkeepers to restock at the end of the study. Given the subsidized global wholesale pri

Rationale & objectiveApproximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.Study designA cross-sectional survey.Setting & participantsStakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.OutcomesPD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.Analytical approachDescriptive statistics.ResultsResponses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.LimitationsLow responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.ConclusionsLarge inter- and intraregional disparities exist in PD availability, accessibility, affordabil

Rationale & objectiveHemodialysis (HD) is the most common form of kidney replacement therapy. This study aimed to examine the use, availability, accessibility, affordability, and quality of HD care worldwide.Study designA cross-sectional survey.Setting & participantsStakeholders (clinicians, policy makers, and consumer representatives) in 182 countries were convened by the International Society of Nephrology from July to September 2018.OutcomesUse, availability, accessibility, affordability, and quality of HD care.Analytical approachDescriptive statistics.ResultsOverall, representatives from 160 (88%) countries participated. Median country-specific use of maintenance HD was 298.4 (IQR, 80.5-599.4) per million population (pmp). Global median HD use among incident patients with kidney failure was 98.0 (IQR, 81.5-140.8) pmp and median number of HD centers was 4.5 (IQR, 1.2-9.9) pmp. Adequate HD services (3-4 hours 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. 32% of countries performed monitoring of patient-reported outcomes; 61%, monitoring of small-solute clearance; 60%, monitoring of bone mineral markers; 51%, monitoring of technique survival; and 60%, monitoring of patient survival. At initiation of maintenance dialysis, only 5% of countries used an arteriovenous access in almost all patients. Vascular access education was suboptimal, funding for vascular access procedures was not uniform, and copayments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs compared with patients in only 4% of high-income countries.LimitationsA cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis.ConclusionsIn summary, findings reveal substantial variations in global HD use, availability, accessibility

Water affordability is central to water access but remains a challenge to measure. California enshrined the human right to safe and affordable water in 2012 but the question remains: how should water affordability be measured across the state? This paper contributes to this question in three steps. First, we identify key dimensions of water affordability measures (including scale, volume of water needed to meet 'basic' needs, and affordability criteria) and a cross-cutting theme (social equity). Second, using these dimensions, we develop three affordability ratios measured at the water system scale for households with median, poverty level, and deep poverty (i.e., half the poverty level) incomes and estimate the corresponding percentage of households at these income levels. Using multiple measures conveys a fuller picture of affordability given the known limitations of specific affordability measures. Third, we analyze our results disaggregated by a key characteristic of water system vulnerability-water system size. We find that water is relatively affordable for median income households. However, we identify high unaffordability for households in poverty in a large fraction of water systems. We identify several scenarios with different policy implications for the human right to water, such as very small systems with high water bills and low-income households within large water systems. We also characterize how data gaps complicate theoretical ideals and present barriers in human right to water monitoring efforts. This paper presents a systematic approach to measuring affordability and represents the first statewide assessment of water affordability within California's community water systems.

RNA sequencing techniques have enabled the systematic elucidation of gene expression (RNA-Seq), transcription start sites (differential RNA-Seq), transcript 3' ends (Term-Seq), and post-transcriptional processes (ribosome profiling). The main challenge of transcriptomic studies is to remove ribosomal RNAs (rRNAs), which comprise more than 90% of the total RNA in a cell. Here, we report a low-cost and robust bacterial rRNA depletion method, RiboRid, based on the enzymatic degradation of rRNA by thermostable RNase H. This method implemented experimental considerations to minimize nonspecific degradation of mRNA and is capable of depleting pre-rRNAs that often comprise a large portion of RNA, even after rRNA depletion. We demonstrated the highly efficient removal of rRNA up to a removal efficiency of 99.99% for various transcriptome studies, including RNA-Seq, Term-Seq, and ribosome profiling, with a cost of approximately $10 per sample. This method is expected to be a robust method for large-scale high-throughput bacterial transcriptomic studies.

BACKGROUND: Over the past decades, informal care has increased in most OECD-countries. Informal care is costly to caregivers and to society in the form of lost income and direct costs of providing care. Existing evidence suggests that providing informal care affects caregivers' overall health. However, estimates of the social costs of informal care based on national data on individuals are currently scarce. OBJECTIVE: This study contributes to the existing evidence on the costs of informal care by estimating the direct and indirect costs to caregivers using a purposive national household survey from Sweden. METHODS: Adopting a bottom-up, prevalence approach, the direct and indirect costs are estimated using the survey data and the value of working time and leisure time from existing sources. RESULTS: The results suggest that around 15% of the adult population of Sweden provide informal care and that such care costs around SEK 152 billion per year (around 3% of GDP; USD 16,3 billion; EUR 14,5 billion), or SEK 128000 per caregiver. Around 55% of costs are in the form of income loss to caregivers. The largest cost items are reduced work hours and direct costs of providing informal care. Replacing informal caregivers with professional care providers would be costly at around SEK 193,6 billion per year. CONCLUSIONS: Findings indicate that, even in a country with a relatively generous welfare system, significant resources are allocated toward providing informal care. The costing analysis suggests that effective support initiatives to ease the burden of informal caregivers may be cost-effective.

Background: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. Methods: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. Results: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of euro7.4 and euro1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. Conclusions: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres

Background Over the past decades, informal care has increased in most OECD-countries. Informal care is costly to caregivers and to society in the form of lost income and direct costs of providing care. Existing evidence suggests that providing informal care affects caregivers' overall health. However, estimates of the social costs of informal care based on national data on individuals are currently scarce. Objective This study contributes to the existing evidence on the costs of informal care by estimating the direct and indirect costs to caregivers using a purposive national household survey from Sweden. Methods Adopting a bottom-up, prevalence approach, the direct and indirect costs are estimated using the survey data and the value of working time and leisure time from existing sources. Results The results suggest that around 15% of the adult population of Sweden provide informal care and that such care costs around SEK 152 billion per year (around 3% of GDP; USD 16,3 billion; EUR 14,5 billion), or SEK 128000 per caregiver. Around 55% of costs are in the form of income loss to caregivers. The largest cost items are reduced work hours and direct costs of providing informal care. Replacing informal caregivers with professional care providers would be costly at around SEK 193,6 billion per year. Conclusions Findings indicate that, even in a country with a relatively generous welfare system, significant resources are allocated toward providing informal care. The costing analysis suggests that effective support initiatives to ease the burden of informal caregivers may be cost-effective.

Background: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. Methods: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. Results: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of euro7.4 and euro1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. Conclusions: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres

Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system., Objetivos: O objetivo primário do estudo será avaliar a segurança e descrever a experiência inicial da implementação da alta precoce (no mesmo dia) dos pacientes coronarianos provenientes do Sistema Único de Saúde submetidos à intervenção coronariana percutânea eletiva, não complicada, por via transradial. O objetivo secundário será avaliar o impacto no custo direito por paciente em comparação aos dados previamente conhecidos da internação clássica utilizada (pernoite no hospital). Métodos: Estudo observacional e prospectivo de pacientes submetidos a intervenção coronariana percutânea eletiva não complicada por via transradial com alta precoce, respeitando os critérios de inclusão e exclusão. Será realizado seguimento dos pacientes para comprovar a segurança da nova estratégia na população do Sistema Único de Saúde e comparar os custos diretos entre o pernoite hospitalar e a de alta no mesmo dia. Este será o primeiro estudo dedicado em avaliar primariamente a segurança da alta precoce após angioplastia coronariana eletiva não complicada por via transradial validando este protocolo na população do sistema público de saúde brasileiro.

Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system., Objetivos: O objetivo primário do estudo será avaliar a segurança e descrever a experiência inicial da implementação da alta precoce (no mesmo dia) dos pacientes coronarianos provenientes do Sistema Único de Saúde submetidos à intervenção coronariana percutânea eletiva, não complicada, por via transradial. O objetivo secundário será avaliar o impacto no custo direito por paciente em comparação aos dados previamente conhecidos da internação clássica utilizada (pernoite no hospital). Métodos: Estudo observacional e prospectivo de pacientes submetidos a intervenção coronariana percutânea eletiva não complicada por via transradial com alta precoce, respeitando os critérios de inclusão e exclusão. Será realizado seguimento dos pacientes para comprovar a segurança da nova estratégia na população do Sistema Único de Saúde e comparar os custos diretos entre o pernoite hospitalar e a de alta no mesmo dia. Este será o primeiro estudo dedicado em avaliar primariamente a segurança da alta precoce após angioplastia coronariana eletiva não complicada por via transradial validando este protocolo na população do sistema público de saúde brasileiro.

Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system., Objetivos: O objetivo primário do estudo será avaliar a segurança e descrever a experiência inicial da implementação da alta precoce (no mesmo dia) dos pacientes coronarianos provenientes do Sistema Único de Saúde submetidos à intervenção coronariana percutânea eletiva, não complicada, por via transradial. O objetivo secundário será avaliar o impacto no custo direito por paciente em comparação aos dados previamente conhecidos da internação clássica utilizada (pernoite no hospital). Métodos: Estudo observacional e prospectivo de pacientes submetidos a intervenção coronariana percutânea eletiva não complicada por via transradial com alta precoce, respeitando os critérios de inclusão e exclusão. Será realizado seguimento dos pacientes para comprovar a segurança da nova estratégia na população do Sistema Único de Saúde e comparar os custos diretos entre o pernoite hospitalar e a de alta no mesmo dia. Este será o primeiro estudo dedicado em avaliar primariamente a segurança da alta precoce após angioplastia coronariana eletiva não complicada por via transradial validando este protocolo na população do sistema público de saúde brasileiro.

Rationale & objectiveApproximately 11% of people with kidney failure worldwide are treated with peritoneal dialysis (PD). This study examined PD use and practice patterns across the globe.Study designA cross-sectional survey.Setting & participantsStakeholders including clinicians, policy makers, and patient representatives in 182 countries convened by the International Society of Nephrology between July and September 2018.OutcomesPD use, availability, accessibility, affordability, delivery, and reporting of quality outcome measures.Analytical approachDescriptive statistics.ResultsResponses were received from 88% (n=160) of countries and there were 313 participants (257 nephrologists [82%], 22 non-nephrologist physicians [7%], 6 other health professionals [2%], 17 administrators/policy makers/civil servants [5%], and 11 others [4%]). 85% (n=156) of countries responded to questions about PD. Median PD use was 38.1 per million population. PD was not available in 30 of the 156 (19%) countries responding to PD-related questions, particularly in countries in Africa (20/41) and low-income countries (15/22). In 69% of countries, PD was the initial dialysis modality for≤10% of patients with newly diagnosed kidney failure. Patients receiving PD were expected to pay 1% to 25% of treatment costs, and higher (>75%) copayments (out-of-pocket expenses incurred by patients) were more common in South Asia and low-income countries. Average exchange volumes were adequate (defined as 3-4 exchanges per day or the equivalent for automated PD) in 72% of countries. PD quality outcome monitoring and reporting were variable. Most countries did not measure patient-reported PD outcomes.LimitationsLow responses from policy makers; limited ability to provide more in-depth explanations underpinning outcomes from each country due to lack of granular data; lack of objective data.ConclusionsLarge inter- and intraregional disparities exist in PD availability, accessibility, affordabil

Rationale & objectiveHemodialysis (HD) is the most common form of kidney replacement therapy. This study aimed to examine the use, availability, accessibility, affordability, and quality of HD care worldwide.Study designA cross-sectional survey.Setting & participantsStakeholders (clinicians, policy makers, and consumer representatives) in 182 countries were convened by the International Society of Nephrology from July to September 2018.OutcomesUse, availability, accessibility, affordability, and quality of HD care.Analytical approachDescriptive statistics.ResultsOverall, representatives from 160 (88%) countries participated. Median country-specific use of maintenance HD was 298.4 (IQR, 80.5-599.4) per million population (pmp). Global median HD use among incident patients with kidney failure was 98.0 (IQR, 81.5-140.8) pmp and median number of HD centers was 4.5 (IQR, 1.2-9.9) pmp. Adequate HD services (3-4 hours 3 times weekly) were generally available in 27% of low-income countries. Home HD was generally available in 36% of high-income countries. 32% of countries performed monitoring of patient-reported outcomes; 61%, monitoring of small-solute clearance; 60%, monitoring of bone mineral markers; 51%, monitoring of technique survival; and 60%, monitoring of patient survival. At initiation of maintenance dialysis, only 5% of countries used an arteriovenous access in almost all patients. Vascular access education was suboptimal, funding for vascular access procedures was not uniform, and copayments were greater in countries with lower levels of income. Patients in 23% of the low-income countries had to pay >75% of HD costs compared with patients in only 4% of high-income countries.LimitationsA cross-sectional survey with possibility of response bias, social desirability bias, and limited data collection preventing in-depth analysis.ConclusionsIn summary, findings reveal substantial variations in global HD use, availability, accessibility

BACKGROUND: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative proposed government-supported voluntary national sugar reduction targets. This intervention's potential effects and cost-effectiveness are unclear. METHODS: A validated microsimulation model, CVD-PREDICT (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends), coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs, and cost-effectiveness of the US National Salt and Sugar Reduction Initiative policy. The model was run at the individual level, incorporating the annual probability of each person's transition between health statuses on the basis of risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011 through 2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from health care and societal perspectives. Uncertainty was evaluated in a 1-way analysis by assuming 50% industry compliance and probabilistic sensitivity analyses through a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal health care cost savings, stratified by age, race, income, and education. RESULTS: Achieving the US National Salt and Sugar Reduction Initiative sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a

BACKGROUND: Over the past decades, informal care has increased in most OECD-countries. Informal care is costly to caregivers and to society in the form of lost income and direct costs of providing care. Existing evidence suggests that providing informal care affects caregivers' overall health. However, estimates of the social costs of informal care based on national data on individuals are currently scarce. OBJECTIVE: This study contributes to the existing evidence on the costs of informal care by estimating the direct and indirect costs to caregivers using a purposive national household survey from Sweden. METHODS: Adopting a bottom-up, prevalence approach, the direct and indirect costs are estimated using the survey data and the value of working time and leisure time from existing sources. RESULTS: The results suggest that around 15% of the adult population of Sweden provide informal care and that such care costs around SEK 152 billion per year (around 3% of GDP; USD 16,3 billion; EUR 14,5 billion), or SEK 128000 per caregiver. Around 55% of costs are in the form of income loss to caregivers. The largest cost items are reduced work hours and direct costs of providing informal care. Replacing informal caregivers with professional care providers would be costly at around SEK 193,6 billion per year. CONCLUSIONS: Findings indicate that, even in a country with a relatively generous welfare system, significant resources are allocated toward providing informal care. The costing analysis suggests that effective support initiatives to ease the burden of informal caregivers may be cost-effective.

BACKGROUND: Over the past decades, informal care has increased in most OECD-countries. Informal care is costly to caregivers and to society in the form of lost income and direct costs of providing care. Existing evidence suggests that providing informal care affects caregivers' overall health. However, estimates of the social costs of informal care based on national data on individuals are currently scarce. OBJECTIVE: This study contributes to the existing evidence on the costs of informal care by estimating the direct and indirect costs to caregivers using a purposive national household survey from Sweden. METHODS: Adopting a bottom-up, prevalence approach, the direct and indirect costs are estimated using the survey data and the value of working time and leisure time from existing sources. RESULTS: The results suggest that around 15% of the adult population of Sweden provide informal care and that such care costs around SEK 152 billion per year (around 3% of GDP; USD 16,3 billion; EUR 14,5 billion), or SEK 128000 per caregiver. Around 55% of costs are in the form of income loss to caregivers. The largest cost items are reduced work hours and direct costs of providing informal care. Replacing informal caregivers with professional care providers would be costly at around SEK 193,6 billion per year. CONCLUSIONS: Findings indicate that, even in a country with a relatively generous welfare system, significant resources are allocated toward providing informal care. The costing analysis suggests that effective support initiatives to ease the burden of informal caregivers may be cost-effective.

To scrutinize the economic impact of different care levels, such as shared care, in the follow-up of adult congenital heart disease (ACHD) patients. The BELgian COngenital heart disease Database combining Administrative and Clinical data (BELCODAC) was analyzed. Patients (N = 6579) were categorized into five care levels based on their cardiac follow-up pattern between 2006 and 2010. Medical costs, hospitalizations, and emergency department visits were measured between 2011 and 2015. In patients with moderate lesions, highly specialized cardiac care (HSC; exclusive follow-up by ACHD specialists) and shared care with predominantly specialized cardiac care (SC+) were associated with significantly lower medical costs and resource use compared to shared care with predominantly general cardiac care (SC-) and general cardiac care (GCC). In the patient population with mild lesions, HSC was associated with better economic outcomes than SC- and GCC, but SC+ was not. HSC was associated with fewer hospitalizations (- 33%) and less pharmaceutical costs (- 46.3%) compared to SC+. Patients with mild and moderate lesions in the no cardiac care (NCC) group had better economic outcomes than those in the GCC and SC- groups, but post-hoc analysis revealed that they had a different patient profile than patients under cardiac care. More specialized care levels are associated with better economic outcomes in patients with mild or moderate lesions in cardiac follow-up. Shared care with strong involvement of ACHD specialists might be a management option to consider. Characteristics of patients without cardiac follow-up but good medium-term economic prospects should be further scrutinized.

Growing demand for accountability, transparency, and efficiency in health professions education is expected to drive increased demand for, and use of, cost and value analyses. In this AMEE Guide, we introduce key concepts, methods, and literature that will enable novices in economics to conduct simple cost and value analyses, hold informed discussions with economic specialists, and undertake further learning on more advanced economic topics. The practical structure for conducting analyses provided in this guide will enable researchers to produce robust results that are meaningful and useful for improving educational practice. Key steps include defining the economic research question, identifying an appropriate economic study design, carefully identifying cost ingredients, quantifying, and pricing the ingredients consumed, and conducting sensitivity analyses to explore uncertainties in the results.

Background: This study evaluated an outreach mobile dental service called Teeth on Wheels (TOW). The dental program targeted Australian children from low household income, who are eligible for the Child Dental Benefits Scheme (CDBS) in Victoria, Australia. The program is complemented with a school-based oral health promotion element. Methods: A retrospective cohort study was performed with a convenience sample. Children must have had at least three dental examinations during the 2016–2019 calendar years to be included in the study. Comparisons were made between the 2016–17 and 2018–19 calendar years. It was hypothesised that the program would result in reduced costs and the number of restorations and extractions in the latter period. Results: A total of 414 children were included in the analysis. The total mean costs of the program per child reduced from AU$605.3 in 2016–17 to AU$531.1 in 2018–19. The results showed an overall mean reduction in all restorations and extractions performed, but only statistical significance was noted for reductions of restored deciduous teeth. Conclusions: This outreach program, which is focused on prevention and minimally invasive dentistry, can be a promising alternative model of delivery for dental services in young children.

Background: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. Methods: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. Results: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of euro7.4 and euro1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. Conclusions: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres

Purpose: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. Methods: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (−9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypo

Purpose: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. Methods: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (−9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypo

Purpose: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. Methods: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (−9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypo

Introduction: Half of the episodes of neonatal sepsis are acquired in the community with a high percentage of mortality and complications.Objective: To estimate the direct costs of hospitalizations due to systemic neonatal infection acquired in the community in low-risk newborns.Materials and methods: For the estimation of costs, we used the perspective of the health systems and the microcosting technique and we established the duration of hospitalization as the time horizon. We identified cost-generating events through expert consensus and the quantification was based on the detailed bill of 337 hospitalized newborns diagnosed with neonatal infection. The costs of the medications were calculated based on the drug price information system (SISMED) and the ISS 2001 rate manuals adjusting percentage, and the mandatory insurance rates for traffic accidents (SOAT). We used the bootstrapping method for cost distribution to incorporate data variability in the estimate.Results: We included the medical care invoices for 337 newborns. The average direct cost of care per patient was USD$ 2,773,965 (Standard Deviation, SD=USD$ 198,813.5; 95% CI: $ 2,384,298 - $ 3,163,632). The main cost-generating categories were hospitalization in intensive care units and health technologies. The costs followed a log-normal distribution.Conclusions: The categories generating the greatest impact on the care costs of newborns with infection were hospitalization in neonatal units and health technologies. The costs followed a log-normal distribution., Introducción. El 50 % de los episodios de sepsis neonatal se originan en la comunidad, con un gran porcentaje de mortalidad y complicaciones.Objetivo. Estimar los costos directos de la hospitalización por infección neonatal adquirida en la comunidad en neonatos a término con bajo riesgo al nacer.Materiales y métodos. Se utilizó la perspectiva del tercer pagador y la técnica de microcosteo; el horizonte de tiempo fue la duración de la hospitalización. La determinación de las situaciones generadoras de costos se obtuvo por medio de un consenso de expertos y se cuantificaron con base en la factura detallada de la atención de 337 neonatos hospitalizados. Los costos de los medicamentos se calcularon con base en el Sistema de Información de Precios de Medicamentos (SISMED) y, el de los procedimientos, según los manuales tarifarios ISS 2001 con porcentaje de ajuste y el seguro obligatorio de accidentes de tráfico (SOAT). Para incorporar la variabilidad de la información en la estimación, se obtuvo una distribución de los costos usando el método de bootstrapping.Resultados. Se incluyeron las facturas por la atención de 337 recién nacidos. El promedio de costos directos de la atención por paciente fue de COL$ 2’773.965 (desviación estándar, DE=$ 198.813,5; IC95%: $ 2’384.298 - $ 3’163.632). Las principales categorías generadoras de costos fueron la internación en la unidad de cuidados intensivos y las tecnologías en salud. Los costos siguieron una una distribución logarítmica normal (log-normal).Conclusiones. Las categorías con mayor impacto en los costos fueron la internación en la unidad neonatal y las tecnologías en salud. Los costos se ajustaron a una distribución logarítmica normal.

Purpose: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. Methods: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (−9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypo

Water affordability is central to water access but remains a challenge to measure. California enshrined the human right to safe and affordable water in 2012 but the question remains: how should water affordability be measured across the state? This paper contributes to this question in three steps. First, we identify key dimensions of water affordability measures (including scale, volume of water needed to meet 'basic' needs, and affordability criteria) and a cross-cutting theme (social equity). Second, using these dimensions, we develop three affordability ratios measured at the water system scale for households with median, poverty level, and deep poverty (i.e., half the poverty level) incomes and estimate the corresponding percentage of households at these income levels. Using multiple measures conveys a fuller picture of affordability given the known limitations of specific affordability measures. Third, we analyze our results disaggregated by a key characteristic of water system vulnerability-water system size. We find that water is relatively affordable for median income households. However, we identify high unaffordability for households in poverty in a large fraction of water systems. We identify several scenarios with different policy implications for the human right to water, such as very small systems with high water bills and low-income households within large water systems. We also characterize how data gaps complicate theoretical ideals and present barriers in human right to water monitoring efforts. This paper presents a systematic approach to measuring affordability and represents the first statewide assessment of water affordability within California's community water systems.

Objetivos: O objetivo primário do estudo será avaliar a segurança e descrever a experiência inicial da implementação da alta precoce (no mesmo dia) dos pacientes coronarianos provenientes do Sistema Único de Saúde submetidos à intervenção coronariana percutânea eletiva, não complicada, por via transradial. O objetivo secundário será avaliar o impacto no custo direito por paciente em comparação aos dados previamente conhecidos da internação clássica utilizada (pernoite no hospital). Métodos: Estudo observacional e prospectivo de pacientes submetidos a intervenção coronariana percutânea eletiva não complicada por via transradial com alta precoce, respeitando os critérios de inclusão e exclusão. Será realizado seguimento dos pacientes para comprovar a segurança da nova estratégia na população do Sistema Único de Saúde e comparar os custos diretos entre o pernoite hospitalar e a de alta no mesmo dia. Este será o primeiro estudo dedicado em avaliar primariamente a segurança da alta precoce após angioplastia coronariana eletiva não complicada por via transradial validando este protocolo na população do sistema público de saúde brasileiro., Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system.

Objetivos: O objetivo primário do estudo será avaliar a segurança e descrever a experiência inicial da implementação da alta precoce (no mesmo dia) dos pacientes coronarianos provenientes do Sistema Único de Saúde submetidos à intervenção coronariana percutânea eletiva, não complicada, por via transradial. O objetivo secundário será avaliar o impacto no custo direito por paciente em comparação aos dados previamente conhecidos da internação clássica utilizada (pernoite no hospital). Métodos: Estudo observacional e prospectivo de pacientes submetidos a intervenção coronariana percutânea eletiva não complicada por via transradial com alta precoce, respeitando os critérios de inclusão e exclusão. Será realizado seguimento dos pacientes para comprovar a segurança da nova estratégia na população do Sistema Único de Saúde e comparar os custos diretos entre o pernoite hospitalar e a de alta no mesmo dia. Este será o primeiro estudo dedicado em avaliar primariamente a segurança da alta precoce após angioplastia coronariana eletiva não complicada por via transradial validando este protocolo na população do sistema público de saúde brasileiro., Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system.

Objetivos: O objetivo primário do estudo será avaliar a segurança e descrever a experiência inicial da implementação da alta precoce (no mesmo dia) dos pacientes coronarianos provenientes do Sistema Único de Saúde submetidos à intervenção coronariana percutânea eletiva, não complicada, por via transradial. O objetivo secundário será avaliar o impacto no custo direito por paciente em comparação aos dados previamente conhecidos da internação clássica utilizada (pernoite no hospital). Métodos: Estudo observacional e prospectivo de pacientes submetidos a intervenção coronariana percutânea eletiva não complicada por via transradial com alta precoce, respeitando os critérios de inclusão e exclusão. Será realizado seguimento dos pacientes para comprovar a segurança da nova estratégia na população do Sistema Único de Saúde e comparar os custos diretos entre o pernoite hospitalar e a de alta no mesmo dia. Este será o primeiro estudo dedicado em avaliar primariamente a segurança da alta precoce após angioplastia coronariana eletiva não complicada por via transradial validando este protocolo na população do sistema público de saúde brasileiro., Objectives: The study's primary objective will be to evaluate the safety and describe the initial experience of implementing early discharge (on the same day) of coronary patients from the Unified Health System undergoing elective, uncomplicated, transradial percutaneous coronary intervention. The secondary objective will be to assess the impact on the direct cost per patient compared to previously known data from the classic hospital stay used (hospital overnight). Methods: Observational and prospective study of patients undergoing elective uncomplicated transradial percutaneous coronary intervention with early discharge, respecting the inclusion and exclusion criteria. Follow-up of patients will be carried out to prove the safety of the new strategy in the population of the Unified Health System and to compare the direct costs between overnight stays and discharge on the same day. This will be the first study dedicated to primarily evaluating the safety of early discharge after elective uncomplicated transradial coronary angioplasty, validating this protocol in the population of the Brazilian public health system.

Purpose: The primary objective was to evaluate prescribing trends for topical ocular hypotensive treatment in the Nordic region during the last decade and, by population projections, estimate the glaucoma burden in 2040. A secondary objective was to analyse national variations in prescription patterns across the Nordic region. Methods: A retrospective analysis of national pharmacy data between 2008 and 2017 on the dispensation of topical ocular hypotensive treatment in the Nordic region was performed. Predictions of the glaucoma burden in 2040 were calculated from official population projections. Results: The total number of patients with ocular hypotensive treatment in the Nordic region increased from 346 000 to 418 000 (21%) between 2008 and 2017. The number of patients with ocular hypotensive treatment in the age group of 50 years and older increased from 3.6% to 3.9%. The daily defined dose (DDD) per patient and day during the study period increased from 1.22 to 1.26. Adjusted for beta-blocker combinations, the same value increased from 1.49 to 1.67. Across the Nordic countries, Finland had almost twice as many DDD per patient and day in 2017 (2.1) compared with Iceland (1.1). Between 2008 and 2017, the annual treatment cost for ocular hypotensive treatment in the Nordic region decreased from 96 million to 87 million Euro (−9%). In 2040, the number of patients with ocular hypotensive treatment in the Nordic region is estimated to 633 000 individuals (+51% compared with 2017). Conclusions: The study revealed an increased use of glaucoma medications in the Nordic region the last decade. This was mainly caused by an increased number of patients with ocular hypotensive treatment, but also because of a more intensive treatment. Marked national differences were detected. Due to the introduction of generic medications, the total cost for ocular hypotensive treatment did however decrease during the last decade. In 2040, the current number of individuals with ocular hypo

BACKGROUND: Over the past decades, informal care has increased in most OECD-countries. Informal care is costly to caregivers and to society in the form of lost income and direct costs of providing care. Existing evidence suggests that providing informal care affects caregivers' overall health. However, estimates of the social costs of informal care based on national data on individuals are currently scarce. OBJECTIVE: This study contributes to the existing evidence on the costs of informal care by estimating the direct and indirect costs to caregivers using a purposive national household survey from Sweden. METHODS: Adopting a bottom-up, prevalence approach, the direct and indirect costs are estimated using the survey data and the value of working time and leisure time from existing sources. RESULTS: The results suggest that around 15% of the adult population of Sweden provide informal care and that such care costs around SEK 152 billion per year (around 3% of GDP; USD 16,3 billion; EUR 14,5 billion), or SEK 128000 per caregiver. Around 55% of costs are in the form of income loss to caregivers. The largest cost items are reduced work hours and direct costs of providing informal care. Replacing informal caregivers with professional care providers would be costly at around SEK 193,6 billion per year. CONCLUSIONS: Findings indicate that, even in a country with a relatively generous welfare system, significant resources are allocated toward providing informal care. The costing analysis suggests that effective support initiatives to ease the burden of informal caregivers may be cost-effective.

IntroductionThere is little data on the cost of treating brain arteriovenous malformations (AVMs). The goal of this study then is to identify cost determinants in multimodal management of brain AVMs.MethodsOne hundred forty patients with brain AVMs prospectively enrolled in the UCSF brain AVM registry and treated between 2012 and 2015 were included in the study. Patient and AVM characteristics, treatment type, and length of stay and radiographic evidence of obliteration were collected from the registry. We then calculated the cost of all inpatient and outpatient encounters, interventions, and imaging attributable to the AVM. We used generalized linear models to test whether there was an association between patient and AVM characteristics, treatment type, and cost and length of stay. We tested whether the proportion of patients with radiographic evidence of obliteration differed between treatment modalities using Fisher's exact test.ResultsThe overall median cost of treatment and interquartile range was $77,865 (49,566-107,448). Surgery with preoperative embolization was the costliest treatment at $91,948 (79,914-140,600), while radiosurgery was the least at $20,917 (13,915-35,583). In multi-predictor analyses, hemorrhage, Spetzler-Martin grade, and treatment type were significant predictors of cost. Patients who had surgery had significantly higher rates of obliteration compared with radiosurgery patients.ConclusionsHemorrhage, AVM grade, and treatment modality are significant cost determinants in AVM management. Surgery with preoperative embolization was the costliest treatment and radiosurgery the least; however, surgical cases had significantly higher rates of obliteration.

Increasing capacity to provide buprenorphine, a treatment for opioid addiction, can help mitigate the opioid epidemic in the United States. This study models black-market pricing of buprenorphine to better understand supply and demand for opioid addiction treatment. A mixed effects linear model was used to quantify the effect of county-level racial composition, health insurance coverage, and drug characteristics on price variation. From November 2010 to June 2018, there were 2481 submissions for street buprenorphine transactions in the StreetRx dataset. The mean price was $3.95/mg (SD = $23.12/mg). Price decreased 3.05% each year and was highest in the summer and spring. Brand name buprenorphine was on average 11.18% more expensive than generic buprenorphine. Buprenorphine/naloxone combinations were on average 19.75% less expensive than pure buprenorphine. Purchases in bulk were on average 10.51% cheaper than purchases not in bulk. Street buprenorphine in film form was on average 14.34% more expensive than in pill/tablet form. Buprenorphine street price was 17.12% higher in spring and 22.26% higher in summer compared to fall. For every percentage point increase in percent white, buprenorphine sold for 0.88% higher price. For every percentage point increase in health insurance coverage, street buprenorphine sold for 0.02% lower price. Findings demonstrate that geographic, demographic, and socioeconomic factors shape the diversion of opioid addiction treatment to the black-market. Buprenorphine street pricing can help estimate public need, gaps in care and emerging public health priorities.

BACKGROUND: Colorectal cancer (CRC) screening remains underused, especially in safety-net systems. The objective of this study was to determine the effectiveness, costs, and cost-effectiveness of organized outreach using fecal immunochemical tests (FITs) compared with usual care. METHODS: Patients age 50-75 years eligible for CRC screening from eight participating primary care safety-net clinics were randomly assigned to outreach intervention with usual care vs usual care alone. The intervention included a mailed postcard and call, followed by a mailed FIT kit, and a reminder phone call if the FIT kit was not returned. The primary outcome was screening participation at 1 year and a microcosting analysis of the outreach activities with embedded long-term cost-effectiveness of outreach. All statistical tests were two-sided. RESULTS: A total of 5386 patients were randomly assigned to the intervention group and 5434 to usual care. FIT screening was statistically significantly higher in the intervention group than in the control group (57.9% vs 37.4%, P < .001; difference = 20.5%, 95% confidence interval = 18.6% to 22.4%). In the intervention group, FIT completion rate was higher in patients who had previously completed a FIT vs those who had not (71.9% vs 35.7%, P < .001). There was evidence of effect modification of the intervention by language, and clinic. Outreach cost approximately $23 per patient and $112 per additional patient screened. Projecting long-term outcomes, outreach was estimated to cost $9200 per quality-adjusted life-year gained vs usual care. CONCLUSION: Population-based management with organized FIT outreach statistically significantly increased CRC screening and was cost-effective in a safety-net system. The sustainability of the program and any impact of economies of scale remain to be determined.

AIMS/HYPOTHESIS: The risk of complications and medical consequences of type 2 diabetes are well known. Hospital costs have been identified as a key driver of total costs in studies of the economic burden of type 2 diabetes. Less evidence has been generated on the impact of individual diabetic complications on the overall societal burden. The objective of this study was to analyse costs of hospital-based healthcare (inpatient and outpatient care) and work absence related to individual macrovascular and microvascular complications of type 2 diabetes in Sweden in 2016. METHODS: Data for 2016 were retrieved from a Swedish national retrospective observational database cross-linking individual-level data for 1997-2016. The database contained information from population-based health, social insurance and socioeconomic registers for 392,200 people with type 2 diabetes and matched control participants (5:1). Presence of type 2 diabetes and of diabetes complications were derived using all years, 1997-2016. Costs of hospital-based care and of absence from work due to diabetes complications were estimated for the year 2016. Regression analysis was used for comparison with control participants to attribute absence from work to individual complications, and to account for joint presence of complications. RESULTS: Use of hospital care for complications was higher in type 2 diabetes compared with control participants in 2016: 26% vs 12% had ≥1 hospital contact; there were 86,104 vs 24,608 outpatient visits per 100,000 people; and there were 9894 vs 2546 inpatient admissions per 100,000 people (all p < 0.001). The corresponding total costs of hospital-based care for complications were €919 vs €232 per person (p < 0.001), and 74.7% of costs were then directly attributed to diabetes (€687 per person). Regression analyses distributed the costs of days absent from work across diabetes complications per se, basic type 2 diabetes effect and unattributed causes. Diabetes complication, Funding Agency:Lund University