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Aim Methods Results Conclusions To assess the cost‐effectiveness of a digital diabetes prevention programme (d‐DPP) compared with a diabetes prevention programme (DPP) for preventing type 2 diabetes (T2D) in individuals with prediabetes in the United States.A Markov cohort model was constructed, simulating a 10‐year period starting at the age of 45 years, with a societal and healthcare sector perspective. The effectiveness of the d‐DPP intervention was evaluated using a meta‐analysis, with that of the DPP as the comparator. The initial cycle represented the treatment period, and transition probabilities for the post‐treatment period were derived from a long‐term lifestyle intervention meta‐analysis. The onset of T2D complications was estimated using microsimulation. Quality‐adjusted life years (QALYs) were calculated based on health utility measured by short form (SF)‐12 scores, and a willingness‐to‐pay threshold of $100 000 per QALY gained was applied.The d‐DPP intervention resulted in cost savings of $3,672 from a societal perspective and $2,990 from a healthcare sector perspective and a gain of 0.08 QALYs compared with the DPP. The dropout rate was identified as a significant factor influencing the results. Probabilistic sensitivity analysis showed that the d‐DPP intervention was preferred in 85.8% in the societal perspective and 85.2% in the healthcare sector perspective.The d‐DPP is a cost‐effective alternative to in‐person lifestyle interventions for preventing the development of T2D among individuals with prediabetes in the United States. [ABSTRACT FROM AUTHOR]

Policy PointsLittle attention to date has been directed at examining how the long‐term services and supports (LTSS) environmental context affects the health and well‐being of older adults with disabilities.We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences.We find the LTSS environment is highly associated with person‐reported care experiences, but the direction of the relationship varies by domain; increased neighborhood social and economic deprivation are highly associated with experiencing adverse consequences due to unmet need, whereas availability and generosity of the health care and social services delivery environment are inversely associated with participation restrictions in valued activities.Policies targeting local and state‐level LTSS‐relevant environmental characteristics stand to improve the health and well‐being of older adults with disabilities, particularly as it relates to adverse consequences due to unmet need and participation restrictions. Context: Long‐term services and supports (LTSS) in the United States are characterized by their patchwork and unequal nature. The lack of generalizable person‐reported information on LTSS care experiences connected to place of community residence has obscured our understanding of inequities and factors that may attenuate them. Methods: We advance a conceptual framework of LTSS‐relevant environmental domains, drawing on newly available data linkages from the 2015 National Health and Aging Trends Study to connect person‐reported care experiences with public use spatial data. We assess relationships between LTSS‐relevant environmental characteristic domains and person‐reported care adverse consequences due to unmet need, participation restrictions, and subjective well‐being for 2,411 older adults with disabilities and for key population subgroups by race, dementia, and Medicaid enrollment status. Findings: We find the LTSS environment is highly associated with person‐reported care experiences, but the direction of the relationship varies by domain. Measures of neighborhood social and economic deprivation (e.g., poverty, public assistance, social cohesion) are highly associated with experiencing adverse consequences due to unmet care needs. Measures of the health care and social services delivery environment (e.g., Medicaid Home and Community‐Based Service Generosity, managed LTSS [MLTSS] presence, average direct care worker wage, availability of paid family leave) are inversely associated with experiencing participation restrictions in valued activities. Select measures of the built and natural environment (e.g., housing affordability) are associated with participation restrictions and lower subjective well‐being. Observed relationships between measures of LTSS‐relevant environmental characteristics and care experiences were generally held in directionality but were attenuated for key subpopulations. Conclusions: We present a framework and analyses describing the variable relationships between LTSS‐relevant environmental factors and person‐reported care experiences. LTSS‐relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Greater attention should be devoted to strengthening state‐ and community‐based policies and practices that support aging in place. [ABSTRACT FROM AUTHOR]

Background: Pelvic inflammatory Disease (PID) disproportionately impacts adolescent and young adult women. The Technology-Enhanced Community Health Nursing (TECH-N) trial demonstrated the potential benefit of a novel community health nursing intervention for female adolescents with PID. In this study, we assess the cost-effectiveness of such an intervention compared to standard care. Methods: We constructed a cohort Markov model to assess the cost-effectiveness of the TECH-N intervention for adolescents with PID in an urban setting. The model used nine health states: PID, two states for STIs (Chlamydia trachomatis and Neisseria gonorrhoeae), four states for PID sequelae (infertility, chronic pelvic pain, tubo-ovarian abscess, and ectopic pregnancy), a recovery state, and a deceased state. The cohort consisted of hypothetical 18-yearold female adolescents with mild to moderate PID. Transition probabilities between health states were derived from the TECH-N clinical trial and published literature. Health state utilities were derived from published literature. Intervention costs were estimated using TECH-N data, and health state costs were derived from published literature. Costeffectiveness was assessed over a 10-year time horizon using a health system perspective. Sensitivity analyses were used to assess uncertainty. Costeffectiveness was assessed using the incremental cost per quality-adjusted life year (QALY). Results: Over 10 years, the intervention cohort generated 9.6 QALYs per individual at a cost of $11,091 compared to 9.5 QALYs per individual at a cost of $11,857 for standard of care. The resulting ICER was negative, since the intervention produced better effects at a lower cost. The cost-saving results was driven by the low cost of the intervention and the reduced risk of STI's and subsequent PID which resulted in lower downstream healthcare costs. Sensitivity analyses identified the cost of the intervention and the relative rate of future PID to be the main drivers of the results. Conclusion: Our model suggests TECH-N is a costsaving public health intervention that yields better outcomes at lower overall costs. In addition, the nature of TECH-N intervention lends itself to be coupled with other home-health /community engagement strategies, which should reduce the operating cost of the intervention and further improve its value proposition. [ABSTRACT FROM AUTHOR]

Background and aims: Despite prescribing declines between 2011 and 2019, opioid morbidity and mortality in the United States continued to rise during this period. We estimated the relationship between opioid prescribing, opioid use disorder (OUD) and fatal opioid overdose in the United States. Design Dynamic Markov model. Setting: United States, using data from the National Survey on Drug Use and Health, Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey and National Epidemiologic Survey on Alcohol and Related Conditions III. Participants: Simulated US individuals 12+ years of age from the general population or with prescription opioid medical use, prescription opioid non‐medical use, illicit opioid (e.g. heroin, illicit fentanyl) use, prescription OUD, illicit OUD with a history of prior prescription opioid non‐medical use or non‐fatal or fatal opioid overdose. Measurements Active OUD cases and fatal prescription opioid overdoses. Findings Between 2010 and 2019, opioid prescribing declined 42.5%. Although fatal opioid overdoses increased by 103.2%, these reductions in opioid prescribing averted an estimated 9600 [95% uncertainty interval (UI) = 7205, 15 478] deaths starting in 2011 relative to continued prescribing at 2010 levels—and are projected to avert another 50 918 (95% UI = 38 829, 79 795) overdose deaths between 2020 and 2029. The median time from initial opioid prescription to fatal opioid overdose was 5.2 years. Of the 2.4 million (95% UI = 2.2 million, 2.7 million) individuals in the United States with estimated active OUD in 2019, 65% (95% UI = 59%, 71%) were attributable to initial opioid use occurring prior to 2011, whereas 14% (95% UI = 12%, 17%) were attributable to initial opioid use occurring between 2017 and 2019. The impact, by 2029, of additional reductions in prescribing initiated in 2020 would be more than three times greater than that of similar reductions initiated in 2025. Conclusions: Observed reductions in opioid prescribing volume in the United States from 2010 to 2019 appear to have saved approximately 9600 lives by 2019 and are anticipated to avert more than 50 000 fatal overdoses by 2029. [ABSTRACT FROM AUTHOR]