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BACKGROUND: Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England. METHODS: We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES). RESULTS: The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004-2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004-2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased. CONCLUSIONS: In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Objective To estimate the economic cost of coronavirus disease 19 (COVID-19) in 31 provincial-level administrative regions and in total, in China. Methods We used data from government reports, clinical guidelines and other publications to estimate the main cost components of COVID-19 during 1 January-31 March 2020. These components were: identification and diagnosis of close contacts; suspected cases and confirmed cases of COVID-19; treatment of COVID-19 cases; compulsory quarantine of close contacts and suspected cases; and productivity losses for all affected residents. Primary outcomes were total health-care and societal costs. Findings The total estimated health-care and societal costs associated with COVID-19 were 4.26 billion Chinese yuan ([yen]; 0.62 billion United States dollars, US$) and 2646.70 billion [yen] (US$ 383.02 billion), respectively. Inpatient care accounted for 44.2% (0.95 billion [yen]/2.15 billion [yen]) of routine health-care costs followed by medicines, accounting for 32.5% (0.70 billion [yen]/2.15 billion [yen]). Productivity losses accounted for 99.8% (2641.61 billion [yen]/2646.70 billion [yen]) of societal costs, which were mostly attributable to the effect of movement-restriction policies on people who did not have COVID-19. Societal costs were most sensitive to salary costs and number of working days lost due to movement-restriction policies. Hubei province had the highest health-care cost while Guangdong province had the highest societal cost. Conclusion Our results highlight the high economic burden of the COVID-19 outbreak in China. The control measures to prevent the spread of disease resulted in substantial costs from productivity losses amounting to 2.7% (US$ 382.29 billion/US$ 14.14 trillion) of China's annual gross domestic product. [phrase omitted] Objectif Estimer l'impact economique de la maladie a coronavirus 2019 (COVID-19) dans 31 regions administratives de niveau provincial ainsi que dans l'ensemble de la Chine. Methodes Nous avons utilise les donnees issues des rapports officiels, des directives cliniques et d'autres publications pour evaluer les principales composantes de cout de la COVID-19 durant la periode comprise entre le 1er janvier et le 31 mars 2020. Ces composantes etaient les suivantes: identification et diagnostic des contacts rapproches; cas suspects et confirmes de COVID-19; traitement des cas de COVID-19; quarantaine obligatoire des contacts rapproches et cas suspects; et enfin, perte de productivite pour toutes les personnes concernees. Le cout total des soins de sante et le cout total pour la societe constituaient les resultats primaires. Resultats Nous avons estime que le cout total des soins de sante et le cout total pour la societe induits par la COVID-19 s'elevaient a 4,26 milliards de yuans (0,62 milliard de dollars americains) dans le premier cas et a 2646,70 milliards de yuans (383,02 milliards de dollars americains) dans le second. Lhospitalisation des patients a represente 44,2% (0,95 milliard de yuans/2,15 milliards de yuans) des frais de soins de sante courants, suivie par les medicaments avec 32,5% (0,70 milliard de yuans/2,15 milliards de yuans). La perte de productivite a represente 99,8% (2641,61 milliards de yuans/2646,70 milliards de yuans) du cout pour la societe, principalement lie a l'impact des politiques de restriction des deplacements sur les personnes ne souffrant pas de la COVID-19. Le cout pour la societe dependait majoritairement des depenses salariales et du nombre de jours de travail perdus a cause des politiques de restriction des deplacements. C'est la province du Hubei qui a debourse le plus pour les soins de sante, tandis que celle du Guangdong a ete la plus durement touchee en termes de cout pour la societe. Conclusion Nos resultats mettent en lumiere le lourd fardeau economique de l'epidemie de COVID-19 en Chine. Les mesures de lutte contre la propagation du virus ont entraine des pertes considerables en raison d'une baisse de productivite equivalant a 2,7% (382,29 milliards de dollars americains/14,14 billions de dollars americains) du produit interieur brut annuel de la Chine. [phrase omitted] Objetivo Estimar el coste economico de la enfermedad coronavirus-19 (COVID-19) en 31 regiones administrativas a nivel provincial y en su totalidad en China. Metodos Utilizamos los datos de los informes del gobierno, las guias clinicas y otras publicaciones para estimar los principales componentes del coste de la COVID-19 desde el 1 de enero al 31 de marzo de 2020. Estos componentes fueron: identificacion y diagnostico de contactos cercanos; casos sospechosos y casos confirmados de COVID-19; tratamiento de los casos de COVID-19; cuarentena obligatoria de contactos cercanos y casos sospechosos; y perdidas de productividad para todos los residentes afectados. El principal resultado fue los costes totales de la atencion sanitaria y de la sociedad. Resultados El total estimado de los costes de atencion sanitaria y de la sociedad asociados con la COVID-19 fue de 4.260 millones de yuanes chinos ([yen]; 0,62 mil millones de dolares estadounidenses) y 2.646,70 mil millones de yuanes (383,02 mil millones de dolares estadounidenses), respectivamente. La atencion hospitalaria represento el 44,2% (0,95 mil millones/2,15 mil millones de yenes) de los costes de la atencion sanitaria rutinaria, seguida de los medicamentos, que representaron el 32,5% (0,70 mil millones/2,15 mil millones de yenes). Las perdidas de productividad representaron el 99,8% (2.641,61 mil millones/2.646,70 mil millones de yenes) de los costes de la sociedad, que se atribuyeron principalmente al efecto de las politicas de restriccion de movimientos en las personas que no tenian COVID-19. Los costes sociales fueron mas sensibles a los costes salariales y al numero de dias de trabajo perdidos debido a las politicas de restriccion de movimiento. La provincia de Hubei tenia el mayor coste de atencion sanitaria, mientras que la provincia de Guangdong tenia el mayor coste social. Conclusion Nuestros resultados destacan la alta carga economica del brote de COVID-19 en China. Las medidas de control para evitar la propagacion de la enfermedad dieron lugar a costes sustanciales por perdidas de productividad que ascendieron al 2,7% (382,29 mil millones de dolares estadounidenses/14,14 millones de millones de dolares estadounidenses) del producto interno bruto anual de China., Introduction Coronavirus disease 2019 (COVID-19) is an infectious disease which results in substantial morbidity and mortality in some population groups. By September 2020, over 32.7 million cases of COVID-19 had [...]

Background: In patients with intracranial aneurysm presenting with spontaneous subarachnoid hemorrhage (SAH), 15% of them could be missed by the initial diagnostic imaging. Repeat delayed imaging can help to identify previously undetected aneurysms, however, the cost-effectiveness of this strategy remains uncertain. Objective: The aim of this study is to assess the cost-effectiveness of repeat delayed imaging in patients with SAH who had a negative result during their initial imaging. Methods: A Markov model was developed to estimate the lifetime costs and quality-adjusted life-year (QALY) for patients who received or not received repeat delayed imaging. The analyses were conducted from a healthcare perspective, with costs reported in UK pounds and expressed in 2020 values. Extensive sensitivity analyses were performed to assess the robustness of the results. Results: The base case incremental cost-effectiveness ratio (ICER) of repeat delayed imaging is £9,314 per QALY compared to no-repeat delayed imaging. This ICER is below the National Institute for Health and Care Excellence (NICE) £20,000 per QALY willingness-to-pay threshold. At the NICE willingness-to-pay threshold of £20,000 per QALY, the probability that repeat delayed imaging is most cost-effective is 0.81. The results are sensitive to age, the utility of survived patients with a favorable outcome, the sensitivity of repeat delayed imaging, and the prevalence of aneurysm. Conclusions: This study showed that, in the UK, it is cost-effective to provide repeat delayed imaging using computed tomographic angiography (CTA) for patients with SAH who had a negative result in their initial imaging. [ABSTRACT FROM AUTHOR]

Background: Discrepancies between the National Institute for Health and Care Excellence (NICE) schizophrenia guideline recommendations and current clinical practice in the UK have been reported.Aims: We aim to assess whether it is cost-effective to improve adherence to the NICE schizophrenia guideline recommendations, compared with current practice.Method: A previously developed whole-disease model for schizophrenia, using the discrete event simulation method, was adapted to assess the cost and health impacts of adherence to the NICE recommendations. Three scenarios to improve adherence to the clinical guidelines were modelled: universal provision of cognitive-behavioural therapy for patients at clinical high risk of psychosis, universal provision of family intervention for patients with first-episode psychosis and prompt provision of clozapine for patients with treatment-resistant schizophrenia. The primary outcomes were lifetime costs and quality-adjusted life-years gained.Results: The results suggest full adherence to the guideline recommendations would decrease cost and improve quality-adjusted life-years. Based on the NICE willingness-to-pay threshold of £20 000-£30 000 per quality-adjusted life-year gained, prompt provision of clozapine for patients with treatment-resistant schizophrenia results in the greatest net monetary benefit, followed by universal provision of cognitive-behavioural therapy for patients at clinical high risk of psychosis, and universal provision of family intervention for patients with first-episode psychosis.Conclusions: Our results suggest that adherence to guideline recommendations would decrease cost and improve quality-adjusted life-years. Greater investment is needed to improve guideline adherence and therefore improve patient quality of life and realise potential cost savings. [ABSTRACT FROM AUTHOR]