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BACKGROUND:The United States is the only high-income nation without universal, government-funded or -mandated health insurance employing a unified payment system. The US multi-payer system leaves residents uninsured or underinsured, despite overall healthcare costs far above other nations. Single-payer (often referred to as Medicare for All), a proposed policy solution since 1990, is receiving renewed press attention and popular support. Our review seeks to assess the projected cost impact of a single-payer approach. METHODS AND FINDINGS:We conducted our literature search between June 1 and December 31, 2018, without start date restriction for included studies. We surveyed an expert panel and searched PubMed, Google, Google Scholar, and preexisting lists for formal economic studies of the projected costs of single-payer plans for the US or for individual states. Reviewer pairs extracted data on methods and findings using a template. We quantified changes in total costs standardized to percentage of contemporaneous healthcare spending. Additionally, we quantified cost changes by subtype, such as costs due to increased healthcare utilization and savings due to simplified payment administration, lower drug costs, and other factors. We further examined how modeling assumptions affected results. Our search yielded economic analyses of the cost of 22 single-payer plans over the past 30 years. Exclusions were due to inadequate technical data or assuming a substantial ongoing role for private insurers. We found that 19 (86%) of the analyses predicted net savings (median net result was a savings of 3.46% of total costs) in the first year of program operation and 20 (91%) predicted savings over several years; anticipated growth rates would result in long-term net savings for all plans. The largest source of savings was simplified payment administration (median 8.8%), and the best predictors of net savings were the magnitude of utilization increase, and savings on administration and drug costs (R2 of 0.035, 0.43, and 0.62, respectively). Only drug cost savings remained significant in multivariate analysis. Included studies were heterogeneous in methods, which precluded us from conducting a formal meta-analysis. CONCLUSIONS:In this systematic review, we found a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US. Actual costs will depend on plan features and implementation. Future research should refine estimates of the effects of coverage expansion on utilization, evaluate provider administrative costs in varied existing single-payer systems, analyze implementation options, and evaluate US-based single-payer programs, as available.

Context. Prairie dogs (Cynomys spp.) are rodents enjoyed by some humans; yet, they cause crop and property damage, and carry zoonotic disease. Non-lethal control of prairie dogs is of interest in urban/suburban settings. The injectable immunocontraceptive vaccine GonaCon (active ingredient is gonadotropin-releasing hormone [GnRH]) has been shown to be effective at reducing fertility in equine and deer, and is a US EPA-registered vaccine for use in these ungulate species. Aims. To conduct a replicated field study to test efficacy of GonaCon in black-tailed prairie dogs(C. ludovicianus), and if found to be efficacious, to help facilitate the EPA registration of this product for prairie dog management in urban/suburban areas. Methods. Prairie dogs were live-trapped in October–December 2018 in three treatment and three controlsites. Every captured female ≥660 g wasinjected with 0.4 mL of either GonaCon (0.032% w/w GnRH) at treatment sites or a sham vaccine (absent of GnRH) at control sites. Juveniles and adults were counted at all six sites to establish juvenile:adult (ratio) and juvenile density in May–June 2019 (determining initial GonaCon effectiveness) and 2020 (determining persistence of contraception). Key results. In 2019, the juvenile:adult ratio was significantly reduced (P = 0.0022) in GonaCon (mean ± s.e.: 0.23 ± 0.01) relative to the sham (1.10 ± 0.58) sites. Juvenile density was three times greater in sham than GonaCon sites. In 2020, GonaCon sites produced equal offspring to nearby sham sites. Conclusions. GonaCon is highly effective during the first year(2019) but not in the second year(2020) if only a small area (0.6–2.8 ha) orsmall proportion of females in a colony is treated, such as was undertaken in this study. Implications. In 2022, GonaCon− Prairie Dogs was EPA-registered. Treating whole colonies of prairie dogs at once is favoured; yet, if small or partial colony treatment is desired, then annual GonaCon treatment may be needed. [ABSTRACT FROM AUTHOR]