Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia.
Ontology highlight
ABSTRACT:
SUBMITTER: Singh K
PROVIDER: S-EPMC6421672 | biostudies-literature | 2019
REPOSITORIES: biostudies-literature
Publications
Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia.
Singh Kavita K Ali Mohammed K MK Devarajan Raji R Shivashankar Roopa R Kondal Dimple D Ajay Vamadevan S VS Menon V Usha VU Varthakavi Premlata K PK Viswanathan Vijay V Dharmalingam Mala M Bantwal Ganapati G Sahay Rakesh Kumar RK Masood Muhammad Qamar MQ Khadgawat Rajesh R Desai Ankush A Prabhakaran Dorairaj D Narayan K M Venkat KMV Phillips Victoria L VL Tandon Nikhil N
Global health research and policy 20190318
<h4>Background</h4>Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia.<h4>Methods/design</h4>This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with po ...[more]
Similar Datasets
Project description:ObjectiveSouth Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.ResultsThe South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients.
| S-EPMC6352446 | biostudies-literature
Project description:BackgroundAchievement of diabetes care goals is suboptimal globally. Diabetes-focused quality improvement (QI) is effective but remains untested in South Asia.ObjectiveTo compare the effect of a multicomponent QI strategy versus usual care on cardiometabolic profiles in patients with poorly controlled diabetes.DesignParallel, open-label, pragmatic randomized, controlled trial. (ClinicalTrials.gov: NCT01212328).SettingDiabetes clinics in India and Pakistan.Patients1146 patients (575 in the intervention group and 571 in the usual care group) with type 2 diabetes and poor cardiometabolic profiles (glycated hemoglobin [HbA1c] level ≥8% plus systolic blood pressure [BP] ≥140 mm Hg and/or low-density lipoprotein cholesterol [LDLc] level ≥130 mg/dL).InterventionMulticomponent QI strategy comprising nonphysician care coordinators and decision-support electronic health records.MeasurementsProportions achieving HbA1c level less than 7% plus BP less than 130/80 mm Hg and/or LDLc level less than 100 mg/dL (primary outcome); mean risk factor reductions, health-related quality of life (HRQL), and treatment satisfaction (secondary outcomes).ResultsBaseline characteristics were similar between groups. Median diabetes duration was 7.0 years; 6.8% and 39.4% of participants had preexisting cardiovascular and microvascular disease, respectively; mean HbA1c level was 9.9%; mean BP was 143.3/81.7 mm Hg; and mean LDLc level was 122.4 mg/dL. Over a median of 28 months, a greater percentage of intervention participants achieved the primary outcome (18.2% vs. 8.1%; relative risk, 2.24 [95% CI, 1.71 to 2.92]). Compared with usual care, intervention participants achieved larger reductions in HbA1c level (-0.50% [CI, -0.69% to -0.32%]), systolic BP (-4.04 mm Hg [CI, -5.85 to -2.22 mm Hg]), diastolic BP (-2.03 mm Hg [CI, -3.00 to -1.05 mm Hg]), and LDLc level (-7.86 mg/dL [CI, -10.90 to -4.81 mg/dL]) and reported higher HRQL and treatment satisfaction.LimitationFindings were confined to urban specialist diabetes clinics.ConclusionMulticomponent QI improves achievement of diabetes care goals, even in resource-challenged clinics.Primary funding sourceNational Heart, Lung, and Blood Institute and UnitedHealth Group.
| S-EPMC6561084 | biostudies-literature
Project description:AimTo estimate the burden of colorectal cancer (CRC) in South East Asia.MethodsWe reviewed the evidence from the published literature found through a systematic review in Medline, Embase, and Global Health and from unpublished data on cancer registries, which were sourced from the International Agency for Research on Cancer. Incidence rates were summarized by calculating descriptive statistics and meta-analysis estimates.ResultsThe crude mean incidence of CRC in South East Asia for both sexes was 6.95/100000 population and the incidence increased with age. The crude meta-analysis estimate was 6.12/100000 population (95% confidence interval 5.64-6.60/100000) and the number of new CRC cases for 2000 was 32058 (29544-34573).ConclusionThe rates of CRC in South East Asia were much lower than those reported for high-income countries, but higher than those reported for Sub Saharan Africa.
| S-EPMC3893985 | biostudies-literature
Project description:BACKGROUND:Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. METHOD:We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs-cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. RESULTS:A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. CONCLUSION:The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.
| S-EPMC6248902 | biostudies-literature
Project description:Sensitivity to satiety constitutes a basic requirement for neuronal coding of subjective reward value. Satiety from natural ongoing consumption affects reward functions in learning and approach behavior. More specifically, satiety reduces the subjective economic value of individual rewards during choice between options that typically contain multiple reward components. The unconfounded assessment of economic reward value requires tests at choice indifference between two options, which is difficult to achieve with sated rewards. By conceptualizing choices between options with multiple reward components ("bundles"), Revealed Preference Theory may offer a solution. Despite satiety, choices against an unaltered reference bundle may remain indifferent when the reduced value of a sated bundle reward is compensated by larger amounts of an unsated reward of the same bundle, and then the value loss of the sated reward is indicated by the amount of the added unsated reward. Here, we show psychophysically titrated choice indifference in monkeys between bundles of differently sated rewards. Neuronal chosen value signals in the orbitofrontal cortex (OFC) followed closely the subjective value change within recording periods of individual neurons. A neuronal classifier distinguishing the bundles and predicting choice substantiated the subjective value change. The choice between conventional single rewards confirmed the neuronal changes seen with two-reward bundles. Thus, reward-specific satiety reduces subjective reward value signals in OFC. With satiety being an important factor of subjective reward value, these results extend the notion of subjective economic reward value coding in OFC neurons.
| S-EPMC8325167 | biostudies-literature
Project description:Accurate incidence estimates are needed to characterize the HIV epidemic and guide prevention efforts. HIV Incidence assays are cost-effective laboratory assays that provide incidence estimates from cross-sectional surveys. We conducted a global market assessment of HIV incidence assays under three market scenarios and estimated the economic value of improved incidence assays. We interviewed 27 stakeholders, and reviewed journal articles, working group proceedings, and manufacturers' sales figures. We determined HIV incidence assay use in 2014, and estimated use in 2015 to 2017 and in 5 to 10-years under three market scenarios, as well as the cost of conducting national and key population surveys using an HIV incidence assay with improved performance. Global 2014 HIV incidence assay use was 308,900 tests, highest in Asia and mostly for case- and population-based surveillance. Estimated 2015 to 2017 use was 94,475 annually, with declines due to China and the United States discontinuing incidence assay use for domestic surveillance. Annual projected 5 to 10 year use under scenario 1 - no change in technology - was 94,475. For scenario 2 - a moderately improved incidence assay - projected annual use was 286,031. Projected annual use for scenario 3 - game-changing technologies with an HIV incidence assay part of (a) standard confirmatory testing, and (b) standard rapid testing, were 500,000 and 180 million, respectively. As HIV incidence assay precision increases, decreased sample sizes required for incidence estimation resulted in $5 to 23 million annual reductions in survey costs and easily offset the approximately $3 million required to develop a new assay. Improved HIV incidence assays could substantially reduce HIV incidence estimation costs. Continued development of HIV incidence assays with improved performance is required to realize these cost benefits.
| S-EPMC5810336 | biostudies-literature
Project description:Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation.Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a "gold standard" medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders.At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes.Clinicaltrials.gov identifier NCT01337063.
| S-EPMC3698100 | biostudies-literature
Project description:Globally, 21 percent of young women are married before their 18th birthday. Despite some progress in addressing child marriage, it remains a widespread practice, in particular in South Asia. While household predictors of child marriage have been studied extensively in the literature, the evidence base on macro-economic factors contributing to child marriage and models that predict where child marriage cases are most likely to occur remains limited. In this paper we aim to fill this gap and explore region-level indicators to predict the persistence of child marriage in four countries in South Asia, namely Bangladesh, India, Nepal and Pakistan. We apply machine learning techniques to child marriage data and develop a prediction model that relies largely on regional and local inputs such as droughts, floods, population growth and nightlight data to model the incidence of child marriages. We find that our gradient boosting model is able to identify a large proportion of the true child marriage cases and correctly classifies 77% of the true marriage cases, with a higher accuracy in Bangladesh (92% of the cases) and a lower accuracy in Nepal (70% of cases). In addition, all countries contain in their top 10 variables for classification nighttime light growth, a shock index of drought over the previous and the last two years and the regional level of education, suggesting that income shocks, regional economic activity and regional education levels play a significant role in predicting child marriage. Given the accuracy of the model to predict child marriage, our model is a valuable tool to support policy design in countries where household-level data remains limited.
| S-EPMC9436147 | biostudies-literature
Project description:INTRODUCTION:There is an unmet need for well-tolerated antiepileptic drugs (AEDs) that effectively control focal onset seizures. This study aimed to evaluate the economic value of new AEDs in the treatment of focal onset seizure, with or without secondary generalization, in Finnish adults and adolescents with epilepsy, comparing brivaracetam with perampanel as adjunctive AEDs. METHODS:Economic value was assessed using cost-utility analysis. Periods of AED initiation, titration, response assessment (seizure freedom,???50% reduction, no response), switching in no response or treatment-emergent adverse events (TEAEs), and death were simulated using a discrete-event simulation model. Responses and switching were simulated based on a comprehensive Bayesian network meta-analysis. The primary modeled outcome was the 3%/year discounted incremental cost-effectiveness ratio (ICER). Discounted quality-adjusted life-years (QALYs), payer costs (year 2017 Euro) per patient, and net monetary benefit (NMB) were secondary outcomes. Probabilistic and comprehensive deterministic sensitivity analyses were conducted. RESULTS:Brivaracetam was more efficacious and had fewer TEAEs than perampanel and other AEDs. Modeled average 5-year QALYs and costs were 3.671 and €28,297 for brivaracetam and 3.611 and €27,979 for perampanel, respectively. The resulting ICER for brivaracetam versus perampanel was only €5345/QALY gained in a deterministic base case scenario. Brivaracetam had a positive NMB and high probability of cost-effectiveness of €1190 and 71% or €1944 and 80% with the assumed willingness to pay of €25,358 or €38,036/QALY gained, respectively. The primary result was robust, with a positive NMB persistent in all sensitivity analysis scenarios. When switching from brivaracetam to perampanel was excluded from the modeling or switching from perampanel to brivaracetam was included, brivaracetam was cost-saving and more effective than perampanel (dominant). CONCLUSION:These simulated comparisons demonstrated that brivaracetam was more effective and potentially also more affordable than perampanel. Thus, brivaracetam is likely a cost-effective and net beneficial alternative to perampanel for treatment of focal onset seizures. Plain language summary available for this article.
| S-EPMC6979440 | biostudies-literature
Project description:IntroductionWorsening air quality and pollution lead to numerous environmental health and sustainability issues in the South Asia region. This study analyzes India, Nepal, Bangladesh, Pakistan, Sri Lanka, and Nepal for air quality data trends and sustainability indicators.MethodologyBy using a population-based study design, six South Asian countries were analyzed using a step-wise approach. Data were obtained from government websites and publicly available repositories for region dynamics and key variables.ResultsBetween 1990 and 2020, air quality data indicated the highest rise in CO2 emissions in India (578.5 to 2441.8 million tons) (MT), Bangladesh, Nepal, and Pakistan. Greenhouse gas emissions, from 1990 to 2018, nearly tripled in India (1990.4 to 3346.6 MT of CO2-equivalents), Nepal (20.6 to 54.6 MT of CO2-equivalents), and Pakistan, and doubled in Bangladesh. Methane emissions rose the highest in Pakistan (70.4 to 151 MT of CO2-equivalents), followed by Nepal (17 to 31 MT of CO2-equivalents) and India (524.8 to 669.3 MT of CO2-equivalents). Nitrous oxide nearly doubled in Bangladesh (16.5 to 29.3 MT of CO2-equivalents), India (141.6 to 256.9 MT of CO2-equivalents), Nepal (17 to 31 MT of CO2-equivalents), and more than doubled in Pakistan (27 to 61 MT of CO2-equivalents). On noting particulate matter 2,5 annual exposure, India saw the highest rise from 81.3 µg/m3 (in 1990) to 90.9 µg/m3 (2017), whereas trends were steady in Pakistan (60.34 to 58.3 µg/m3). The highest rise was noted in Nepal (87.6 to 99.7 µg/m3) until 2017. During the coronavirus disease 19 pandemic, the pre-and post-pandemic changes between 2018 and 2021 indicated the highest PM2.5 concentration in Bangladesh (76.9 µg/m3), followed by Pakistan (66.8 µg/m3), India (58.1 µg/m3), Nepal (46 µg/m3) and Sri Lanka (17.4 µg/m3). Overall, South Asian countries contribute to the worst air quality and sustainability trends regions worldwide.ConclusionsAir pollution is prevalent across a majority of South Asia countries. Owing to unsustainable industrial practices, pollution trends have risen to hazardous levels. Economic, environmental, and human health impacts have manifested and require urgent, concerted efforts by governing bodies in the region.
| S-EPMC9224398 | biostudies-literature