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Estimating the Health and Economic Benefits of Universal Salt Iodization Programs to Correct Iodine Deficiency Disorders.

ABSTRACT: Background: There has been tremendous progress over the past 25 years to control iodine deficiency disorders (IDDs) through universal salt iodization (USI). In 2019, using the median urinary iodine concentration (MUIC), only 19 countries in the world are classified as iodine deficient; in contrast in 1993, using the total goiter rate (TGR), 113 countries were classified as iodine deficient. However, few analyses have tried to quantify the global health and economic benefits of USI programs, and the shift from TGR to MUIC as the main indicator of IDDs complicates assessment of progress. Methods: We used a novel approach to estimate the impact of USI on IDDs, applying a regression model derived from observational data on the relationship between the TGR and the MUIC from 24 countries. The model was used to generate hypothetical national TGR values for 2019 based on current MUIC data. TGR in 1993 and modeled TGR in 2019 were then compared for 139 countries, and using consequence modeling, the potential health and economic benefits realized between 1993 and 2019 were estimated. Results: Based on this approach, the global prevalence of clinical IDDs (as assessed by the TGR) fell from 13.1% to 3.2%, and 720 million cases of clinical IDDs have been prevented by USI (a reduction of 75.9%). USI has significantly reduced the number of newborns affected by IDDs, with 20.5 million cases prevented annually. The resulting improvement in cognitive development and future earnings suggest a potential global economic benefit of nearly $33 billion. However, 4.8 million newborns will be affected by IDDs in 2019, who will experience life-long productivity losses totaling a net present value of $12.5 billion. Conclusions: The global improvements in iodine status over the past 25 years have resulted in major health and economic benefits, mainly in low- and middle-income countries. Efforts should now focus on sustaining this achievement and expanding USI to reach the continuing large number of infants who remain unprotected from IDDs.

SUBMITTER: Gorstein JL

PROVIDER: S-EPMC7757618 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Estimating the Health and Economic Benefits of Universal Salt Iodization Programs to Correct Iodine Deficiency Disorders.

Gorstein Jonathan Louis JL Bagriansky Jack J Pearce Elizabeth N EN Kupka Roland R Zimmermann Michael B MB

Thyroid : official journal of the American Thyroid Association 20200717 12

<b><i>Background:</i></b> There has been tremendous progress over the past 25 years to control iodine deficiency disorders (IDDs) through universal salt iodization (USI). In 2019, using the median urinary iodine concentration (MUIC), only 19 countries in the world are classified as iodine deficient; in contrast in 1993, using the total goiter rate (TGR), 113 countries were classified as iodine deficient. However, few analyses have tried to quantify the global health and economic benefits of USI ...[more]

PMID: 32458745

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Project description:BACKGROUND: In many low-income countries, children are at high risk of iodine deficiency disorders, including brain damage. In the early 1990s, Tanzania, a country that previously suffered from moderate to severe iodine deficiency, adopted universal salt iodation (USI) as an intervention strategy, but its impact remained unknown. METHODS: We report on the first national survey in mainland Tanzania, conducted in 2004 to assess the extent to which iodated salt was used and its apparent impact on the total goitre prevalence (TGP) and urinary iodine concentrations (UIC) among the schoolchildren after USI was initiated. In 2004, a cross-sectional goitre survey was conducted; covering 140,758 schoolchildren aged 6 - 18 years were graded for goitre according to new WHO goitre classification system. Comparisons were made with district surveys conducted throughout most of the country during the 1980s and 90s. 131,941 salt samples from households were tested for iodine using rapid field test kits. UIC was determined spectrophotometrically using the ammonium persulfate digestion method in 4523 sub-sampled children. RESULTS: 83.6% (95% CI: 83.4 - 83.8) of salt samples tested positive for iodine. Whereas the TGP was about 25% on average in the earlier surveys, it was 6.9% (95%CI: 6.8-7.0) in 2004. The TGP for the younger children, 6-9 years old, was 4.2% (95%CI: 4.0-4.4), n = 41,965. In the 27 goitre-endemic districts, TGP decreased from 61% (1980s) to 12.3% (2004). The median UIC was 204 (95% CF: 192-215) microg/L. Only 25% of children had UIC <100 microg/L and 35% were > or = 300 microg/L, indicating low and excess iodine intake, respectively. CONCLUSION: Our study demonstrates a marked improvement in iodine nutrition in Tanzania, twelve years after the initiation of salt iodation programme. The challenge in sustaining IDD elimination in Tanzania is now two-fold: to better reach the areas with low coverage of iodated salt, and to reduce iodine intake in areas where it is excessive. Particular attention is needed in improving quality control at production level and perhaps the national salt iodation regulations may need to be reviewed.

Project description:BACKGROUND AND OBJECTIVES:Infections caused by multidrug-resistant organisms and Clostridium difficile are associated with substantial morbidity and mortality as well as excess costs. Antimicrobial exposure is the leading cause for these infections. Approximately 30% of antimicrobial doses administered in outpatient hemodialysis facilities are considered unnecessary. Implementing an antimicrobial stewardship program in outpatient hemodialysis facilities aimed at improving prescribing practices would have important clinical and economic benefits. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The main outcomes were total antimicrobial use, infections caused by multidrug-resistant organisms and C. difficile, infection-related mortality, and total costs. The analysis considered all patients on outpatient hemodialysis in the United States. The value of implementing antimicrobial stewardship programs, assuming a 20% decrease in unnecessary antimicrobial doses, was calculated as the incremental differences in clinical end points and cost outcomes. Event probabilities, antimicrobial regimens, and health care costs were informed by publicly available sources. RESULTS:On a national level, implementation of antimicrobial stewardship programs was predicted to result in 2182 fewer infections caused by multidrug-resistant organisms and C. difficile (4.8% reduction), 629 fewer infection-related deaths (4.6% reduction), and a cost savings of $106,893,517 (5.0% reduction) per year. The model was most sensitive to clinical parameters as opposed to antimicrobial costs. CONCLUSIONS:The model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.

Project description:BackgroundPromoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs.MethodsUsing a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs.ResultsThe more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, 'post-discharge symptom monitoring and management' and 'discharge planning', are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions.ConclusionsThe results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers' choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.

Dataset Information

Estimating the Health and Economic Benefits of Universal Salt Iodization Programs to Correct Iodine Deficiency Disorders.

Publications

Estimating the Health and Economic Benefits of Universal Salt Iodization Programs to Correct Iodine Deficiency Disorders.

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