4 research outputs found
Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa
No full textBackground: Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited.Objective: Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription.Methods: A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR.Results: For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC—including malaria and complete blood count testing—indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant.Conclusion: The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians’ confidence in prescribing decisions and is a favourable strategy.</p
Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa
No full textBackground
Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited.
Objective
Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription.
Methods
A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR.
Results
For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC—including malaria and complete blood count testing—indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant.
Conclusion
The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians’ confidence in prescribing decisions and is a favourable strategy
Cost Effectiveness of a CYP2C19 Genotype-Guided Strategy in Patients with Acute Myocardial Infarction:Results from the POPular Genetics Trial
No full textINTRODUCTION: The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI).OBJECTIVE: In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel.METHODS: A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y12 inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y12 inhibitors, and equal distribution of thrombotic events between the two strategies).RESULTS: Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant.CONCLUSION: In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings.TRIAL REGISTRATION: Clinicaltrials.gov number: NCT01761786, Netherlands trial register number: NL2872.</p
Determinants of return to work after musculoskeletal injury a scoping review
No full textRESUMEN
Objetivo: El objetivo consistió en identificar los factores determinantes del retorno al trabajo después de una alteración músculo esquelética. Partiendo de la caracterización del proceso de retorno al trabajo desde la afectación física y funcional hasta el reintegro de las actividades laborales, como en la descripción de los factores determinantes que afectan de manera positiva o negativa el retorno al trabajo para proponer algunas recomendaciones relacionadas a los procesos de retorno al trabajo.
Métodos: Se realizó una búsqueda sistemática tipo revisión de alcance por medio de la metodología PRIMA ScR para dar respuesta a la pregunta ¿cuáles son los factores determinantes en el retorno al trabajo?, se utilizaron las bases de datos principales como PUBMED, Science Direct, Springer Link publicados entre el 2019 y 2024.
Resultados: El retorno al trabajo es un proceso complejo influido por factores personales y del entorno que actúan como barreras o facilitadores. Las barreras incluyen edad avanzada, ausentismo prolongado, obesidad, tabaquismo, lesiones graves, ansiedad, depresión y desconexión del empleador, que limitan la recuperación y reintegración. En contraste, los facilitadores como un mayor nivel educativo, optimismo, apoyo del empleador, adaptaciones laborales, tecnología asistida, entrevistas motivacionales y programas de actividad física mejoran las tasas de RTW. Un enfoque multidisciplinario que integre estas herramientas y gestione de manera efectiva los desafíos identificados puede optimizar la reincorporación laboral, promoviendo resultados sostenibles y reduciendo el impacto económico y social del proceso.
Conclusiones: El retorno al trabajo es un proceso dinámico en el cual confluyen muchos actores, factores y elementen que pueden garantizar el éxito o el fracaso para regresar un trabajador a su lugar de trabajo posterior a una lesión musculoesquelética. La presencia de dolor y el grado de discapacidad son unas de las barreras más importantes como el apoyo del empleador y los compañeros de trabajo un facilitador.Especialización en ErgonomíaEspecializaciónABSTRACT
Objective: The objective was to identify the determining factors of the return to work after a musculoskeletal alteration. Starting from the characterization of the process of return to work from the physical and functional affectation to the reinstatement of work activities, as well as the description of the determining factors that positively or negatively affect the return to work to propose some recommendations related to the processes of return to work.
Methods: A systematic search using the PRIMA methodology was conducted, resulting in 40 articles identifying barriers and facilitators in returning to work and describing the
process in major databases such as PUBMED, Science Direct, and Springer Link published between 2019 and 2024.
Results: RTW is a complex process influenced by personal and environmental factors that act as barriers or facilitators. Barriers include older age, prolonged absenteeism, obesity, smoking, serious injuries, anxiety, depression, and employer disconnection, which limit recovery and reintegration. In contrast, facilitators such as higher educational level, optimism, employer support, work accommodations, assistive technology, motivational interviewing, and physical activity programs improve RTW rates. A multidisciplinary approach that integrates these tools and effectively manages the identified challenges can optimize return to work, promoting sustainable outcomes and reducing the economic and social impact of the process.
Conclusions: Returning to work is a dynamic process in which many actors, factors and elements come together to ensure success or failure in returning a worker to his or her workplace after a musculoskeletal injury. The presence of pain and the degree of disability are some of the most important barriers, as is the support of the employer and coworkers
