Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia:A Cross-sectional Stated Preference Approach

Background: The Saudi Healthcare System is universal, financed entirely from government revenue principally derived from oil, and is ‘free at the point of delivery’ (non-contributory). However, this system is unlikely to be sustainable in the medium to long term. This study investigates the feasibility and acceptability of healthcare financing reform by examining households’ willingness to pay (WTP) for a contributory national health insurance scheme. Methods: Using the contingent valuation method, a pre-tested interviewer-administered questionnaire was used to collect data from 1187 heads of household in Jeddah province over a 5-month period. Multi-stage sampling was employed to select the study sample. Using a double-bounded dichotomous choice with the follow-up elicitation method, respondents were asked to state their WTP for a hypothetical contributory national health insurance scheme. Tobit regression analysis was used to examine the factors associated with WTP and assess the construct validity of elicited WTP. Results: Over two-thirds (69.6%) indicated that they were willing to participate in and pay for a contributory national health insurance scheme. The mean WTP was 50 Saudi Riyal (US$13.33) per household member per month. Tobit regression analysis showed that household size, satisfaction with the quality of public healthcare services, perceptions about financing healthcare, education and income were the main determinants of WTP. Conclusions: This study demonstrates a theoretically valid WTP for a contributory national health insurance scheme by Saudi people. The research shows that willingness to participate in and pay for a contributory national health insurance scheme depends on participant characteristics. Identifying and understanding the main influencing factors associated with WTP are important to help facilitate establishing and implementing the national health insurance scheme. The results could assist policy-makers to develop and set insurance premiums, thus providing an additional source of healthcare financing

P3.368 STD Clinic Patients’ Preferences For HIV Prevention Strategies

Background More information is needed to understand how the newer HIV prevention methods should be positioned and which mix of prevention methods should be offered and promoted within the at risk populations. This study sought to obtain data about the preferences for effective biomedical interventions by individuals from the diverse ethnic and racial backgrounds that comprise the STD clinic populations in Miami Methods A cross sectional survey was used to assess knowledge and preference of traditional (condoms) and new biomedical methods to prevent HIV (Circumcision -C-, Pre-exposure prophylaxis -PreP and microbicides -M) in STD clinic patients. After an initial assessment, the study coordinator provided basic simple descriptions of three new methods of HIV prevention by pamphlets and/or recorded video. The relative preference for each of all the prevention strategies was re-assessed information was provided. Results Thirty five participants are reported in this interim analysis; 55% were female; 58% were African American; 25% were Hispanic and 12% were Haitians. Most of the participants were not aware of the efficacy of C (68%), PreP (77%) or M (79%) in decreasing the risk of acquiring HIV infection. At baseline, participants described as their preferred method to prevent HIV the use of male condoms (77%) and had marginal preference for the newer methods C (3%), M (6%) and PreP (3%). After the information about the new methods was provided, most of the participants reported to be aware of these methods (80%) and although male condoms was still the first choice for most of the participants (46%) a higher percentage of participants preferred M (20%) and PreP (14%). Conclusions STD clinic patients who participated in this study had very limited knowledge about the new biomedical strategies to prevent HIV infection. A brief informational session can increase their willingness to use the newer HIV preventive strategies

Plasma lipidomic profiles improve upon traditional risk factors for the prediction of cardiovascular events in type 2 diabetes

Background- Clinical lipid measurements do not show the full complexity of the altered lipid metabolism associated with diabetes or cardiovascular disease. Lipidomics enables the assessment of hundreds of lipid species as potential markers for disease risk. Methods- Plasma lipid species (310) were measured by a targeted lipidomic analysis with liquid chromatography electrospray ionisation-tandem mass spectrometry on a case-cohort (n=3,779) subset from the ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation) trial. The-case cohort was 61% male with a mean age of 67. All participants had type 2 diabetes mellitus with one or more additional cardiovascular risk factors and 35% had a history of macrovascular disease. Weighted Cox regression was used to identify lipid species associated with future cardiovascular events (non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and cardiovascular death during a five year follow-up period. Multivariable models combining traditional risk factors with lipid species were optimized using the Akaike information criteria. C-statistics and net reclassification indices (NRI) were calculated within a five-fold cross validation framework. Results- Sphingolipids, phospholipids (including lyso- and ether- species), cholesteryl esters and glycerolipids were associated with future cardiovascular events and cardiovascular death. The addition of 7 lipid species to a base model (14 traditional risk factors and medications) to predict cardiovascular events increased the C-statistic from 0.680 (95% CI, 0.678-0.682) to 0.700 (95% CI, 0.698-0.702, p&lt;0.0001) with a corresponding continuous NRI of 0.227 (95% CI, 0.219-0.235). The prediction of cardiovascular death was improved with the incorporation of 4 lipid species to the base model, showing an increase in the C-statistic from 0.740 (95% CI, 0.738-0.742) to 0.760 (95% CI, 0.757-0.762, p&lt;0.0001) and a continuous NRI of 0.328 (95%CI, 0.317-0.339). The results were validated in a subcohort with type 2 diabetes (n=511) from the LIPID (The Long-Term Intervention with Pravastatin in Ischaemic Disease) trial. Conclusion- The improvement in the prediction of cardiovascular events, above traditional risk factors, demonstrates the potential of plasma lipid species as biomarkers for cardiovascular risk stratification in diabetes.</p

PREDICTORS OF NURSING STUDENTS’ INTENTION TO RECEIVE COVID-19 VACCINATION: A MULTI-UNIVERSITY STUDY IN SAUDI ARABIA

Aims: This study examined the predictors of student nurses’ intention to vaccinate against COVID-19. We measured the nursing students’ risk perceptions, anxiety, fears and beliefs on COVID-19 vaccine; attitudes towards it and vaccine literacy (VL). Design: This study is a multi-university study utilizing the quantitative, cross-sectional and predictive approach. Methods: Using convenience sampling (n = 1170), we surveyed 10 Saudi universities from November 26, 2020, to December 31, 2020. Forward stepwise multinomial lo gistic regression was performed in identifying the factors predicting student nurses’ intention to vaccinate against COVID-19. Results: The overall mean in the risk perception, anxiety and fear was 9.59 (SD = 2.82, possible range = 1–15), 3.95 (SD = 4.77, possible range = 0–20) and 18.17 (SD = 6.65, possible range = 7–35) respectively. They also reported a mean of 29.90 (SD = 6.56, possible range = 8–40) on COVID-19 belief. COVID-19 positive and negative attitudes mean score was 3.64 (SD = 0.92) and 2.72 (SD = 0.90) in a 1–4 range of scores respec tively. The functional and interactive-critical COVID-19 VL of the students were at moderate levels. More than half of the respondents (55.9%) intended to be vaccinated against COVID-19, 17.6% did not intend to do so and 26.5% were unsure. High-risk perceptions, low levels of COVID-19 anxiety, positive beliefs and attitudes towards COVID-19 vaccine, and high levels of interactive-critical COVID-19 VL were signifi cant predictors of student nurses’ intentions to vaccinate against COVID-19. Conclusion: Policymakers could consider the factors identified in this study and why the students did not intend to receive the vaccine in planning a nationwide vaccina tion program. The colleges of nursing could also utilize the findings in developing edu cational programs that aim to improve VL and beliefs and attitudes towards COVID-19 vaccin

Plasma lipidomic profiles improve on traditional risk factors for the prediction of cardiovascular events in type 2 diabetes mellitus

Background: Clinical lipid measurements do not show the full complexity of the altered lipid metabolism associated with diabetes mellitus or cardiovascular disease. Lipidomics enables the assessment of hundreds of lipid species as potential markers for disease risk. Methods: Plasma lipid species (310) were measured by a targeted lipidomic analysis with liquid chromatography electrospray ionization–tandem mass spectrometry on a case-cohort (n=3779) subset from the ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation). The case-cohort was 61% male with a mean age of 67 years. All participants had type 2 diabetes mellitus with ≥1 additional cardiovascular risk factors, and 35% had a history of macrovascular disease. Weighted Cox regression was used to identify lipid species associated with future cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and cardiovascular death during a 5-year follow-up period. Multivariable models combining traditional risk factors with lipid species were optimized with the Akaike information criteria. C statistics and NRIs were calculated within a 5-fold cross-validation framework. Results: Sphingolipids, phospholipids (including lyso- and ether- species), cholesteryl esters, and glycerolipids were associated with future cardiovascular events and cardiovascular death. The addition of 7 lipid species to a base model (14 traditional risk factors and medications) to predict cardiovascular events increased the C statistic from 0.680 (95% confidence interval [CI], 0.678–0.682) to 0.700 (95% CI, 0.698–0.702; P<0.0001) with a corresponding continuous NRI of 0.227 (95% CI, 0.219–0.235). The prediction of cardiovascular death was improved with the incorporation of 4 lipid species into the base model, showing an increase in the C statistic from 0.740 (95% CI, 0.738–0.742) to 0.760 (95% CI, 0.757–0.762; P<0.0001) and a continuous net reclassification index of 0.328 (95% CI, 0.317–0.339). The results were validated in a subcohort with type 2 diabetes mellitus (n=511) from the LIPID trial (Long-Term Intervention With Pravastatin in Ischemic Disease). Conclusions: The improvement in the prediction of cardiovascular events, above traditional risk factors, demonstrates the potential of plasma lipid species as biomarkers for cardiovascular risk stratification in diabetes mellitus

Upfront Alternative Donor Transplant versus Immunosuppressive Therapy in Patients with Severe Aplastic Anemia Who Lack a Fully HLA- Matched Related Donor: Systematic Review and Meta-Analysis of Retrospective Studies, on Behalf of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation

Idiopathic aplastic anemia is a rare and life-threatening disorder, and hematopoietic stem cell transplantation (HSCT) from a matched sibling donor (MSD) is the standard treatment strategy for young patients. Alternative donor transplantation (ADT) from a matched unrelated donor or an HLA haploidentical donor is not commonly used in the frontline setting. This systematic review/meta-analysis was conducted to compare ADT as an upfront, rather than delayed, treatment strategy in the absence of an MSD to immunosuppressive therapy (IST) in severe aplastic anemia (SAA). We searched PubMed/MEDLINE and Embase (1998 to 2019) for studies that compared the outcomes of ADT with IST as upfront therapy in patients with SAA. We included studies with 5 patients or more in each arm. Studies that included patients with inherited forms of bone marrow failure syndromes were excluded. The primary outcome was the 5-year overall survival (OS) rate. Five studies met the inclusion criteria and were included in this meta -analysis. The pooled 5-year odds ratio (OR) for OS was statistically significant at 0.44 (95% confidence interval [CI], 0.23 to 0.85) in favor of upfront ADT. In addition, survival was compared between upfront ADT versus salvage ADT in 6 studies. The pooled 5-year OR for OS was statistically significant at 0.31 (95% CI, 0.15 to 0.64) in favor of upfront ADT. Although this analysis has some limitations, including the retrospective nature of the included studies, the lack of ethnic diversity, the predominantly pediatric population, and the relatively suboptimal IST regimen used in some of the studies, it indicates that upfront ADT is a potential alternative treatment option in young and pediatric SAA patients who lack an HLA identical sibling donor, particularly when optimal IST is not available.Immunobiology of allogeneic stem cell transplantation and immunotherapy of hematological disease