Are new models needed to optimize the utilization of new medicines to sustain healthcare systems?

Medicines have made an appreciable contribution to improving health. However, even high-income countries are struggling to fund new premium-priced medicines. This will grow necessitating the development of new models to optimize their use. The objective is to review case histories among health authorities to improve the utilization and expenditure on new medicines. Subsequently, use these to develop exemplar models and outline their implications. A number of issues and challenges were identified from the case histories. These included the low number of new medicines seen as innovative alongside increasing requested prices for their reimbursement, especially for oncology, orphan diseases, diabetes and HCV. Proposed models center on the three pillars of pre-, peri- and post-launch including critical drug evaluation, as well as multi-criteria models for valuing medicines for orphan diseases alongside potentially capping pharmaceutical expenditure. In conclusion, the proposed models involving all key stakeholder groups are critical for the sustainability of healthcare systems or enhancing universal access. The models should help stimulate debate as well as restore trust between key stakeholder groups

Physical and Mental Health Among Mexican American Children and Adolescents Living On The Texas-Mexico Border

Objective: The study aimed to i)describe the cohort characteristic and examine how the family socioeconomic status, family education level and social and cultural environment factors affect the development of mental health problems; ii)examine how the individual and household characteristics affect the development of overweight/obesity; iii)examine the impact of pubertal stage and overweight/obesity on the cardiometabolic risk factors (CMRF) of Mexican American children living on the Texas-Mexico border. Methods: This study involved children (8 to 18 years old) enrolled in Cameron County Hispanic Cohort from 2014-2020. The main statistical analytical plan involved building multivariable models aligned with the three aims: i) logistic regression model to determine the association between the social environmental factors and the risk of developing depression, (ii) hierarchical multilevel model to assess the association of being overweight/obese with individual and household level factors, (iii) multivariable regression models to assess the impact of pubertal stage and weight status on individual/clustering of CMRF. Results: About 10% of the children enrolled in CCHC were depressed, 52% were overweight/obese, and 63.1% had at least one CMRF. Individuals with higher childhood trauma score (OR=1.08, 95% CI 1.03 – 1.12) and had more stressful life events (OR=1.15, 95%CI 1.08-1.23) had a higher risk of developing depression. Every unit increase in parents’ BMI was associated with 7% higher odds of their child being overweight/obese (OR=1.07, 95%CI 1.02-1.12). Children from higher-income households were 1.8 times more likely to be overweight/obese than those from lower-income households (OR=1.80, 95% CI 1.02-3.08). Pubertal stage was associated with hypertriglyceridemia, insulin resistance (IR), and clustering of CMRF. Being overweight/obese were associated with 45 times the odds of high central adiposity (OR=45.04 95%CI 15.47-131.09), 4.77 times higher odds of hypertriglyceridemia (OR=4.77 95%CI 2.77-8.22), 7.59 times higher odds of low HDL-C (OR=7.59 95%CI 3.75-15.34) and 6.41 times higher odds of IR (OR=6.41 95%CI 3.8-10.9). Conclusions: The rate of depression, overweight/obesity, and CMRF were high. The risk of depression was positively associated with childhood trauma and stressful life events. Boys, children from higher household income, and those with parents with higher BMI had higher odds of being overweight/obese. Tanner stage, being overweight/obese and the presence of depression/anxiety were associated with CMRF

Nirmatrelvir/ritonavir treatment and the risk of post-COVID condition over 180 days in Malaysia

Abstract Background The effect of nirmatrelvir/ritonavir on preventing post-COVID condition (PCC) in the BA4, BA5, and XBB Omicron predominant periods is not well understood. The purpose of this study was to assess how nirmatrelvir/ritonavir treatment affected both PCC and health-related quality of life. Methods This retrospective cohort study enrolled 2,524 adults aged 18 years and older who were eligible for nirmatrelvir/ritonavir between July 14 to November 14, 2022. All outcomes were observed from the patient’s first visit to the primary health clinic, 1 week, 1 month, 3 months, and 6 months after testing positive for COVID-19. The primary outcome was the presence of PCC. Secondary outcomes included the effects on health-related quality of life, such as walking, bathing and dressing, activities, cause adverse emotions or signs that prevent individuals from leading normal lives over a 180-day observation period. Results There were no significant differences observed between the nirmatrelvir/ritonavir and those not administered (control group) in terms of PCC symptoms at 3 months (OR 0.71 95% CI 0.31, 1.64) and 6 months (OR 1.30 95% CI 0.76, 2.21). At 3 months, the use of nirmatrelvir/ritonavir was associated with a 26% reduction in symptoms causing negative emotions (OR 0.74 95% CI 0.60, 0.92) and an increased likelihood of symptoms limiting walking (OR 1.58 95% CI 1.10, 2.27). However, there were no significant differences between the nirmatrelvir/ritonavir and the control group in terms of the impact of PCC on health-related quality of life at 6 months. Conclusions Our study indicates that the administration of nirmatrelvir/ritonavir does not significantly reduce PCC after 3 months and 6 months in a population with high vaccination coverage

Centroamérica y el TLC: efectos inmediatos e implicaciones futuras

Add.1: Anexo estadísticoIncluye Bibliografí

Real-world nirmatrelvir-ritonavir outpatient treatment in reducing hospitalization for high-risk patients with COVID-19 during Omicron BA.4, BA.5 and XBB subvariants dominance in Malaysia: A retrospective cohort study

Objective: To determine if nirmatrelvir-ritonavir 300mg/100mg treatment for 5 days in high-risk outpatients with mild to moderate COVID-19 symptoms was associated with a reduction in hospitalization, intensive care unit (ICU) admission, and death. Methods: This 1:1 propensity score matched cohort study from 647 public health clinics in Malaysia included all patients with COVID-19 with positive tests aged 18 years and older, who were eligible for nirmatrelvir-ritonavir treatment within 5 days of illness from July 14, 2022, to November 14, 2022. The exposed group was patients with COVID-19 initiated with nirmatrelvir-ritonavir treatment, whereas those not initiated with the drug served as the control group. Data was analyzed from July 14, 2022 to December 31, 2022. Results: A total of 20,966 COVID-19 high-risk outpatients (n = 10,483 for nirmatrelvir-ritonavir group and n = 10,483 for control group) were included in the study. Nirmatrelvir-ritonavir treatment was associated with a 36% reduction (adjusted hazard ratio 0.64 [95% CI 0.43, 0.94]) in hospitalization compared with those not given the drug. There was a single ICU admission for the control group and one death each was reported in the nirmatrelvir-ritonavir and control group, respectively. Conclusions: Nirmatrelvir-ritonavir treatment was associated with reduced hospitalization in high-risk patients with COVID-19 even in highly vaccinated populations

Comparison of patient characteristics at TH and GH.

<p>Comparison of patient characteristics at TH and GH.</p

Comparison of procedural details and outcomes at TH and GH.

<p>Comparison of procedural details and outcomes at TH and GH.</p

Pathway for the costing analysis of elective PCI.

<p>Pathway for the costing analysis of elective PCI.</p

Comparison of length of stay and costs of PCI at TH and GH.

<p>Comparison of length of stay and costs of PCI at TH and GH.</p