Financial risks of care seeking for malaria by rural households in Jimma Zone, Oromia Region, Southwest Ethiopia: a cross-sectional study

Objectives Despite major progress in the prevention and control of malaria in recent years, the disease remains a major cause of morbidity in Ethiopia. Malaria also imposes substantial socioeconomic costs on households. The aim of this study is to estimate the financial risk of seeking malaria service for rural households across socioeconomic statuses in the Jimma Zone, Oromia Region. Design A facility-based cross-sectional survey. Setting Jimma Zone, Oromia Region, Southwest Ethiopia. Participants A total of 221 patients with malaria from 10 public health facilities were interviewed between September 2018 and December 2019. Primary and secondary outcome measures The main outcome measures capture the financial risks associated with malaria services, specifically catastrophic and impoverishing health expenditures. Catastrophic health expenditure (CHE) occurs when healthcare costs reach 10% of a household’s monthly income, whereas impoverishment occurs when a household’s monthly income falls below the national poverty level after paying for health service. Descriptive statistics were used to summarise the expenditure patterns associated with malaria services. All costs were gathered in Ethiopian birr and reported in 2019 US$. Results The average cost of receiving malaria services was US$4.40 (bootstrap 95% CI: 3.6 to 5.3), with indirect costs accounting for 52% of total costs. Overall, at the 10% threshold, 12% (bootstrap 95% CI: 8.1% to 16.7%) of patients with malaria incurred CHE: 40% (bootstrap 95% CI: 26.7% to 55.6%) of the household in the poorest quintile experienced CHE, but none from the richest quintile did. The proportion of households living in poverty increased by more than 2-3% after spending on malaria-specific health services. Conclusion Healthcare seeking for malaria imposes a substantial financial risk on rural households, particularly for the poorest and most vulnerable. Malaria policies and interventions should therefore seek to alleviate both the direct costs and productivity losses associated with the disease, especially among the poor.publishedVersio

Integrating value of research into NCI Clinical Trials Cooperative Group research review and prioritization: A pilot study

BackgroundThe Institute of Medicine has called for approaches to help maximize the return on investments (ROI) in cancer clinical trials. Value of Research (VOR) is a health economics technique that estimates ROI and can inform research prioritization. Our objective was to evaluate the impact of using VOR analyses on the clinical trial proposal review process within the SWOG cancer clinical trials consortium.MethodsWe used a previously developed minimal modeling approach to calculate VOR estimates for 9 phase II/III SWOG proposals between February 2015 and December 2016. Estimates were presented to executive committee (EC) members (N = 12) who determine which studies are sent to the National Cancer Institute for funding consideration. EC members scored proposals from 1 (best) to 5 based on scientific merit and potential impact before and after receiving VOR estimates. EC members were surveyed to assess research priorities, proposal evaluation process satisfaction, and the VOR process.ResultsValue of Research estimates ranged from −$2.1B to$16.46B per proposal. Following review of VOR results, the EC changed their score for eight of nine proposals. Proposal rankings were different in pre‐ vs postscores (P value: 0.03). Respondents had mixed views of the ultimate utility of VOR for their decisions with most supporting (42%) or neutral (41%) to the idea of adding VOR to the evaluation process.ConclusionsThe findings from this pilot study indicate use of VOR analyses may be a useful adjunct to inform proposal reviews within NCI Cooperative Clinical Trials groups.The Instiztute of Medicine has called for approaches to help maximize the return on investments in cancer clinical trials. The findings from this pilot study indicate use of value of research analyses may be a useful adjunct to inform proposal reviews within NCI Cooperative Clinical Trials groups.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146484/1/cam41657.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146484/2/cam41657_am.pd

The economic impact of childhood acute gastroenteritis on Malawian families and the healthcare system

OBJECTIVES: This prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi. SETTING: Data were collected in two Malawian settings: a rural health centre in Chilumba and an urban tertiary care hospital in Blantyre. PARTICIPANTS: Children under 5 years of age presenting with diarrhoeal disease between 1 January 2013 and 21 November 2014 were eligible for inclusion. Illnesses attributed to other underlying causes were excluded, as were illnesses commencing more than 2 weeks prior to presentation. Complete data were collected on 514 cases at both the time of the initial visit to the participating healthcare facility and 6 weeks after discharge. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the total cost of an episode of illness. Costs to the health system were gathered from chart review (drugs and diagnostics) and actual hospital expenditure (staff and facility costs). Household costs, including lost income, were obtained by interview with the parents/guardians of patients. RESULTS: Total costs in 2014 US$for rural inpatient, rural outpatient, urban inpatient and urban outpatient were$65.33, $8.89,$60.23 and $14.51, respectively (excluding lost income). Mean household contributions to these costs were 15.8%, 9.8%, 21.3% and 50.6%. CONCLUSION: This study found significant financial burden from childhood diarrhoeal disease to the healthcare system and to households. The latter face the risk of consequent impoverishment, as the study demonstrates how the costs of seeking treatment bring the income of the majority of families in all income strata below the national poverty line in the month of illness

Economic evaluations of health system strengthening activities in low-income and middle-income country settings : a methodological systematic review

Objective -- Health system strengthening (HSS) activities should accompany disease-targeting interventions in low/middle-income countries (LMICs). Economic evaluations provide information on how these types of investment might best be balanced but can be challenging. We conducted a systematic review to evaluate how researchers address these economic evaluation challenges. Methods -- We identified studies about economic evaluation of HSS activities in LMICs using a two-stage approach. First, we conducted a broad search to identify areas where economic evaluations of HSS activities were being conducted. Next, we selected specific interventions for more targeted literature review. We extracted study characteristics using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Finally, we summarised authors’ modelling decisions using a framework that examines how models are developed to emphasise generalisability, precision, or realism. Findings -- Our searches produced 1978 studies, out of which we included 36. Most studies used data from prospective trials and calculated cost-effectiveness directly from these trial inputs, rather than using simulation methods. As a group, these studies primarily emphasised precision and realism over generalisability, meaning that their results were best suited to specific settings. Conclusions -- The number of included studies was small. Our findings suggest that most economic evaluations of HSS do not leverage methods like sensitivity analyses or inputs from literature review that would produce more generalisable (but potentially less precise) results. More research into how decision-makers would use economic evaluations to define the expansion path to strengthening health systems would allow for conceptualising impactful work on the economic value of HSS

Different paths to the modern state in Europe: the interaction between domestic political economy and interstate competition

Theoretical work on state formation and capacity has focused mostly on early modern Europe and on the experience of western European states during this period. While a number of European states monopolized domestic tax collection and achieved gains in state capacity during the early modern era, for others revenues stagnated or even declined, and these variations motivated alternative hypotheses for determinants of fiscal and state capacity. In this study we test the basic hypotheses in the existing literature making use of the large date set we have compiled for all of the leading states across the continent. We find strong empirical support for two prevailing threads in the literature, arguing respectively that interstate wars and changes in economic structure towards an urbanized economy had positive fiscal impact. Regarding the main point of contention in the theoretical literature, whether it was representative or authoritarian political regimes that facilitated the gains in fiscal capacity, we do not find conclusive evidence that one performed better than the other. Instead, the empirical evidence we have gathered lends supports to the hypothesis that when under pressure of war, the fiscal performance of representative regimes was better in the more urbanized-commercial economies and the fiscal performance of authoritarian regimes was better in rural-agrarian economie

Calibration of the CMS hadron calorimeters using proton-proton collision data at root s=13 TeV

Methods are presented for calibrating the hadron calorimeter system of theCMSetector at the LHC. The hadron calorimeters of the CMS experiment are sampling calorimeters of brass and scintillator, and are in the form of one central detector and two endcaps. These calorimeters cover pseudorapidities vertical bar eta vertical bar ee data. The energy scale of the outer calorimeters has been determined with test beam data and is confirmed through data with high transverse momentum jets. In this paper, we present the details of the calibration methods and accuracy.Peer reviewe

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Using Health Economics Tools to Enhance the Clinical Utility of Artificial Intelligence-Based Diagnostics: A Case Study in Breast Cancer Screening

Thesis (Ph.D.)--University of Washington, 2020Researchers in artificial intelligence (AI) have recently produced several products for medical diagnosis that perform at the same level as human clinicians. Artificial intelligence products will also need to be developed that will be trusted by clinicians and are known to produce positive effects in patients. One important area where AI may be applied is breast cancer screening which, despite its benefits, currently harms many women through false positives and overdiagnosis. This dissertation involved the use of two tools from health economics – discrete choice experiments and outcomes modeling – to solve translational issues affecting AI, all in the setting of breast cancer screening. In the first aim, we assessed primary care providers’ (PCPs’) preferences for a hypothetical AI system for mammogram interpretation. We used qualitative interviewing to develop a discrete choice instrument, which we administered online to ninety-one PCPs from around the United States. While advances in improving AI’s diagnostic accuracy were important to respondents, they also reported valuing the diversity of training data and understandability of AI decision-making. The surveyed PCPs were broadly accepting of using AI to “triage” likely negative screens, so that radiologists do not need to interpret every image. In the second aim, we used outcomes modeling to compare the performance of 28 AI algorithms that had been developed for breast cancer screening. We first performed receiver operating characteristic (ROC) curve analysis to get a conventional metric (area under the curve) for model comparison. We then used a model of breast cancer screening and outcomes to estimate the quality-adjusted life years (QALYs) associated with using each model at its optimal operating point. These outcomes were compared with the outcomes associated with using two other methods of operating point selection – Youden’s index and decision curve analysis. Outcomes modeling ranked algorithms in the same order as area under ROC curve and did not produce substantially different outcomes at the QALY-optimizing operating point compared to the use of decision curve analysis. This suggests that outcomes modeling may be most useful in model comparison and operating point selection when detailed data including case heterogeneity is available