Area-level Socioeconomic Inequalities in the Use of Mammography Screening: A Multilevel Analysis of the Health of Houston Survey

An emerging literature reports that women who reside in socioeconomically deprived communities are less likely to adhere to mammography screening. This study explored associations between area-level socioeconomic measures and mammography screening among a racially and ethnically diverse sample of women in Texas

Implementation costs of a multi-component program to increase human papillomavirus (HPV) vaccination in a network of pediatric clinics

Introduction: HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs. Methods: Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation. Results: Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and$368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was$2,126 per clinic. Conclusion: The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or$4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents

Estimating Development Cost of an Interactive Website Based Cancer Screening Promotion Program

Author's manuscript made available in accordance with the publisher's policy.Objectives The aim of this study was to estimate the initial development costs for an innovative talk show format tailored intervention delivered via the interactive web, for increasing cancer screening in women 50–75 who were non-adherent to screening guidelines for colorectal cancer and/or breast cancer. Methods The cost of the intervention development was estimated from a societal perspective. Micro costing methods plus vendor contract costs were used to estimate cost. Staff logs were used to track personnel time. Non-personnel costs include all additional resources used to produce the intervention. Results Development cost of the interactive web based intervention was $.39 million, of which 77% was direct cost. About 98% of the cost was incurred in personnel time cost, contract cost and overhead cost. Conclusions The new web-based disease prevention medium required substantial investment in health promotion and media specialist time. The development cost was primarily driven by the high level of human capital required. The cost of intervention development is important information for assessing and planning future public and private investments in web-based health promotion interventions

Reimbursement For Hpv Vaccine Cost in the Private Sector: a Comparison across Specialties

The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by 3rd-party payers is a critical enabling factor for clinicians to continue offering vaccines. This study found that net returns from HPV vaccine cost reimbursements are lowest for family physicians ($0.34/dose) and highest for pediatricians ($5.08/dose). Furthermore, a $1 increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Reimbursement for HPV vaccine costs by private payers is adequate; however, return margins are small for non-pediatric specialties

Parental intent to initiate and Complete the Human Papillomavirus Vaccine Series in the Usa: a Nationwide, Cross-Sectional Survey

BACKGROUND: Human papillomavirus (HPV) vaccine uptake among US adolescents is primarily dependent on the intent of their parents. to the best of our knowledge, an analysis quantifying parental intent to initiate and complete the HPV vaccine series in the USA at both the national and state level has not been done. We aim to estimate parental intent to initiate and complete the HPV vaccine series at the national-level and state-level and to identify reasons for lack of intent to initiate and complete the vaccine series. METHODS: This cross-sectional study uses data from the adolescent component of the 2017-18 National Immunization Survey (NIS-Teen). Study participants were parents or caregivers of US adolescents aged 13-17 years, who were most knowledgeable about the immunisation status of the adolescents. The primary outcome was parental intent to vaccinate the adolescent in the next 12 months. The secondary outcomes were (1) the prevalence of reasons given for lack of intent to initiate and complete the HPV vaccine series, and (2) the relationship between receiving a recommendation from a health-care provider to vaccinate and intent to initiate the vaccination series. We computed national-level and state-level estimates for parental lack of intent to initiate and to complete the vaccine series; population-level estimates were derived using survey weights. A survey design-adjusted Wald F test was used for bivariate analysis. A multivariate logistic regression model was used to examine the association between health-care provider recommendation and parental intent to initiate the series. Analyses were stratified by history of health-care provider recommendation to initiate the HPV vaccine series. FINDINGS: In 2017-18, the parent or caregiver of 82 297 US adolescents aged 13-17 years completed the NIS-Teen survey. 30 558 (37·1%) were unvaccinated and 9073 (10·8%) received only one HPV vaccine dose. Parents of 58·0% (17 171/29 086) of unvaccinated adolescents with data available on parental intent had no intention to initiate the HPV vaccine series. More than 65% of parents of unvaccinated adolescents in Idaho, Kansas, Michigan, Montana, Nebraska, North Dakota, Oklahoma, and Utah had no intention to initiate the HPV vaccine series. Parents of 23·5% (2166/9072) of initiators with data available on parental intent had no intention to complete the HPV vaccine series. More than 30% of parents in Arkansas, Florida, Georgia, Hawaii, Idaho, Utah, and West Virginia did not intend to complete the HPV vaccine series, whereas in the District of Columbia (11·2% [22/166]) and Rhode Island (20·4% [21/112]) parental lack of intent was relatively low (both regions have an HPV vaccine mandate). The most common reason for lack of intent among parents to initiate the vaccine for unvaccinated adolescents was safety concerns (22·8% [4182/16 455]); lack of a recommendation from a health-care provider (22·2% [440/1944]) was the most frequently cited reason for absence of intent to complete the series among parents of adolescents who received only one HPV vaccine dose. Receipt of a recommendation from a health-care provider was associated with greater odds of parental intent to initiate the HPV vaccine series (odds ratio 1·11, 95% CI 1·01-1·22). 45·5% (13 156/29 086) of parents of unvaccinated adolescents had reportedly received an HPV vaccine recommendation. Parents of 60·6% (7938/13 156) of unvaccinated adolescents with a recommendation from a health-care provider and data available on parental intent had no intention to initiate the series. INTERPRETATION: Lack of parental intent to initiate and complete the HPV vaccine series for adolescents is a major public health concern in the USA. Combating vaccine safety concerns and strong recommendations from health-care providers could improve the currently suboptimal HPV vaccination coverage. FUNDING: US National Cancer Institute

Comparing Survival Rates and Mortality in Operative Versus Nonoperative Treatment For Femoral Neck Fractures among alzheimer\u27s Disease Patients: a Retrospective Cohort Study

INTRODUCTION: Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer\u27s disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD. METHODS: This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients\u27 demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups\u27 post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates. RESULTS: Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, DISCUSSION: The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures

Comparing Survival Rates and Mortality in Operative Versus Nonoperative Treatment for Femoral Neck Fractures Among Alzheimer\u27s Disease Patients: A Retrospective Cohort Study

INTRODUCTION: Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer\u27s disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD. METHODS: This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients\u27 demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups\u27 post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates. RESULTS: Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, DISCUSSION: The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures

Economic Evaluation of Web- versus Telephone-based Interventions to Simultaneously Increase Colorectal and Breast Cancer Screening Among Women

Screening for colorectal and breast cancer is considered cost effective, but limited evidence exists on cost-effectiveness of screening promotion interventions that simultaneously target both cancers. Increasing Colorectal and Breast Cancer Screening (Project COBRA), a randomized controlled trial conducted in the community, examined the cost-effectiveness of an innovative tailored web-based intervention compared with tailored telephone counseling and usual care. Screening status at 6 months was obtained by participant surveys plus medical record reviews. Cost was prospectively measured from the patient and provider perspectives using time logs and project invoices. Relative efficiency of the interventions was quantified by the incremental cost-effectiveness ratios. Nonparametric bootstrapping and net benefit regression analysis were used to assess statistical uncertainty of the results. The average cost per participant to implement the Phone counseling, Web-based, and Web + Phone counseling interventions were $277,$314, and $337, respectively. Comparing Phone counseling with usual care resulted in an additional cost of$300 (95% confidence interval [CI]: $283-$320) per cancer screening test and $421 (95$400-$441) per additional person screened in the target population. Phone counseling alone was more cost-effective than the Web + Phone intervention. Web-based intervention alone was more costly but less effective than the Phone counseling. When simultaneously promoting screening for both colorectal and breast cancer the Web-based intervention was less cost-effective compared with Phone and Web + Phone strategies. The results suggest that targeting multiple cancer screening may improve the cost-effectiveness of cancer screening interventions. PREVENTION RELEVANCE: This study informs researchers, decision makers, healthcare providers, and payers about the improved cost-effectiveness of targeting multiple cancer screenings for cancer early detection programs

An Economic and Disease Transmission Model of Human Papillomavirus and oropharyngeal Cancer in Texas

In 2017, 46,157 and 3,127 new oropharyngeal cancer (OPC) cases were reported in the U.S. and Texas, respectively. About 70% of OPC were attributed to human papillomavirus (HPV). However, only 51% of U.S. and 43.5% of Texas adolescents have completed the HPV vaccine series. Therefore, modeling the demographic dynamics and transmission of HPV and OPC progression is needed for accurate estimation of the economic and epidemiological impacts of HPV vaccine in a geographic area. An age-structured population dynamic model was developed for the U.S. state of Texas. With Texas-specific model parameters calibrated, this model described the dynamics of HPV-associated OPC in Texas. Parameters for the Year 2010 were used as the initial values, and the prediction for Year 2012 was compared with the real age-specific incidence rates in 23 age groups for model validation. The validated model was applied to predict 100-year age-adjusted incidence rates. The public health benefits of HPV vaccine uptake were evaluated by computer simulation. Compared with current vaccination program, increasing vaccine uptake rates by 50% would decrease the cumulative cases by 4403, within 100 years. The incremental cost-effectiveness ratio of this strategy was $94,518 per quality-adjusted life year (QALY) gained. Increasing the vaccine uptake rate by 50% can: (i) reduce the incidence rates of OPC among both males and females; (ii) improve the quality-adjusted life years for both males and females; (iii) be cost-effective and has the potential to provide tremendous public health benefits in Texas