Effects of nutritional supplements on the re-infection rate of soil-transmitted helminths in school-age children : a systematic review and meta-analysis

Background The effect of nutritional supplements on the re-infection rate of species-specific soil-transmitted helminth infections in school-aged children remains complex and available evidence on the subject matter has not been synthesized. Methods The review included randomised controlled trials (RCTs) and cluster RCTs investigating food supplements on school-aged children between the age of 4–17 years. A search for RCTs was conducted on eight databases from inception to 12th June 2019. Cochrane Risk of Bias tool was used to assess the risk of bias in all included studies. Meta-analysis and narrative synthesis were conducted to describe and analyze the results of the review. Outcomes were summarized using the mean difference or standardized mean difference where appropriate. Results The search produced 1,816 records. Six studies met the inclusion criteria (five individually RCTs and one cluster RCT). Four studies reported data on all three STH species, while one study only reported data on Ascaris lumbricoides infections and the last study reported data on only hookworm infections. Overall, the risk of bias in four individual studies was low across most domains. Nutritional supplementation failed to statistically reduce the re-infection rates of the three STH species. The effect of nutritional supplements on measures of physical wellbeing in school-aged children could not be determined. Conclusions The findings from this systematic review suggest that nutritional supplements for treatment of STH in children should not be encouraged unless better evidence emerges. Conclusion of earlier reviews on general populations may not necessarily apply to children since children possibly have a higher re-infection rate

Costs of Treating Lymphoproliferative Disorders in Ukraine: a Pilot Evaluation

Chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) are two of the most widespread lymphoproliferative disorders among the adult population of Ukraine and other Central and Western European countries. Considering that pharmaceutical treatment accounts for the major part of medical expenses in the management of these conditions, the aim of this study was to assess the costs of pharmacotherapy of CLL and MM. The analysis was performed retrospectively using the results of our own pilot study, in which we examined medical histories of the patients treated at a specialized medical center in Kiev. The average annual cost of pharmacotherapy of all Ukrainian patients was 340 750 162 RUB for CLL and 89 184 759 RUB for MM. We found a negative correlation between the patient’s age and the cost of pharmacotherapy

Systematic reviews as a “lens of evidence”: determinants of cost-effectiveness of breast cancer screening

Systematic reviews with economic components are important decision tools for stakeholders seeking to evaluate technologies, such as breast cancer screening (BCS) programs. This overview of systematic reviews explores the determinants of the cost‐effectiveness of BCS and assesses the quality of secondary evidence. The search identified 30 systematic reviews that reported on the determinants of the cost‐effectiveness of BCS, including the costs of breast cancer and BCS. While the quality of the reviews varied widely, only four out of 30 papers were considered to be of a high quality. We did not identify publication bias in the original evidence on the cost‐effectiveness of mammography screening; however, we highlight a need for improved clarity in both reporting and data verification. The reviews consisted mainly of studies from high‐income countries. Breast cancer costs varied widely among the studies. Factors leading to higher costs included: time (diagnosis and last months before death), later stage or metastases, recurrence of the disease, age below 64 years and type of follow‐up (more intensive or more specialized). Overall, screening with mammography was considered cost‐effective in the age range 50‐69 years in Western European and Northern American countries but not for older or younger women. Its cost‐effectiveness was questionable for low‐income settings and Asia. Mammography screening was more cost‐effective with biennial screening compared to annual screening and single reading using computer‐aided detection vs double reading. No information on the cost‐effectiveness of ultrasonography was found, and there is much uncertainty on the cost‐effectiveness of CBE because of methodological limitations

Modelling the impact of the coronavirus pandemic on bowel cancer screening outcomes in England: a decision analysis to prepare for future screening disruption

The English Bowel Cancer Screening Programme invites people between the ages of 60 and 74 to take a Faecal Immunochemical Test every two years. This programme was interrupted during the coronavirus pandemic. The research aimed: (1) to estimate the impact of colorectal cancer (CRC) Faecal Immunochemical Test screening pauses of different lengths and the actual coronavirus-related screening pause in England, and (2) to analyse the most effective and cost-effective strategies to re-start CRC screening to prepare for future disruptions. The analysis used the validated Microsimulation Model in Cancer of the Bowel built in the R programming language. The model simulated the life course of a representative English screening population from 2019, by age, sex, socio-economic deprivation, and prior screening history. The modelling scenarios were based on assumptions and data from screening centres in England. Pausing bowel screening in England due to coronavirus pandemic is predicted to increase CRC deaths by 0.73% within 10 years and 0.13% over the population's lifetime, with excess deaths due to peak in 2023. More deaths are expected in men and people aged over 70. Pausing screening for longer would result in greater additional CRC cases and deaths. Postponing screening for everyone would be the most cost-effective strategy to minimise the impact of screening disruption without any additional endoscopy capacity. If endoscopy capacity can be increased, temporarily raising the Faecal Immunochemical Test threshold to 190 μg/g may help to minimise CRC deaths, particularly if screening programmes start from age 50 in the future