Comparative Cost-Effectiveness of Hypertension Treatment in Non-Hispanic Blacks and Whites According to 2014 Guidelines: A Modeling Study

BACKGROUND: We compared the cost-effectiveness of hypertension treatment in non-Hispanic blacks and non-Hispanic whites according to 2014 US hypertension treatment guidelines. METHODS: The cardiovascular disease (CVD) policy model simulated CVD events, quality-adjusted life years (QALYs), and treatment costs in 35- to 74-year-old adults with untreated hypertension. CVD incidence, mortality, and risk factor levels were obtained from cohort studies, hospital registries, vital statistics, and national surveys. Stage 1 hypertension was defined as blood pressure 140-149/90-99mm Hg; stage 2 hypertension as ≥150/100mm Hg. Probabilistic input distribution sampling informed 95% uncertainty intervals (UIs). Incremental cost-effectiveness ratios (ICERs) < $50,000/QALY gained were considered cost-effective. RESULTS: Treating 0.7 million hypertensive non-Hispanic black adults would prevent about 8,000 CVD events annually; treating 3.4 million non-Hispanic whites would prevent about 35,000 events. Overall 2014 guideline implementation would be cost saving in both groups compared with no treatment. For stage 1 hypertension but without diabetes or chronic kidney disease, cost savings extended to non-Hispanic black males ages 35-44 but not same-aged non-Hispanic white males (ICER$57,000/QALY; 95% UI $15,000-$100,000) and cost-effectiveness extended to non-Hispanic black females ages 35-44 (ICER $46,000/QALY;$17,000-$76,000) but not same-aged non-Hispanic white females (ICER$181,000/QALY; $111,000-$235,000). CONCLUSIONS: Compared with non-Hispanic whites, cost-effectiveness of implementing hypertension guidelines would extend to a larger proportion of non-Hispanic black hypertensive patients

Major trauma presentations and patient outcomes in English hospitals during the COVID-19 pandemic: An observational cohort study.

BACKGROUND: Single-centre studies suggest that successive Coronavirus Disease 2019 (COVID-19)-related "lockdown" restrictions in England may have led to significant changes in the characteristics of major trauma patients. There is also evidence from other countries that diversion of intensive care capacity and other healthcare resources to treating patients with COVID-19 may have impacted on outcomes for major trauma patients. We aimed to assess the impact of the COVID-19 pandemic on the number, characteristics, care pathways, and outcomes of major trauma patients presenting to hospitals in England. METHODS AND FINDINGS: We completed an observational cohort study and interrupted time series analysis including all patients eligible for inclusion in England in the national clinical audit for major trauma presenting between 1 January 2017 and 31 of August 2021 (354,202 patients). Demographic characteristics (age, sex, physiology, and injury severity) and clinical pathways of major trauma patients in the first lockdown (17,510 patients) and second lockdown (38,262 patients) were compared to pre-COVID-19 periods in 2018 to 2019 (comparator period 1: 22,243 patients; comparator period 2: 18,099 patients). Discontinuities in trends for weekly estimated excess survival rate were estimated when lockdown measures were introduced using segmented linear regression. The first lockdown had a larger associated reduction in numbers of major trauma patients (-4,733 (21%)) compared to the pre-COVID period than the second lockdown (-2,754 (6.7%)). The largest reductions observed were in numbers of people injured in road traffic collisions excepting cyclists where numbers increased. During the second lockdown, there were increases in the numbers of people injured aged 65 and over (665 (3%)) and 85 and over (828 (9.3%)). In the second week of March 2020, there was a reduction in level of major trauma excess survival rate (-1.71%; 95% CI: -2.76% to -0.66%) associated with the first lockdown. This was followed by a weekly trend of improving survival until the lifting of restrictions in July 2020 (0.25; 95% CI: 0.14 to 0.35). Limitations include eligibility criteria for inclusion to the audit and COVID status of patients not being recorded. CONCLUSIONS: This national evaluation of the impact of COVID on major trauma presentations to English hospitals has observed important public health findings: The large reduction in overall numbers injured has been primarily driven by reductions in road traffic collisions, while numbers of older people injured at home increased over the second lockdown. Future research is needed to better understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first lockdown

Major trauma presentations and patient outcomes in English hospitals during the COVID-19 pandemic: An observational cohort study.

BackgroundSingle-centre studies suggest that successive Coronavirus Disease 2019 (COVID-19)-related "lockdown" restrictions in England may have led to significant changes in the characteristics of major trauma patients. There is also evidence from other countries that diversion of intensive care capacity and other healthcare resources to treating patients with COVID-19 may have impacted on outcomes for major trauma patients. We aimed to assess the impact of the COVID-19 pandemic on the number, characteristics, care pathways, and outcomes of major trauma patients presenting to hospitals in England.Methods and findingsWe completed an observational cohort study and interrupted time series analysis including all patients eligible for inclusion in England in the national clinical audit for major trauma presenting between 1 January 2017 and 31 of August 2021 (354,202 patients). Demographic characteristics (age, sex, physiology, and injury severity) and clinical pathways of major trauma patients in the first lockdown (17,510 patients) and second lockdown (38,262 patients) were compared to pre-COVID-19 periods in 2018 to 2019 (comparator period 1: 22,243 patients; comparator period 2: 18,099 patients). Discontinuities in trends for weekly estimated excess survival rate were estimated when lockdown measures were introduced using segmented linear regression. The first lockdown had a larger associated reduction in numbers of major trauma patients (-4,733 (21%)) compared to the pre-COVID period than the second lockdown (-2,754 (6.7%)). The largest reductions observed were in numbers of people injured in road traffic collisions excepting cyclists where numbers increased. During the second lockdown, there were increases in the numbers of people injured aged 65 and over (665 (3%)) and 85 and over (828 (9.3%)). In the second week of March 2020, there was a reduction in level of major trauma excess survival rate (-1.71%; 95% CI: -2.76% to -0.66%) associated with the first lockdown. This was followed by a weekly trend of improving survival until the lifting of restrictions in July 2020 (0.25; 95% CI: 0.14 to 0.35). Limitations include eligibility criteria for inclusion to the audit and COVID status of patients not being recorded.ConclusionsThis national evaluation of the impact of COVID on major trauma presentations to English hospitals has observed important public health findings: The large reduction in overall numbers injured has been primarily driven by reductions in road traffic collisions, while numbers of older people injured at home increased over the second lockdown. Future research is needed to better understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first lockdown

Comparing Strategies for Lipid Lowering in Argentina: An Analysis from the CVD Policy Model-Argentina.

IntroductionIn Argentina, the national guidelines for lipid control emphasize the use of relatively inexpensive low- or moderate-potency statins by patients at high risk (&gt;20&nbsp;%) of a cardiovascular event. The objective of this study was to compare the impact and costs of the current national CVD prevention guidelines with regard to morbidity and mortality in Argentina with the impact and costs of three strategies that incorporate high-potency statins.MethodsWe used the CVD Policy Model-Argentina to model the proposed interventions. This model is a national-scale, state-transition (Markov) computer simulation model of the CVD incidence, prevalence, mortality, and costs in adults 35-84 years of age. We modeled three scenarios: scenario 1 lowers the risk threshold for treatment to &gt;10&nbsp;% according the Framingham Risk Score (FRS); scenario 2 intensifies statin potency under current treatment thresholds; and scenario 3 combines both scenarios by lowering the treatment threshold to ≥10&nbsp;% FRS and intensifying statin potency.ResultsScenario 1 would translate into 1400 fewer MIs and 500 fewer CHD deaths every year, a 3&nbsp;% and 2&nbsp;% reduction, respectively. Scenario 2 would lead to 2000 fewer MIs and 1000 fewer CHD deaths every year. Scenario 3 would result in the greatest reduction in MIs and CHD deaths, with 3400 fewer MIs and 1400 fewer CHD deaths every year, which translates to a 7&nbsp;% and 6&nbsp;% reduction, respectively. All scenarios were cost-effective if the cost of a high-potency statin pill was under US$0.25.ConclusionIncorporating those individuals with greater than 10&nbsp;% cardiovascular risk and the use of high-potency statins into Argentina's national lipid guidelines could result in fewer CHD deaths and events at a reasonable cost

Discovery and Verification of Extracellular microRNA Biomarkers for Diagnostic and Prognostic Assessment of Preeclampsia at Triage

Preeclampsia (PE) is a major cause of maternal and neonatal morbidity and mortality. Current methods for evaluation of patients with suspected PE do not reliably predict which patients will later develop PE nor distinguish between PE with and without severe features. The objective of this study was to identify candidate extracellular miRNA (ex-miRNA) biomarkers for early diagnosis and prognosis of PE in a cohort of subjects presenting for evaluation of suspected PE. Small RNA-seq libraries were created from maternal serum samples, prospectively collected from participants undergoing evaluation for suspected PE between 20-40 weeks gestational age. Measurements for bivariate biomarkers, consisting of ratios of pairs of ex-miRNAs were performed. 110 bivariate ex-miRNA biomarkers passed both discovery (48 cases, 34 controls) and verification (23 cases, 18 controls) criteria. Specific biomarkers differed in their patterns of expression among different categories of hypertensive disorders in pregnancy (HDP). An iterative machine learning method was then used to identify 3 bivariate miRNA biomarkers that, when applied serially, differentiated cases from controls with a sensitivity of 93% and a positive predictive value (PPV) of 55%, and additionally distinguished between PE cases of different severity. In an independent validation cohort of 11 cases and 7 controls, these three biomarkers had a sensitivity of 91% and a PPV of 85%. We have discovered, verified, and validated 3 bivariate ex-miRNA biomarkers, which, when applied serially, enable accurate early diagnosis of preeclampsia. Bivariate ex-miRNA biomarkers can distinguish between different subtypes of HDP

Total number of cardiovascular disease events and deaths avoided over 10 y among Mexican adults aged 35–94 y under different assumptions about sugar-sweetened beverage consumption reduction and replacement with calories from other sources.

<p>Total number of cardiovascular disease events and deaths avoided over 10 y among Mexican adults aged 35–94 y under different assumptions about sugar-sweetened beverage consumption reduction and replacement with calories from other sources.</p

Age-stratified decrease in cardiovascular disease events and deaths predicted for a 10% reduction in sugar-sweetened beverage consumption with 39% caloric compensation, compared to a base case simulation assuming no change in consumption.

<p>(A) Total events and deaths prevented over 10 y under the intervention scenario. (B) The fraction of the total events predicted under the base case scenario that are prevented under the intervention scenario. The total counts of events and deaths for each age decile under the base case scenario and the change in events under the 10% and 20% SSB reduction scenarios are presented in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002158#pmed.1002158.s005" target="_blank">S4 Table</a>. CHD, coronary heart disease; CVD, cardiovascular disease.</p

Number of incident cases of diabetes prevented and diabetes healthcare costs saved under intervention scenarios compared to the base case scenario among Mexican adults aged 35–94 y for 2013–2022.

<p>Number of incident cases of diabetes prevented and diabetes healthcare costs saved under intervention scenarios compared to the base case scenario among Mexican adults aged 35–94 y for 2013–2022.</p