Families affected by catastrophic costs due to tuberculosis

The high household costs associated with tuberculosis (TB) diagnosis and treatment can create barrier to access and adherence. To achieve World Health Organisation’s ‘End TB Strategy ’target that no TB affected households should face catastrophic cost. To estimate the occurrence of catastrophic cost associated with TB diagnosis and treatment in a low and middle income countries (LMICs), the meta analysis showed that still overall 55% of TB affected households were experiencing catastrophic costs due to TB diagnosis and treatment. Among them 75% are from the poor economic segment of the patients and 45% from the rich segment of the patients. Over the recent years World Health Organisation as promoted the concept of Universal Health Coverage emphasising the need for access to services at an affordable costs to protect households from catastrophic health expenditures. Policy makers have designed many interventions to provide financial protection to TB patients. However still, there is a financial burden for TB patients in LMICs reported that cost a percentage of income was particularly high among poor peopl

Economic aspects of shortening the duration of tuberculosis treatment

With the currently recommended 6-month antituberculosis therapy (ATT), 85% of people with drugsensitive tuberculosis could be cured.1 However, this regimen still requires four medications and a minimum of 6 months of therapy. Long duration of treatment and drug-related toxicity leads to drug fatigue and non-compliance. Recurrence, community transmission, and acquired drug-resistance are all risks associated with premature treatment discontinuation, especially for drug-resistant tuberculosis, which requires more intensive treatment and longer duration.2 The prevailing cost of treatment constrains available resources in lowincome and middle-income countries, and thus shorter regimens for both drug-susceptible and drug-resistant tuberculosis are vital

Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021

Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies

The Prevalence of Self-Reported Tuberculosis in the Andaman and Nicobar Islands, India: Evidence from the NFHS-IV and V

Introduction: Since 1992, many rounds of the National Family Health Surveys have produced a significant quantity of data in India. The magnitude of the tuberculosis (TB) burden in Andaman and Nicobar Island can be better understood with this data. The household-level information on self-reported TB may provide useful information on the prevalence and distribution of TB as well as care-seeking behaviour. The primary objective is to analyse the data from the NFHS-IV and NFHS-V to understand the prevalence of self-reported TB as well as healthcare-seeking patterns for TB in the Andaman and Nicobar Islands. Methodology: We performed secondary data analysis of NFHS-IV and NFHS-V data. After taking into consideration the survey’s cluster design and sampling weights, the prevalence was estimated. The association of identified factors with self-reported TB was investigated using the chi-square and logistic regression models. Results: The point prevalence of self-reported TB was 615 (418, 873) and 221 (122, 367) in the NFHS-IV and NFHS-V, respectively (p = 0.012). The elderly, those from rural areas, those belonging to a tribe, and those with a poor wealth index were more likely to report TB. Self-reported TB prevalence was higher in the Nicobar district. There is an increase in a significant proportion of individuals not seeking care. Conclusion: The NFHS-IV and NFHS-V show a decline in self-reported TB, which is consistent with national estimates. However, the enhanced TB case detection in individuals at high risk of TB among the Nicobar districts and tribal communities could significantly contribute to the fight against tuberculosis.Improved awareness of TB could improve care seeking for TB

The Cost-Effectiveness of the BEAT-TB Regimen for Pre-Extensively Drug-Resistant TB

Objective: To measure the economic impacts of the longer pre-XDR-TB treatment regimen and the shorter BEAT-TB India regimen. Methods: In the current study, the economic impacts of the current 18-month pre-XDR-TB treatment regimen and the 6–9 month BEAT-TB regimen were evaluated using an economic model via a decision tree analysis from a societal perspective. The incremental costs and quality-adjusted life years (QALYs) gained from the introduction of the BEAT- TB regimen for pre-XDR-TB patients were estimated. Results: For a cohort of 1000 pre-XDR-TB patients, we found that the BEAT-TB India regimen yielded higher undiscounted life years (40,548 vs.21,009) and more QALYs gained (27,633 vs. 15,812) than the 18-month regimen. The BEAT-TB India regimen was found to be cost-saving, with an incremental cost of USD −128,651 when compared to the 18-month regimen. The current analysis did not consider the possibility of reduced TB recurrence after use of the BEAT-TB regimen, so it might have under-estimated the benefits. Conclusion: As a lower-cost intervention with improved health outcomes, the BEAT-TB India regimen is dominant when compared to the 18-month regimen

Cost-effectiveness of incorporating Mycobacterium indicus pranii vaccine to multidrug therapy in newly diagnosed leprosy cases for better treatment outcomes & immunoprophylaxis in contacts as leprosy control measures for National Leprosy Eradication Programme in India

BACKGROUND & OBJECTIVES: The elimination goal for leprosy as a public health problem at the national level was achieved in 2005 in India. However, the number of new cases reporting annually remained nearly the same during the last 10-15 years. Moreover, a substantial number of these new cases reported disabilities for the first time. Therefore, besides multidrug therapy (MDT), newer strategies with focus on effectively decreasing the number of new cases, optimizing the treatment of detected cases, averting disabilities and arresting the transmission of the disease are required. So the objective of this study was to assess the cost-effectiveness of Mycobacterium indicus pranii (MIP) vaccine implementation in National Leprosy Eradication Programme (NLEP) for newly diagnosed leprosy patients as well as their contacts to arrest/decrease the transmission and occurrence of new cases. METHODS: This was a model-based estimation of incremental costs, total quality-adjusted life years (QALYs) gained, new cases averted, deaths averted, incremental cost-effectiveness ratio (ICER) and budget impact of the vaccination intervention. This model included the addition of MIP treatment intervention to the newly detected leprosy patients as well as vaccination with MIP to their contacts. RESULTS: Using the societal perspective, discounted ICER was estimated to be ₹73,790 per QALY gained over a five-year time period. Probabilistic sensitivity analysis (PSA) was assessed by varying the values of input parameters. Majority (96%) of simulations fell in North East quadrant of cost-effectiveness plane, which were all below the willingness to pay threshold. INTERPRETATION & CONCLUSIONS: Introduction of MIP vaccination in the NLEP appears to be a cost-effective strategy for India. Significant health gains were reduction in the number of new leprosy cases, decreased incidence and severity of reactions during treatment, and after release from treatment, prevention of disabilities, thus reducing the cost as well as stigma of the disease

A national-level analysis of life expectancy associated with the COVID-19 pandemic in India.

BACKGROUND From a demographic perspective, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on life expectancy is not clear. Hence, there is a need to study the number of years of life lost concerning the existing average life expectancy due to COVID-19 in India. OBJECTIVE This study aimed to estimate the impact of life expectancy due to the COVID-19 pandemic in India. METHODOLOGY We considered day-wise age-specific mortality due to COVID-19 which was extracted from the COVID-19 data repository from March 11, 2020, to June 30, 2021, in India. All-cause mortality was collected from the United Nations population estimates. An abridged life table technique was utilized for calculating life expectancies based on all-cause mortality and mortality due to COVID-19. MortPak software was used to calculate the life expectancy with and without the COVID-19 pandemic. Life expectancy at birth in different age groups was estimated with respect to with and without COVID-19. RESULTS A total of 399,459 deaths due to COVID-19 were distributed age wise, and their corresponding life expectancy was calculated. The general mortality was compared with COVID-19 mortality for the various age groups, and it was observed that mortality due to COVID-19 was significantly higher among the elderly age group [i.e., 45 to 60 years (36%) and > 60 years (51%)] when compared with < 25 years (1%) and 26-44 years (11%) (trend Chi-square 7.59; = 0.001). The life expectancy without and with COVID-19 was 69.28 years and 69.16 years, respectively. CONCLUSION Overall, it was estimated that COVID-19 has an impact on life expectancy by 0.12 years during the study period. Even though mortality due to COVID-19 was high, factors such as lockdown, vaccination, and accidents also had an influence on mortality. Thus, there is a need to assess the impact of COVID-19 on life expectancy in future