Cost-effective analysis of the fractional flow reserve in an iranian cohort with multivessel coronary artery disease

Background: The fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has proven effective in decreasing cardiac events by comparison with all-comers stenting. In this study, we aimed to evaluate the cost-effectiveness of this method in an Iranian population. Methods: In this prospective cohort, patients with moderate stenosis (50�70 severity) were included, while those with acute coronary syndrome were excluded. The patients were divided into 2 groups: the FFR group, for whom revascularization was performed based on FFR results, and the control group, for whom revascularization was performed based on the interventionist�s assessment. An FFR of less than 0.80 was considered ischemic in this investigation. Results: A total of 188 patients with moderate coronary artery lesions scheduled for elective PCI were included: 98 patients were assigned to the FFR group and 90 to the control group. Readmission and major adverse cardiac events (MACE) were decreased significantly in the FFR group (24.4 vs 11.2; P = 0.017 and 25.6 vs 12.2; P = 0.019, respectively). The quality-adjusted life-year (QALY) value was improved in the FFR group in comparison with the control group (0.8643 ± 0.0961 vs 0.7449 ± 0.10139, respectively; P < 0.001), resulting in a lower cost for each QALY in the FFR group than in the control group (131 395 349 QALY/rials vs 210 666 667 QALY/rials, respectively; P < 0.001). Additionally, our calculation of the incremental cost-effectiveness ratio showed that the cost-effectiveness of the FFR utilization was at least 409 million rials and at most 431 million rials for each QALY, depending on the inclusion of the cost of the FFR catheter. Conclusions: Our results demonstrated the effectiveness of FFR in diminishing MACE. The method was cost-effective according to various calculation methods in an Iranian population. (Iranian Heart Journal 2020; 21(3): 64-72). © 2020, Iranian Heart Association. All rights reserved

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: The Right to Sight: An analysis for the Global Burden of Disease Study

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. Findings: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]). Interpretation: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. Funding: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Additional file 4 of Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018

Additional file 4: Supplemental results.1. README. 2. Prevalence range across districts. 3. Prevalence range between sexes. 4. Prevalence range between ages. 5. Age-specific district ranges