Large Cohort Data Based Cost-Effective Disease Prevention Design Strategy: Strong Heart Study

Background and Objective: A multitude of large cohort studies have collected data on incidence and covariates/risk factors of various chronic diseases. However, approaches for utilization of these large data and translation of the valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper, we proposed, based on large cohort study data, a novel conceptual cost-effective disease prevention design strategy for a target group when it is not affordable to include everyone in the target group for intervention. Methods and Results: Data from American Indian participants (n = 3516;2056 women) aged 45 - 74 years in the Strong Heart Study, the diabetes risk prediction model from the study, a utility function, and regression models were used. A conceptual cost-effective disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to address cost-effective prevention design issues. These issues include complex associations of a disease with its significant risk factors, cost-effectively selecting individuals at high risk of developing disease to undergo intervention, individual differences in health conditions, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustrative example can also be analogously adopted and applied to other diseases preventions. The proposed strategy provides a way to translate and apply epidemiological study results to clinical disease prevention practice.

New cheaper human papilloma virus mass screening strategy reduces cervical cancer incidence in Changsha city:A clinical trial

BACKGROUND Cervical cancer is the second leading cause of death in women worldwide,second only to breast cancer.Around 80%of women have been infected with human papillomavirus(HPV)in their lifetime.Early screening and treatment are effective means of preventing cervical cancer,but due to economic reasons,many parts of the world do not have free screening programs to protect women’s health.AIM To increase HPV cervical cancer screening in Changsha and reduce the incidence of cervical cancer.METHODS Cervical cancer screening included gynecological examination,vaginal secretion examination and HPV high-risk typing testing.Cervical cytology examination(ThinPrep cytology test)was performed for individuals who test positive for HPV types other than 16 and 18.Vaginal colposcopy examination was performed for HPV16 and 18 positive individuals,as well as for those who were positive for ThinPrep cytology test.If the results of vaginal colposcopy examination were abnormal,histopathological examination was performed.We conducted a cost-benefit analysis after 4 years.RESULTS From 2019 to 2022,523437 women aged 35-64 years in Changsha city were screened and 73313 were positive,with a 14%positive rate.The detection rate of precancerous lesions of cervical cancer was 0.6%and the detection rate of cervical cancer was 0.037%.Among 311212 patients who underwent two cancers examinations,the incidence rate was reduced by more than half in the second examination.The average screening cost per woman was 120 RMB.The average cost of detecting early cases was 10619 RMB,with an early detection cost coefficient of 0.083.CONCLUSION Our screening strategy was effective and cost-effective,making it valuable for early diagnosis and treatment of cervical cancer.It is worth promoting in economically limited areas.

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy

This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.

Strategic options for syphilis control in Papua New Guineae impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model

Objectives:Papua New Guinea(PNG)has among the highest rates of sexually transmitted infections(STIs)globally and is committed to reducing their incidence.The Syphilis Interventions Towards Elimination(SITE)model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios.Methods:SITE is a dynamical model of syphilis transmission among adults 15-49 years.Individuals are divided into nine groups based on sexual behaviour and into six stages of infection.The model was calibrated to PNG using data from routine surveillance,biobehavioural surveys,research studies and program records.Inputs included syphilis prevalence,risk behaviours,intervention coverage and service delivery unit costs.Scenarios compared different interventions(clinical treatment,contact tracing,syphilis screening,and condom promotion)for incidence and cost per infection averted over 2021-2030.Results:Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35%in 2020 to 60%from 2023 onwards reduced estimated incidence over 2021-2030 by 55%,compared to a scenario assuming constant coverage at 2019-2020 levels.The introduction of contact tracing in 2020,assuming 0.4 contacts per symptomatic person treated,reduced incidence over 2021-2030 by 10%.Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3e16%depending on the target population.Scaling-up clinical,symptom-driven treatment and contact tracing had the lowest cost per infection averted,followed by condom promotion and periodic screening of female sex workers and men who have sex with men.Conclusions:PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions.SITE is a useful tool countries can apply to inform national STI programming and resource allocation.

N,P-codoped porous carbon derived from chitosan with hierarchical N-enriched structure and ultra-high specific surface Area toward high-performance supercapacitors

In this work,a facile"carbonization-activation"strategy is developed to synthesize N,P-codoped hierarchical porous carbon.Phosphoric acid is innovatively introduced during the hydrothermal process to achieve in-situ P doping as well as create abundant pores,and the employment of sodamide is of vital importance to simultaneously serve as activating agent and N-source to succeed a high-level N doping.Thus,the obtained samples exhibit a unique three-dimensional hierarchical structure with an ultra-high specific surface area(3646 m^(2)g^(-1))and ultra-high N-doping level(9.81 at.%).Computational analyses confirm that N,P co-doping and higher N content can enhance active sites and widen potential differences of carbon materials to improve their capacitance.The as-prepared carbon materials demonstrate superior electrochemical performances,such as an ultra-high capacitance of 586 Fg^(-1)at 1 Ag^(-1),a superior rate capability of 409 Fg^(-1)at 20 Ag^(-1),and excellent long-term stability of 97%capacitance retention after10,000 cycles in 6 M KOH.Moreover,an assembled symmetric supercapacitor delivers a high energy density of 28.1 Wh kg^(-1)at the power density of 450 W kg^(-1)in 1 M Na_(2)SO_(4),demonstrating a great potential for applications in supercapacitors.