Lisandro D Colantonio
University of Alabama at Birmingham, Epidemiology, Graduate Student
Objective. To determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. Data Sources/Study Setting. Data... more
Objective. To determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries.
Data Sources/Study Setting. Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which recruited African American and white participants across the continental United States from 2003–2007, were linked to Medicare claims.
Study Design. We used panel data models to analyze changes in doctor visits for evaluation and management of conditions after participants were assessed, utilizing the study’s rolling recruitment to control for secular trends.
Data Extraction Methods. We extracted Medicare claims for the 24 months before through 24 months after assessment via REGARDS for 5,884 participants.
Principal Findings. Semi-annual doctor visits for previously undiagnosed conditions increased by 22 percentage points (95 percent confidence interval: 16–28) 2 years following assessment. The effect was similar by gender, race, region, and Medicaid, but it may have been lower among participants who lacked a usual health care provider.
Conclusions. In-home assessment of cholesterol, blood pressure, and blood glucose can increase doctor visits for individuals with previously undiagnosed conditions. However, biomarker assessment may have more limited impact among individuals with low access to care.
Key Words. Medicare, screening, diabetes, hypertension, high cholesterol
Data Sources/Study Setting. Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, which recruited African American and white participants across the continental United States from 2003–2007, were linked to Medicare claims.
Study Design. We used panel data models to analyze changes in doctor visits for evaluation and management of conditions after participants were assessed, utilizing the study’s rolling recruitment to control for secular trends.
Data Extraction Methods. We extracted Medicare claims for the 24 months before through 24 months after assessment via REGARDS for 5,884 participants.
Principal Findings. Semi-annual doctor visits for previously undiagnosed conditions increased by 22 percentage points (95 percent confidence interval: 16–28) 2 years following assessment. The effect was similar by gender, race, region, and Medicaid, but it may have been lower among participants who lacked a usual health care provider.
Conclusions. In-home assessment of cholesterol, blood pressure, and blood glucose can increase doctor visits for individuals with previously undiagnosed conditions. However, biomarker assessment may have more limited impact among individuals with low access to care.
Key Words. Medicare, screening, diabetes, hypertension, high cholesterol
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Estimate the burden of disease, the proportion attributable to the principal modifiable cardiovascular risk factors, and the direct medical cost of hospitalization associated with coronary heart disease and stroke in Argentina. An... more
Estimate the burden of disease, the proportion attributable to the principal modifiable cardiovascular risk factors, and the direct medical cost of hospitalization associated with coronary heart disease and stroke in Argentina. An analitical model was prepared using Argentina's 2005 mortality data and the prevalence of the principal cardiovascular risk factors (hypertension, hypercholesterolemia, overweight, obesity, hyperglycemia, current and past smoking, sedentary lifestyle, and inadequate intake of fruits and vegetables). The burden of disease-years of potential life lost (YPLL) and years of healthy life lost (YHLL)- and hospitalization costs for the cardiovascular diseases analyzed were estimated. In 2005 over 600 000 YHL were lost in Argentina and the number of YPLL due to heart disease and stroke was calculated at 400 000; 71.1% of the YHLL, 73.9% of the YPLL, and 76.0% of the associated costs were attributable to modifiable risk factors. Hypertension was the risk factor with the greatest impact in both men and in women, responsible for 37.3% of the total cost, 37.5% of the YPLL, and 36.6% of the YHLL. Most of the burden of disease from cardiovascular disease in Argentina is associated with modifiable, and therefore preventable, risk factors and could be reduced through population-based and clinical interventions that employ a risk approach; such interventions have already proven to be cost effective, accessible, and feasible in countries like Argentina.
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Adults with a 10 year predicted atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% are candidates for statin therapy for primary prevention. Lifestyle interventions may benefit this high risk group. Hypothesis: We estimated the use... more
Adults with a 10 year predicted atherosclerotic cardiovascular disease (ASCVD) risk ≥7.5% are candidates for statin therapy for primary prevention. Lifestyle interventions may benefit this high risk group. Hypothesis: We estimated the use of healthy lifestyles and their association with ASCVD and mortality risk in adults with a 10 year predicted ASCVD risk ≥7.5%. Methods: The REasons for Geographic and Racial Differences in Stroke cohort study enrolled adults ≥45 years old from the 48 continental US states and District of Columbia in January 2003 - October 2007 (n=30,239). The final sample was restricted to adults 45 - 79 years old, without ASCVD or diabetes history, low density lipoprotein cholesterol 70 - 189 mg/dL and a 10 year predicted ASCVD risk ≥7.5% (n=5,709). Ideal lifestyle factors, assessed during an in-home physical exam and through surveys, included non-obese waist circumference (<88/<102 cm for women/men), physical activity (PA) ≥4 times per week, nonsmoking, low...
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Objective The aim of this study is to determine the relationship between heart rate and/or blood pressure variability, measured at 28 weeks' gestation, and the incidence of pregnancy-induced hypertension or preeclampsia. Study... more
Objective The aim of this study is to determine the relationship between heart rate and/or blood pressure variability, measured at 28 weeks' gestation, and the incidence of pregnancy-induced hypertension or preeclampsia. Study Design Secondary analysis of data from a prospectively enrolled cohort of 385 active military women in whom spectral analysis of continuous heart rate and variability was measured at 28 weeks' gestation. The primary outcome was the predictive value of spectral analysis of heart rate and blood pressure for hypertensive diseases of pregnancy. Results High-frequency heart rate variability was reduced and low-frequency variability of systolic and diastolic blood pressure increased in women who would develop pregnancy-induced hypertension but not preeclampsia. Low-frequency variability of diastolic blood pressure remained a significant predictor of pregnancy-induced hypertension but not preeclampsia after adjustment for age, weight, and blood pressure in a ...
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About one-half of individuals with an acute myocardial infarction have a low-density lipoprotein cholesterol level of less than 100 mg/dL at the time of occurrence, but remain at risk for recurrent events. This residual risk is likely... more
About one-half of individuals with an acute myocardial infarction have a low-density lipoprotein cholesterol level of less than 100 mg/dL at the time of occurrence, but remain at risk for recurrent events. This residual risk is likely mediated by multiple factors, including burden of atherosclerosis, residual dyslipidemia, nonlipid risk factors, and suboptimal implementation of lifestyle therapy and evidence-based pharmacologic therapy. This article reviews management options for this high-risk population.
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Cardiovascular research output and citations of publications from Africa have historically been low yet may be increasing. However, data from the continent are limited. To evaluate the cardiovascular research output and citations from 52... more
Cardiovascular research output and citations of publications from Africa have historically been low yet may be increasing. However, data from the continent are limited. To evaluate the cardiovascular research output and citations from 52 African countries between 1999 and 2008, we created a bibliometric filter to capture cardiovascular research articles published in the Web of Knowledge based on specialist journals and title words. Two coauthors with expertise in cardiovascular medicine tested and refined this filter to achieve >90% precision and recall. We matched retrieved records with their associated citation reports and calculated the running 5-year citation count postpublication, including the year of publication. Publications from Africa were identified by author addresses. South Africa published 872 cardiovascular research papers, Egypt 393, Tunisia 264, and Nigeria 192 between 1999 and 2008. The number of publications increased over the time period for a small number of ...
Depression and stress have each been found to be associated with poor prognosis in patients with coronary heart disease. A recently offered psychosocial perfect storm conceptual model hypothesizes amplified risk will occur in those with... more
Depression and stress have each been found to be associated with poor prognosis in patients with coronary heart disease. A recently offered psychosocial perfect storm conceptual model hypothesizes amplified risk will occur in those with concurrent stress and depressive symptoms. We tested this hypothesis in a large sample of US adults with coronary heart disease. Participants included 4487 adults with coronary heart disease from the REasons for Geographic and Racial Differences in Stroke study, a prospective cohort study of 30 239 black and white adults. We conducted Cox proportional hazards regression with the composite outcome of myocardial infarction or death and adjustment for demographic, clinical, and behavioral factors. Overall, 6.1% reported concurrent high stress and high depressive symptoms at baseline. During a median 5.95 years of follow-up, 1337 events occurred. In the first 2.5 years of follow-up, participants with concurrent high stress and high depressive symptoms ha...
Research Interests: Depression, Life Style, Risk assessment, Comorbidity, Multivariate Analysis, and 16 moreHumans, United States, Female, Male, Risk factors, African Americans, Aged, Middle Aged, Myocardial Infarction, Public health systems and services research, Time Factors, Prognosis, European Continental Ancestry Group, Risk Factors, Risk Assessment, and Proportional Hazards Models
The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins for adults ≥50 years old with CKD. The American College of Cardiology/American Heart Association endorses statins for adults with atherosclerotic... more
The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins for adults ≥50 years old with CKD. The American College of Cardiology/American Heart Association endorses statins for adults with atherosclerotic cardiovascular disease, adults with LDL cholesterol≥190 mg/dl, and adults 40-79 years old with LDL cholesterol=70-189 mg/dl and diabetes or a 10-year predicted risk for atherosclerotic cardiovascular disease ≥7.5% estimated using the Pooled Cohort risk equations. Using data from the Reasons for Geographic and Racial Differences in Stroke Study, we calculated the agreement for statin treatment between these two guidelines for adults 50-79 years old with CKD (eGFR<60 ml/min per 1.73 m(2) or albuminuria≥30 mg/g) not on dialysis. We assessed the validity of the Pooled Cohort risk equations in individuals with CKD. Study participants were enrolled between 2003 and 2007, and we report incident cardiovascular disease events (stroke and coronary heart disease) thro...
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ABSTRACT At younger ages, chronic kidney disease (CKD) is a progressive disorder associated with an increased risk for end-stage renal disease (ESRD). Older individuals with CKD are 10 to 20 times more likely to die than progress to ESRD.... more
ABSTRACT At younger ages, chronic kidney disease (CKD) is a progressive disorder associated with an increased risk for end-stage renal disease (ESRD). Older individuals with CKD are 10 to 20 times more likely to die than progress to ESRD. We hypothesized that, among individuals with CKD, the association between traditional cardiovascular risk factors with mortality would be weaker and the association between psychosocial risk factors with mortality would be stronger for individuals ≥ 75 years of age compared to those &lt; 75 years of age. We included 5,924 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with CKD without ESRD at baseline. CKD was defined as an albumin-to-creatinine ratio ≥ 30 mg/g or an estimated glomerular filtration rate &lt; 60 mL/min/1.73m2. The 12-item Short Form Health Survey (SF-12) was administered and low physical and mental component scores (PCS and MCS) were defined as scores in the lowest quintile. Mortality was assessed through biannual telephone follow-up and contact with proxies provided by the study participant upon recruitment. Date of death was confirmed through death certificates, National Death Index, or Social Security Death Index. Over a median follow-up of 5.0 years, 1,255 deaths occurred. The mortality rate was 30.9 (95% CI: 28.6 - 33.4) and 74.8 (95% CI: 69.2 - 80.8) per 1,000 person-years for individuals &lt; 75 years and ≥ 75 years of age, respectively. Diabetes, history of stroke, and systolic blood pressure were associated with an increased risk for mortality among individuals &lt; 75 years of age but not among those ≥ 75 years of age (Table 1). Low PCS was associated with a higher risk for mortality for both younger and older adults. Symptoms of depression and low MCS were not associated with mortality in either age group. In conclusion, some cardiovascular risk factors are associated with an increased risk for mortality among younger but not older individuals with CKD. These data suggest approaches to reduce mortality risk may differ for younger and older adults with CKD.
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Robot-assisted laparoscopy has been reported to be a safe and feasible alternative to traditional laparoscopy. The aim of this study was to compare short-term results in patients with colonic cancer who underwent robot-assisted... more
Robot-assisted laparoscopy has been reported to be a safe and feasible alternative to traditional laparoscopy. The aim of this study was to compare short-term results in patients with colonic cancer who underwent robot-assisted laparoscopic colonic resection (RC) or laparoscopic colonic resection (LC). The study was a retrospective case control study of all patients with colonic cancer who underwent RC from March 2010 to March 2012 or LC from January 2009 to December 2011 at a tertiary-care university hospital. Data were retrieved from the national chart database and patient journals. Biochemical markers [C-reactive protein (CRP), hemoglobin, white blood cell count, and thrombocyte count] were recorded before surgery and for the first 3 days after surgery. A total of 101 patients underwent RC and 162 patients underwent LC. There were no significant differences in the rate of conversion to open surgery, number of permanent enterostomies, number of intraoperative complications, level of postoperative cellular stress response, number of postoperative complications, length of postoperative hospital stay, or 30-day mortality between the two groups. There was a significantly longer setup time for RC (77.1 vs. 69.7 min, P = 0.000), but surgical time was significantly shorter for RC (165.8 vs. 183.4 min, P = 0.006) and there was no difference in the overall procedure time (254.0 vs. 243.6 min, P = 0.086). We found RC to be a safe and feasible alternative to LC for colonic cancer. We found that for RC surgical time was shorter and overall procedure time was comparable to that for LC; however, these results should be confirmed in future randomized clinical trials.
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ABSTRACT We read with interest, the report of the recently conducted original study by Vignali et al. entitled &quot;Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery&quot; in the February... more
ABSTRACT We read with interest, the report of the recently conducted original study by Vignali et al. entitled &quot;Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery&quot; in the February 2013 issue of Colorectal Disease [1]. While this study&#39;s findings are without doubt of clinical merit, as avid students of epidemiology and clinical research, we wanted to provide feedback regarding the its design and analysis. Vignali at al described their study as a &quot;case-matched control&quot; or in other words, a matched case-controlled study, but the patients were defined as being based on the exposure instead of the outcome i.e. those who underwent laparoscopic surgery (exposure) were called cases whereas those who underwent open colectomy (comparison or the unexposed group) were identified as controls. This article is protected by copyright. All rights reserved.
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Research Interests: Information Policy, Tobacco, Resource Allocation, Argentina, Adolescent, and 26 moreCardiovascular disease, Applied Economics, Mass media, Humans, High Blood Pressure, Cost Effectiveness Analysis, Female, Male, Young Adult, Cost effectiveness, Risk factors, Aged, Middle Aged, Theoretical Models, Adult, Coronary heart disease, Public health systems and services research, Cost Benefit Analysis, Cost Saving, High Cholesterol, Drug Therapy, Cardiovascular Diseases, Risk Factors, Cost of Illness, Primary Prevention, and Relative Risk
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Research Interests: Evidence Based Medicine, Quality of Mental Health Care, Health Services Research, Maternal and Child Health, Pregnancy, and 12 moreHumans, Child, Female, Income, Systematic review, Adult, Paediatric, Public health systems and services research, Review Literature As Topic, Child Health Services, Health Personnel, and Socioeconomic Factors
Objetivo Comparar el efecto sobre el espesor íntima media carotídeo (EIMC) del tratamiento con niacina de liberación prolongada (NLP) con el de ezetimibe en pacientes con enfermedad aterosclerótica conocida o equivalentes, en tratamiento... more
Objetivo Comparar el efecto sobre el espesor íntima media carotídeo (EIMC) del tratamiento con niacina de liberación prolongada (NLP) con el de ezetimibe en pacientes con enfermedad aterosclerótica conocida o equivalentes, en tratamiento con estatinas y con colesterol HDL bajo.
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No abstract is available. To read the body of this article, please view the Full Text online. ... © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved. ... Visit... more
No abstract is available. To read the body of this article, please view the Full Text online. ... © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site do not constitute a guarantee or endorsement by the journal, Association, or publisher of the quality or value of such product or of the claims made for it by its manufacturer.
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Research Interests: Argentina, Chile, Applied Economics, United Kingdom, HUMAN PAPILLOMAVIRUS, and 17 moreLatin America, Cross-Cultural Comparison, Humans, Female, Male, Young Adult, Great Britain, Middle Aged, Questionnaires, Quality adjusted life years, Adult, Public health systems and services research, Analysis of Variance, Health surveys, Cost of Illness, Cross Sectional Studies, and health status indicators
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This paper reviews the evidence supporting the use of etiological treatment for Chagas disease that has changed the standard of care for patients with Trypanosoma cruzi infection in the last decades. Implications of this evidence on... more
This paper reviews the evidence supporting the use of etiological treatment for Chagas disease that has changed the standard of care for patients with Trypanosoma cruzi infection in the last decades. Implications of this evidence on different levels of prevention as well as gaps in current knowledge are also discussed. In this regard, etiological treatment has shown to be beneficial as an intervention for secondary prevention to successfully cure the infection or to delay, reduce, or prevent the progression to disease, and as primary disease prevention by breaking the chain of transmission. Timely diagnosis during initial stages would allow for the prescription of appropriate therapies mainly in the primary health care system thus improving chances for a better quality of life. Based on current evidence, etiological treatment has to be considered as an essential public health strategy useful to reduce disease burden and to eliminate Chagas disease altogether.
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Cardiovascular diseases are the main cause of death in Argentina. This article analyzes economic evaluations on cardiovascular prevention for this country. A literature search was conducted in five electronic databases during December... more
Cardiovascular diseases are the main cause of death in Argentina. This article analyzes economic evaluations on cardiovascular prevention for this country. A literature search was conducted in five electronic databases during December 2009. Inclusion criteria were complete economic evaluations addressing at least one cardiovascular health outcome for the Argentinean population. Finally, nine studies were included evaluating 14 comparisons. Interventions oriented to primary or secondary prevention in patients that had undergone coronary angioplasty, with a previous cardiovascular event or equivalents, with a hospitalization for heart failure or general population were evaluated. Bread salt reduction, antihypertensive treatment, mass educational campaigns and polypill strategies could be considered cost effective. The available economic evidence to guide resource allocation in cardiovascular disease in Argentina seems to be scarce and limited.
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OBJECTIVE: To describe the development and validation of a health economic model (HEM) to address the tobacco disease burden and the cost-effectiveness of smoking cessation interventions (SCI) in seven Latin American countries. METHODS:... more
OBJECTIVE:
To describe the development and validation of a health economic model (HEM) to address the tobacco disease burden and the cost-effectiveness of smoking cessation interventions (SCI) in seven Latin American countries.
METHODS:
The preparatory stage included the organization of the research network, analysis of availability of epidemiologic data, and a survey to health decision makers to explore country-specific information needs. The development stage involved the harmonization of a methodology to retrieve local relevant parameters and develop the model structure. Calibration and validation was performed using a selected country dataset (Argentina 2005). Predicted event rates were compared to the published rates used as model inputs. External validation was undertaken against epidemiologic studies that were not used to provide input data.
RESULTS:
Sixty-eight decision makers were surveyed. A microsimulation HEM was built considering the availability and quality of epidemiologic data and relevant outcomes conceived to suit the identified information needs of decision makers. It considers all tobacco-related diseases (i.e., heart, cerebrovascular and chronic obstructive pulmonary disease, pneumonia/influenza, lung cancer, and nine other neoplasms) and can incorporate individual- and population-level interventions. The calibrated model showed all simulated event rates falling within ± 10% of the sources (-9%-+5%). External validation showed a high correlation between published data and model results.
CONCLUSIONS:
This evidence-based, internally and externally valid HEM for the assessment of the effects of smoking and SCIs incorporates a broad spectrum of tobacco related diseases, SCI, and benefit measures. It could be a useful policy-making tool to estimate tobacco burden and cost-effectiveness of SCI.
To describe the development and validation of a health economic model (HEM) to address the tobacco disease burden and the cost-effectiveness of smoking cessation interventions (SCI) in seven Latin American countries.
METHODS:
The preparatory stage included the organization of the research network, analysis of availability of epidemiologic data, and a survey to health decision makers to explore country-specific information needs. The development stage involved the harmonization of a methodology to retrieve local relevant parameters and develop the model structure. Calibration and validation was performed using a selected country dataset (Argentina 2005). Predicted event rates were compared to the published rates used as model inputs. External validation was undertaken against epidemiologic studies that were not used to provide input data.
RESULTS:
Sixty-eight decision makers were surveyed. A microsimulation HEM was built considering the availability and quality of epidemiologic data and relevant outcomes conceived to suit the identified information needs of decision makers. It considers all tobacco-related diseases (i.e., heart, cerebrovascular and chronic obstructive pulmonary disease, pneumonia/influenza, lung cancer, and nine other neoplasms) and can incorporate individual- and population-level interventions. The calibrated model showed all simulated event rates falling within ± 10% of the sources (-9%-+5%). External validation showed a high correlation between published data and model results.
CONCLUSIONS:
This evidence-based, internally and externally valid HEM for the assessment of the effects of smoking and SCIs incorporates a broad spectrum of tobacco related diseases, SCI, and benefit measures. It could be a useful policy-making tool to estimate tobacco burden and cost-effectiveness of SCI.
Research Interests: Health Economics, Monte Carlo, Tobacco, Treatment Outcome, Health Services Research, and 24 moreAdolescent, Applied Economics, Latin America, Humans, Smoking Cessation, Computer Simulation, Smoking, Tobacco Control, Lung Diseases, Young Adult, Cost effectiveness, Regional Security in Latin American Countries, Aged, Middle Aged, Adult, Public health systems and services research, Economic Models, Cost Benefit Analysis, Neoplasms, Economic Model, Reproducibility of Results, Cardiovascular Diseases, Health Care Costs, and Preventive Health Services
OBJETIVE: Estimate the burden of disease, the proportion attributable to the principal modifiable cardiovascular risk factors, and the direct medical cost of hospitalization associated with coronary heart disease and stroke in Argentina.... more
OBJETIVE: Estimate the burden of disease, the proportion attributable to the principal modifiable cardiovascular risk factors, and the direct medical cost of hospitalization associated with coronary heart disease and stroke in Argentina. METHODOLOGY: An analitical model was prepared using Argentina's 2005 mortality data and the prevalence of the principal cardiovascular risk factors (hypertension, hypercholesterolemia, overweight, obesity, hyperglycemia, current and past smoking, sedentary lifestyle, and inadequate intake of fruits and vegetables). The burden of disease-years of potential life lost (YPLL) and years of healthy life lost (YHLL)- and hospitalization costs for the cardiovascular diseases analyzed were estimated. RESULTS: In 2005 over 600 000 YHL were lost in Argentina and the number of YPLL due to heart disease and stroke was calculated at 400 000; 71.1% of the YHLL, 73.9% of the YPLL, and 76.0% of the associated costs were attributable to modifiable risk factors. Hypertension was the risk factor with the greatest impact in both men and in women, responsible for 37.3% of the total cost, 37.5% of the YPLL, and 36.6% of the YHLL. CONCLUSIONS: Most of the burden of disease from cardiovascular disease in Argentina is associated with modifiable, and therefore preventable, risk factors and could be reduced through population-based and clinical interventions that employ a risk approach; such interventions have already proven to be cost effective, accessible, and feasible in countries like Argentina.
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BACKGROUND: Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute... more
BACKGROUND:
Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.
METHODS:
An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.
RESULTS:
An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved)
CONCLUSIONS:
Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.
Cardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.
METHODS:
An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.
RESULTS:
An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved)
CONCLUSIONS:
Most of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.
Research Interests: Information Policy, Tobacco, Resource Allocation, Argentina, Adolescent, and 26 moreCardiovascular disease, Applied Economics, Mass media, Humans, High Blood Pressure, Cost Effectiveness Analysis, Female, Male, Young Adult, Cost effectiveness, Risk factors, Aged, Middle Aged, Theoretical Models, Adult, Coronary heart disease, Public health systems and services research, Cost Benefit Analysis, Cost Saving, High Cholesterol, Drug Therapy, Cardiovascular Diseases, Risk Factors, Cost of Illness, Primary Prevention, and Relative Risk
Implementation of cervical cancer (CC) vaccination in Latin America is expected to reduce the high CC burden in those countries. But the efficiency of such vaccination programs in the region still remains unknown. This study assesses the... more
Implementation of cervical cancer (CC) vaccination in Latin America is expected to reduce the high CC burden in those countries. But the efficiency of such vaccination programs in the region still remains unknown. This study assesses the cost-effectiveness and cost-utility of introducing vaccination into the current CC disease management of five Latin American countries (Argentina, Brazil, Chile, Mexico, and Peru). The modelling results indicate that universal mass vaccination is cost-effective in the current health care setting of each country (<3x gross domestic product per capita, per country) with a substantial number of CC cases and deaths avoided in addition to an increase of quality-adjusted life years. This study will help guide the design of future clinical programmes and health-related policies. It will assist early and effective decision-making processes related to vaccine implementation in Latin America.
Research Interests: Health Care, Cancer, Peru, Cancer Vaccines, Biological Sciences, and 13 moreLatin America, Humans, Virus, Cost Effectiveness Analysis, Female, Vaccine, Cost effectiveness, Regional Security in Latin American Countries, Cervical Cancer, Economic Models, Cost Benefit Analysis, Disease Management, and Immunization Programs
There are many systematic reviews of continuing education programmes and educational strategies for quality improvement in health care. Most of the reviewed studies are one-off evaluations rather than impact evaluations with long-term... more
There are many systematic reviews of continuing education programmes and educational strategies for quality improvement in health care. Most of the reviewed studies are one-off evaluations rather than impact evaluations with long-term follow-up. There are few systematic reviews of organisational, financial and regulatory interventions, and few high-quality studies. These interventions are probably as or more important than educational strategies, although they are less well evaluated. Few studies have been undertaken in low- and middle-income countries (LMIC) or that address maternal and child health (MCH). Thus, the results of the available studies and reviews need to be interpreted cautiously when applied to LMIC. Interactive workshops, reminders and multifaceted interventions can improve professional practice, and they generally have moderate effects. Educational outreach visits consistently improve prescribing but have variable effects on other behaviours. Audit and feedback interventions have variable effects on professional practice, but most often these are small to moderate effects. Mass-media and patient-mediated interventions may change professional practice. Multifaceted interventions that combine several quality-improvement strategies are also effective but may not be more so than single interventions. While all of these strategies are applicable to MCH in LMIC, the applicability of the results to rural settings, in particular, may be limited. Use of these strategies could exacerbate inequalities, and this should be taken into consideration when planning implementation. Scaling up and sustainability may be difficult to achieve in LMIC contexts and need careful consideration. The use of financial interventions has not been well studied; financial incentives and disincentives may be difficult to use effectively and efficiently, although their impact on practice needs to be considered. Organisational interventions are likely to be important, given that there are often underlying organisational or system problems. Regulatory interventions have not been well evaluated, but may sometimes be both inexpensive and effective. There are no 'magic bullets' or simple solutions for ensuring the quality of health care services. Interventions should be selected or tailored to address the underlying reasons for a failure to deliver effective services. Decision-makers should select the most appropriate interventions for specific problems. This requires a governance structure that clearly assigns responsibility for quality-improvement activities, priority setting, selection and design of interventions, and evaluation.
Research Interests: Evidence Based Medicine, Quality of Mental Health Care, Quality Improvement, Developing Countries, Health Services Research, and 16 moreSystematic Reviews, Maternal and Child Health, Pregnancy, Humans, Child, Female, Income, Systematic review, Adult, Paediatric, Public health systems and services research, Interventions, Review Literature As Topic, Child Health Services, Health Personnel, and Socioeconomic Factors
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 1 http://www.thecochranelibrary.com ... Ezetimibe for primary hypercholesterolemia... more
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 1 http://www.thecochranelibrary.com ... Ezetimibe for primary hypercholesterolemia (Protocol) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley &amp;amp; Sons, Ltd. ... Ezetimibe for primary hypercholesterolemia (Protocol) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley &amp;amp; Sons, Ltd. ... Lisandro Damián Colantonio1, Emilio Carlos Cermignani2, Agustín Ciapponi3
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Screening interventions can produce very different treatment and health outcomes, depending on the reasons why patients went unscreened in the first place. Economists have paid scant attention to the complexities of evaluating screening... more
Screening interventions can produce very different treatment and health outcomes, depending on the reasons why patients went unscreened in the first place. Economists have paid scant attention to the complexities of evaluating screening interventions. In this paper, we propose a simple economic framework to guide policy-makers and analysts in designing and evaluating the impact of screening interventions on uptake of relevant treatment. We then apply these insights to several salient empirical examples that illustrate the different kinds of effects screening programs might produce. Our empirical examples focus on contexts relevant to the top cause of death in the United States, heart disease.