Prevalence and Incidence of Schizophrenia Spectrum Disorders:                     Implications for Prevention

Objective This paper reviews the historical and conceptual background to proposals about prevention of schizophrenia through intervention targeting asymptomatic, high-risk individuals. It also examines the outcomes of a hypothetical model of prevention based on a two-stage risk segmenting approach. Method The assumptions and parameters used in the model are derived from actual epidemiological and clinical research. The two risk criteria selected are: (i) genetic risk (having a parent with schizophrenia); and (ii) neurocognitive deficit (abnormal performance on the Continuous Performance Task, CPT). The parameters and risk factors are applied to a hypothetical screening program covering a population of 100 000. Results At the end of the second stage of screening the program using the risk criteria to search for preventable cases will have correctly identified only three out of 20 ‘true’ cases and will have incorrectly assigned to treatment two non-cases. The great majority of people at risk who will eventually develop schizophrenia are likely to remain undetected by current screening or preclinical diagnostic programs, while a certain number of people actually not at risk would be falsely identified as high-risk and offered treatment. Conclusions Reliably identifying, with intention to treat, asymptomatic people in the community who are presumed to be at high risk of developing schizophrenia is at present epidemiologically non-viable. This caveat should not apply to strategies for early diagnosis and treatment of incipient episodes of schizophrenia where strategies to reduce the duration of untreated psychosis are likely to be both feasible and cost-effective.

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Abstract 3772: Alternate Listing Transplantation is a Cost-Effective Treatment for End-Stage Heart Failure Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_858 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Mark J Russo ◽

Jonathan M Chen ◽

Kimberly N Hong ◽

Michael Argenziano ◽

Ryan R Davies ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Cost Model ◽

Case Series ◽

Cost Effective ◽

Intention To Treat ◽

Cost Effective Treatment ◽

Number Of Patients ◽

Transplant Candidates ◽

End Stage

BACKGROUND: In order to offer the benefit of heart transplantation to a greater number of patients some centers match high-risk recipients (HR) with non-standard or ”marginal” donors (MD) in a strategy known as Alternate Listing Transplantation (ALT). However, pairing sicker recipients with lower quality donor organs remains both clinically and ethically controversial. The purpose of this study was to determine the cost-effectiveness of this strategy. METHODS: The United Network of Organ Sharing provided deidentified patient-level data. UNOS data was used to determine clinical outcomes, including waiting time, post-transplant survival, length of stay, re-hospitalizations, episodes of rejection, and infection, based on all adult heart transplant candidates (age [gt] 18 yo) and listed between 1995–2005 (n=35,049). Through a systematic literature review of randomized controlled trials and case series that estimated related costs, a cost model (see Table ) using an intention-to-treat assumption was developed to calculate the incremental cost-effectiveness ratio (ICER) for HR candidates who subsequently received marginal donor hearts (HTR) compared with candidates who were not transplanted (NTXP). High-risk recipient criteria included age [gt] 65yo, retransplantation, HepC+, HIV+, CrCl <30 ml/min, DM with PVD, DM with Crcl <40 ml/min. MD criteria included age [gt] 55yo, DM, HIV+, HepC+, EF<45%, and donor:recipient weight <0.7. RESULTS: Median survival from listing was 0.55 yrs and 5.1 yrs in the HTR and NTXP groups, respectively. The estimated ICER was $66,645($34,046–$127,491) ICER varied by HR recipient criteria. CONCLUSIONS: The ICER for ALT falls at the upper limits acceptability for being cost-effective. However, stratified analysis by HR group suggests that this strategy is not appropriate for all groups. Cost Model Assumptions

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Can we increase efficiency of CT lung cancer screening by combining with CVD and COPD screening? Results of an early economic evaluation

European Radiology ◽

10.1007/s00330-021-08422-7 ◽

2022 ◽

Author(s):

Carina M. Behr ◽

Hendrik Koffijberg ◽

Koen Degeling ◽

Rozemarijn Vliegenthart ◽

Maarten J. IJzerman

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

High Risk ◽

Low Dose ◽

Screening Program ◽

Cost Effective ◽

Economic Viability ◽

Chronic Obstructive ◽

Screening Population ◽

Target Screening

Abstract Objectives Estimating the maximum acceptable cost (MAC) per screened individual for low-dose computed tomography (LDCT) lung cancer (LC) screening, and determining the effect of additionally screening for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or both on the MAC. Methods A model-based early health technology assessment (HTA) was conducted to estimate whether a new intervention could be cost-effective by calculating the MAC at a willingness-to-pay (WTP) of €20k/quality-adjusted life-year (QALY) and €80k/QALY, for a population of current and former smokers, aged 50–75 years in The Netherlands. The MAC was estimated based on incremental QALYs gained from a stage shift assuming screened individuals are detected in earlier disease stages. Data were obtained from literature and publicly available statistics and validated with experts. Results The MAC per individual for implementing LC screening at a WTP of €20k/QALY was €113. If COPD, CVD, or both were included in screening, the MAC increased to €230, €895, or €971 respectively. Scenario analyses assessed whether screening-specific disease high-risk populations would improve cost-effectiveness, showing that high-risk CVD populations were more likely to improve economic viability compared to COPD. Conclusions The economic viability of combined screening is substantially larger than for LC screening alone, primarily due to benefits from CVD screening, and is dependent on the target screening population, which is key to optimise the screening program. The total cost of breast and cervical cancer screening is lower (€420) than the MAC of Big-3, indicating that Big-3 screening may be acceptable from a health economic perspective. Key Points • Once-off combined low-dose CT screening for lung cancer, COPD, and CVD in individuals aged 50–75 years is potentially cost-effective if screening would cost less than €971 per screened individual. • Multi-disease screening requires detailed insight into the co-occurrence of these diseases to identify the optimal target screening population. • With the same target screening population and WTP, lung cancer-only screening should cost less than €113 per screened individual to be cost-effective.

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Acute Urinary Tract Infections

Acute Medicine Journal ◽

10.52964/amja.0089 ◽

2005 ◽

Vol 4 (1) ◽

pp. 21-26

Author(s):

Arun Chaudhuri ◽

Keyword(s):

At Risk ◽

Urinary Tract ◽

High Risk ◽

Urinary Tract Infections ◽

Management Strategies ◽

Cost Effective ◽

Risk Groups ◽

Effective Management ◽

Proper Understanding ◽

Tract Infections

Urinary tract infections remain a significant cause of morbidity throughout the globe. Proper understanding of the disease is extremely important for appropriate management. Recent studies have helped to define the population groups at risk for these infections, as well as the most cost-effective management strategies. This article will discuss aspects of initial diagnosis and subsequent management of different high risk groups.

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Is screening for pancreatic cancer in high-risk groups cost-effective? – Experience from a Danish national screening program

Pancreatology ◽

10.1016/j.pan.2016.03.013 ◽

2016 ◽

Vol 16 (4) ◽

pp. 584-592 ◽

Cited By ~ 15

Author(s):

Maiken Thyregod Joergensen ◽

Anne-Marie Gerdes ◽

Jan Sorensen ◽

Ove Schaffalitzky de Muckadell ◽

Michael Bau Mortensen

Keyword(s):

Pancreatic Cancer ◽

High Risk ◽

Screening Program ◽

Cost Effective ◽

Risk Groups

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Screening and Treatment of Latent Tuberculosis Among Healthcare Workers at Low, Moderate, and High Risk for Tuberculosis Exposure: A Cost-Effectiveness Analysis

Infection Control and Hospital Epidemiology ◽

10.1086/502343 ◽

2004 ◽

Vol 25 (12) ◽

pp. 1056-1061 ◽

Cited By ~ 17

Author(s):

Shelley R. Salpeter ◽

Edwin E. Salpeter

Keyword(s):

High Risk ◽

Healthcare Workers ◽

Screening Program ◽

Cost Savings ◽

Cost Effective ◽

Risk Groups ◽

Published Data ◽

Tuberculosis Case ◽

Effective Screening ◽

Screening Interval

AbstractObjective:To evaluate cost-effective screening and treatment strategies for healthcare workers (HCWs) at risk for tuberculosis exposure.Design:A Markov model was developed to track three hypothetical cohorts of HCWs at low, moderate, and high risk for tuberculosis exposure. For those found to be tuberculin reactors at entry, the choice was for isoniazid treatment or no treatment. For those without tuberculin reactivity, the choice of screening intervals was 6 months, 1 year, 2 years, or 5 years. Outcomes measured were tuberculosis cases, death, life expectancy, and cost. Assumptions were derived from published data and analyses.Results:Treatment of initial reactors with isoniazid in all three risk groups was associated with a net savings of $14,800 to $15,700 for each tuberculosis case prevented. For those without evidence of infection at entry, the most cost-effective screening interval was 1 year for high-risk groups, 2 years for moderate-risk groups, and 5 years for low-risk groups, with a net savings $0.20 to $26 per HCW per year. Screening at a more frequent interval was still cost-effective.Conclusions:For HCWs found to be tuberculin reactors, treatment of their latent infection is to their benefit and is associated with a net cost-savings. Regular tuberculin screening of HCWs can be cost-effective or result in a net cost-savings. Each institution could use its own skin test surveillance data to create an optimum screening program for its employees. However, for most HCWs, a 1-year screening interval would be a cost-effective and safe choice.

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Cost-Effectiveness Analysis of High-Risk Groups Tuberculosis Screening in Malaysia

Frontiers in Public Health ◽

10.3389/fpubh.2021.699735 ◽

2021 ◽

Vol 9 ◽

Author(s):

Nor Zam Azihan Mohd Hassan ◽

Asmah Razali ◽

Mohd Ridzwan Shahari ◽

Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran ◽

Juanita Halili ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Incremental Cost ◽

Screening Program ◽

Cost Effective ◽

Risk Groups ◽

Effective Strategy ◽

Tree Model ◽

Cost Effective Strategy ◽

The Cost

Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.

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Hand Edema in Patients at Risk of Breast Cancer–Related Lymphedema: Health Professionals Should Take Notice

Physical Therapy ◽

10.1093/ptj/pzy007 ◽

2018 ◽

Vol 98 (6) ◽

pp. 510-517 ◽

Cited By ~ 4

Author(s):

Cheryl L Brunelle ◽

Meyha N Swaroop ◽

Melissa N Skolny ◽

Maria S Asdourian ◽

Hoda E Sayegh ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

At Risk ◽

High Risk ◽

Clinical Examination ◽

Screening Program ◽

Significant Risk ◽

Small Sample ◽

Subjective Data ◽

Breast Cancer Related Lymphedema

Abstract Background There is little research on hand edema in the population at risk for breast cancer–related lymphedema (BCRL). Objectives Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE. Design/Methods This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital's lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported. Results Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high-risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination. Limitations The small sample size and lack of validated measures of subjective data were limitations. Conclusions In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted.

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