Costs of Imatinib, Costs of Transplants and Gross National Income Per Capita Impact on Transplant Rates for Chronic Myeloid Leukemia in European Countries.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2979-2979
Author(s):  
Alois Gratwohl ◽  
Helen Baldomero ◽  
Alvin Schwendener ◽  
Michael Gratwohl ◽  
Karl Frauendorfer ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Drug Treatment ◽  
World Bank ◽  
Myeloid Leukemia ◽  
National Income ◽  
High Income ◽  
European Countries ◽  
Middle Income ◽  
Allogeneic Hsct ◽  
Per Capita

Abstract Hematopoietic stem cell transplants (HSCT) are among the most expensive medical procedures. As a consequence, transplants are preferentially done in more wealthy countries. This significant dependency between transplant rates (number of transplants per 10 million inhabitants) and gross national income (GNI) per capita has been well described. We noticed a different pattern in HSCT for chronic myeloid leukemia (CML) in recent years. We did investigate the evolution of transplant rates for leukemias in Europe in respect to the economy of the participating 38 countries. Using World Bank definitions, countries were grouped according to their GNI per capita into low (A), middle (B), and high income (C) countries and trends of transplant rates for CML and acute myeloid leukemia (AML) were computed with regression analyses from 1991 to 2004. Transplant rates increased for AML in significant dependency with GNI per capita from 0.1 (A), 0.3 (B) and 12 (C) in 1991 to 2.8 (A), 22 (B) and 47 (C) in 2004. Transplant rates were distinct by World Bank category and the increase presented in all three groups with a near linear clear predictability as illustrated by the R2 ’s of 93.55, 94.34 or 98.76 (Groups A, B, C). A different pattern was observed for CML. Initially transplant rates did increase from 0.1 (A), 0.7 (B) and 13 (C) in 1991 to 0.28 (A), 15 (B) and 28 (C) in 1999, distinct by World Bank category and with a similar linear prediction pattern as for AML (R2 96.39, 95.75, 95.35 for groups A, B, C). Transplant rates then declined for CML in high income countries (C), they remained at the same level in middle income countries to the extent that comparable transplant rates (15, 15) were observed for middle and high income countries in recent years. We compared costs. Costs for one year treatment with Imatinib (400 mg daily dose) in the different participating European countries ranged between 28 000 and 44 000 Euros with a median of 30 411 Euros (mean 32 417 Euros). Costs for an allogeneic HSCT from an HLA identical sibling ranged from 26 515 Euros to 180 000 Euros with a median of 63 450 Euros (mean 72 173 Euros). Cost comparisons indicate that cost for an allogeneic HSCT correspond to 0·9 to 5·9 (median of 2·0, mean 2·3) years of drug treatment. Data suggest that Imatinib has replaced HSCT preferentially in countries with high income. HSCT remains a cost effective procedure in countries with middle income. Cost considerations appear to impact on the choice between a once in a lifetime procedure or continuous drug treatment. Integration of cost analyses into the decision algorythms will become of increasing importance.

Current trends in hematopoietic stem cell transplantation in Europe

Blood ◽  
2002 ◽  
Vol 100 (7) ◽  
pp. 2374-2386 ◽  
Author(s):  
Alois Gratwohl ◽  
Helen Baldomero ◽  
Bruno Horisberger ◽  
Caroline Schmid ◽  
Jakob Passweg ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Chronic Myeloid Leukemia ◽  
Solid Tumors ◽  
Myeloid Leukemia ◽  
European Countries ◽  
Medium Term ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Autologous Hsct ◽  
Acute Myeloid

Major changes have occurred in the transplantation of hematopoietic stem cells (HSCs) during the last decade. This report reveals the changes, reflects current status, and provides medium-term projections of HSC transplantation (HSCT) development in Europe. Data on 132 963 patients, 44 165 with allogeneic HSC transplant (33%) and 88 798 with an autologous HSC transplant (67%), collected prospectively from 619 centers by the European Group for Blood and Marrow Transplantation (EBMT) in 35 European countries between 1990 (4234 HSCTs) and 2000 (19 136 HSCTs) illustrate utilization of HSCT. HSCT increased in all European countries and for all indications. There were major differences depending on disease indication and donor type. Transplantation rates (numbers of HSCTs per 10 million inhabitants) varied from less than 1 for some rare indications to 37.7 ± 4.1 for acute myeloid leukemia in allogeneic HSCT or 95.5 ± 13.5 for non-Hodgkin lymphoma in autologous HSCT. There were indications with a steady, continuing increase and others with initial increase but subsequent decrease. Projections on medium-term development for each disease based on a weighted sensitivity analysis predict an ongoing increase in allogeneic HSCT except for chronic myeloid leukemia. In autologous HSCT they predict an increase for lymphoproliferative disorders, acute myeloid leukemia, myelodysplastic syndromes, and some solid tumors but a decrease for most solid tumors, acute lymphoid leukemia, and chronic myeloid leukemia. Transplantation rates can be predicted with reasonable sensitivity for most disease indications. Despite marked changes in the rapidly developing field of HSCT, this information on current use, trends, and midterm predictions forms a rational basis for patient counseling and health care planning.

scholarly journals Psychiatry in Ukraine

2006 ◽  
Vol 3 (2) ◽  
pp. 38-40 ◽  
Author(s):  
Semyon Gluzman ◽  
Stanislav Kostyuchenko
Keyword(s):  
World Bank ◽  
National Income ◽  
Middle Income Country ◽  
Gross National Income ◽  
Income Country ◽  
Middle Income ◽  
Income Per Capita ◽  
Lower Middle Income Country ◽  
Per Capita

Ukraine, at 603 700 km2, has the second largest landmass in Europe. It has a population of about 47.4 million. Ukraine is a lower-middle-income country with a gross national income per capita of US$1260 (World Bank, 2002).

Gross national income and antibiotic resistance in invasive isolates: analysis of the top-ranked antibiotic-resistant bacteria on the 2017 WHO priority list

2019 ◽  
Vol 74 (12) ◽  
pp. 3619-3625 ◽  
Author(s):  
Alessia Savoldi ◽  
Elena Carrara ◽  
Beryl Primrose Gladstone ◽  
Anna Maria Azzini ◽  
Siri Göpel ◽  
...  
Keyword(s):  
Low Income ◽  
National Income ◽  
Resistant Bacteria ◽  
Middle Income ◽  
Priority List ◽  
Income Status ◽  
Rate Of Increase ◽  
Invasive Infections ◽  
Per Capita ◽  
Klebsiella Spp

Abstract Objectives To assess the association between country income status and national prevalence of invasive infections caused by the top-ranked bacteria on the WHO priority list: carbapenem-resistant (CR) Acinetobacter spp., Klebsiella spp. and Pseudomonas aeruginosa; third-generation cephalosporin-resistant (3GCR) Escherichia coli and Klebsiella spp.; and MRSA and vancomycin-resistant Enterococcus faecium (VR E. faecium). Methods Active surveillance systems providing yearly prevalence data from 2012 onwards for the selected bacteria were included. The gross national income (GNI) per capita was used as the indicator for income status of each country and was log transformed to account for non-linearity. The association between antibiotic prevalence data and GNI per capita was investigated individually for each bacterium through linear regression. Results Surveillance data were available from 67 countries: 38 (57%) were high income, 16 (24%) upper-middle income, 11 (16%) lower-middle income and two (3%) low income countries. The regression showed significant inverse association (P<0.0001) between resistance prevalence of invasive infections and GNI per capita. The highest rate of increase per unit decrease in log GNI per capita was observed in 3GCR Klebsiella spp. (22.5%, 95% CI 18.2%–26.7%), CR Acinetobacter spp. (19.2% 95% CI 11.3%–27.1%) and 3GCR E. coli (15.3%, 95% CI 11.6%–19.1%). The rate of increase per unit decrease in log GNI per capita was lower in MRSA (9.5%, 95% CI 5.2%–13.7%). Conclusions The prevalence of invasive infections caused by the WHO top-ranked antibiotic-resistant bacteria is inversely associated with GNI per capita at the global level. Public health interventions designed to limit the burden of antimicrobial resistance should also consider determinants of poverty and inequality, especially in lower-middle income and low income countries.

Randomized Comparison of Primary Allogeneic Stem Cell Transplantation and Best Available Drug Treatment in Chronic Myeloid Leukemia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 427-427 ◽  
Author(s):  
Rudiger Hehlmann ◽  
Markus Pfirrmann ◽  
Andreas Hochhaus ◽  
Martin C. Müller ◽  
Jörg Hasford ◽  
...  
Keyword(s):  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Stem Cell Transplantation ◽  
Drug Treatment ◽  
Treatment Strategy ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Line Treatment ◽  
Survival Curves ◽  
Related Donor

Abstract Early allogeneic hematopoietic stem cell transplantation (HSCT) has been proposed as primary treatment modality for patients (pts) with chronic myeloid leukemia (CML). This concept has been challenged by persisting transplantation mortality and improved drug therapy. In order to verify retrospective and observational results and to counsel pts and doctors about survival prospects with each treatment strategy, a randomized controlled trial was designed to compare primary HSCT and best available drug treatment in a cohort of 621 newly diagnosed CML pts in chronic phase. Assignment to treatment strategy was by eligibility for HSCT and genetic randomization according to availability of a matched related donor. Evaluation followed the intention to treat principle. 354 pts (62% male; median age 40 years, range 11–59) were eligible and randomized. 135 pts (38 %) had a matched related donor of which 123 (91%) received a transplant within a median of 10 months (range 2–106) from diagnosis. 4 pts died before scheduled transplantation, 8 pts withdrew consent. 219 pts (62%) had no related donor and received best available drug treatment. Of these, 97 pts (44%) received a matched unrelated donor (MUD) transplant in 1st chronic phase and were censored at the time of transplantation. As 1st line treatment after randomization pts received interferon alpha based therapy. In the course of the study a total of 197 pts were switched to imatinib after failure of interferon alpha. Currently 31 (57%) of 54 living pts of the drug treatment group receive imatinib or 2nd generation tyrosine kinase inhibitors (dasatinib n=2, nilotinib n=1). With a median observation time of 8.9 years (range 4.2–11.2) median survival of all 621 pts was 8.1 years. During the first 8 years after diagnosis survival curves of drug treated patients were superior to those of transplanted patients reflecting transplant-related mortality. Beyond 8 years survival curves were no longer distinct. 5 (10) year survival was 62% (53%) for transplanted and 73% (52%) for drug treated pts, in the low risk group 68% (59%) for transplanted and 85% (62%) for drug treated pts, respectively. Survival was superior for drug treated pts up to the cutpoint of survival curves at year 8 (p=0.041) and during the study period up to 11 years from diagnosis (p=0.049), particularly so in low risk pts (p=0.027 to cutpoint, p=0.032 overall). Significantly higher proportions of complete cytogenetic remissions (91% vs 61%, p=0.002) and of major molecular responses (ratio BCR-ABL/ABL &lt;0.1%; 81% vs 45%, p=0.001) were found in the transplant group indicating higher levels of residual disease in the group receiving drug treatment. In summary, the general recommendation of HSCT as 1st line treatment option in chronic phase CML can no longer be maintained. It should be replaced by a trial with modern drug treatment first and a risk adapted strategy according to the individual disease and transplantation risks thereafter. HSCT remains an important treatment option in a risk adapted strategy on the basis of higher cytogenetic and molecular long term remission rates.

scholarly journals Are digital financial payments constrained by the country's income: Evidence from the Global Findex database

2021 ◽  
pp. 115-129
Author(s):  
Marija Antonijević ◽  
Isidora Ljumović ◽  
Velimir Lukić
Keyword(s):  
Correlation Analysis ◽  
Linear Relationship ◽  
World Bank ◽  
Financial Services ◽  
National Income ◽  
Positive Linear Relationship ◽  
Per Capita ◽  
Payment Services ◽  
Digital Payments

The combined effect of ICT improvement, digitalization and change in clients' habits lead to changes in the financial sector worldwide. Increased use of digital financial services (DFS) is a change that might help to increase financial inclusion, which is particularly important for developing countries. As income is considered a critical driver of digital payments, this study aims to determine whether there is a linear relationship between a country's income measured by the level of Gross National Income per capita (GNI p.c.) and the use of digital payment services, i.e., making and receiving digital payments. We used data from the Global Findex and World Bank databases for 2017 to conduct the research, which covered 141 countries. The presence of a linear relationship between the level of GNI p.c. and the use of digital payments was tested using correlation analysis. The results of the correlation analysis show that there is a significant strong positive linear relationship between the level of GNI p.c. and the use of digital payment services in both segments, i.e., making and receiving payments. Findings are consistent with previous research and confirmed the important role of income as a driver of the use of DFS.

scholarly journals Is the proportion of per capita fat supply associated with the prevalence of overweight and obesity? an ecological analysis

BMC Nutrition ◽  
2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Hasinthi Swarnamali ◽  
Ranil Jayawardena ◽  
Michail Chourdakis ◽  
Priyanga Ranasinghe
Keyword(s):  
Balance Sheet ◽  
National Income ◽  
Population Level ◽  
Overweight And Obesity ◽  
Strong Positive Correlation ◽  
Obesity Prevalence ◽  
Middle Income ◽  
Low Fat Diet ◽  
Per Capita ◽  
United Nations Food

Abstract Background Although it is reported in numerous interventional and observational studies, that a low-fat diet is an effective method to combat overweight and obesity, the relationship at the global population level is not well established. This study aimed to quantify the associations between worldwide per capita fat supply and prevalence of overweight and obesity and further classify this association based on per capita Gross National Income (GNI). Methods A total of 93 countries from four GNI groups were selected. Country-specific overweight and obesity prevalence data were retrieved from the most recent WHO Global Health Observatory database. Per capita supply of fat and calories were obtained from the United Nations Food and Agricultural Organization database; FAOSTAT, Food Balance Sheet for years 2014–2016. The categorizations of countries were done based on GNI based classification by the World Bank. Results Among the selected countries, the overweight prevalence ranged from 3.9% (India) to 78.8% (Kiribati), while obesity prevalence ranged from 3.6% (Bangladesh) to 46.0% (Kiribati). The highest and the lowest per capita fat supply from total calorie supply were documented in Australia (41.2%) and Madagascar (10.5%) respectively. A significant strong positive correlation was observed between the prevalence of overweight (r = 0.64, p < 0.001) and obesity (r = 0.59, p < 0.001) with per capita fat supply. The lower ends of both trend lines were densely populated by the low- and lower-middle-income countries and the upper ends of both lines were greatly populated by the high-income countries. Conclusions Per capita fat supply per country is significantly associated with both prevalence of overweight and obesity.

scholarly journals Is Physical Rehabilitation Need Associated With the Rehabilitation Workforce Supply? An Ecological Study Across 35 High-Income Countries

2020 ◽  
Author(s):  
Tiago S. Jesus ◽  
Michel D. Landry ◽  
Helen Hoenig ◽  
Gilles Dussault ◽  
Gerald C. Koh ◽  
...  
Keyword(s):  
Population Size ◽  
Health Expenditure ◽  
Ecological Study ◽  
National Income ◽  
Physical Rehabilitation ◽  
High Income ◽  
Outcome Variable ◽  
Significant Independent Predictor ◽  
Per Capita ◽  
Rehabilitation Need

Background: To determine whether population-adjusted rates of physical rehabilitation need (ie, disability-related epidemiological data) are associated with the workforce supply (ie, combined rates of practicing physical therapists (PTs) and occupational therapists (OTs) per 10 000 population) across high-income countries (HICs), adjusted for socio-demographic and economic covariates. Methods: This is a cross-national ecological study. Hierarchical, multiple linear regressions analyzed current international data across 35 HICs using: current PTs and OTs supply data obtained from the international professional federations (outcome variable); needs data obtained from the Global Burden of Disease 2017 (GBD 2017); and finally relevant socio-demographic variables and supply-side covariates extracted from the World Bank, GBD 2017, the supply data sources, and the Global Health Expenditure Database. Results: The PTs and OTs per capita varied greatly across the 35 HICs, differing by as much as 40-fold. Denmark had the greatest supply per capita. Physical rehabilitation need was not a significant, independent predictor of workforce supply regardless of the multiple regression model used (P >.10). In the final model, after Bonferroni correction, 3 covariates were significant, independent predictors of the supply variable: gross national income (GNI) per capita and the current health expenditure in % of gross domestic product (GDP) were positive factors for workforce supply, while population size was a negative factor (all P <.01). Conclusion: PT and OT workforce supply is highly variable across HICs. This variability is not accounted for by an indicator of population need but rather by financial indicators and population size.

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