scholarly journals Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review

2018 ◽  
Vol 16 (1) ◽  
pp. 11 ◽  
Author(s):  
Eric Agbata ◽  
Rachael Morton ◽  
Zeno Bisoffi ◽  
Emmanuel Bottieau ◽  
Christina Greenaway ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Treatment Efficacy ◽  
Cost Effective ◽  
Systematic Search ◽  
Screening Tests ◽  
Parasitic Infections ◽  
European Economic Area ◽  
Economic Modelling ◽  
The European Union ◽  
Serological Tests

We aimed to evaluate the evidence on screening and treatment for two parasitic infections—schistosomiasis and strongyloidiasis—among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle–Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.

scholarly journals The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

2018 ◽  
Vol 15 (9) ◽  
pp. 2013 ◽  
Author(s):  
Christina Greenaway ◽  
Iuliia Makarenko ◽  
Claire Abou Chakra ◽  
Balqis Alabdulkarim ◽  
Robin Christensen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis C ◽  
Lower Risk ◽  
Linkage To Care ◽  
Cost Effective ◽  
Screening Tests ◽  
European Economic Area ◽  
The European Union ◽  
Wide Range ◽  
The Eu

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

scholarly journals The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review

2018 ◽  
Vol 15 (9) ◽  
pp. 1898 ◽  
Author(s):  
Daniel Myran ◽  
Rachael Morton ◽  
Beverly-Ann Biggs ◽  
Irene Veldhuijzen ◽  
Francesco Castelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Cost Effective ◽  
European Economic Area ◽  
The European Union ◽  
Vaccination Programs ◽  
B Virus ◽  
The Eu

Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention.

scholarly journals Does the WTO Government Procurement Agreement Deliver What It Promises?

2018 ◽  
Vol 18 (4) ◽  
pp. 609-634 ◽  
Author(s):  
BEDRI KAMIL ONUR TAŞ ◽  
KAMALA DAWAR ◽  
PETER HOLMES ◽  
SÜBIDEY TOGAN
Keyword(s):  
Foreign Firm ◽  
Public Procurement ◽  
Cost Effective ◽  
Government Procurement ◽  
European Economic Area ◽  
The European Union ◽  
Data Set ◽  
Procurement Price ◽  
The Impact ◽  
The Eu

AbstractWe examine the impact of the World Trade Organization (WTO) Government Procurement Agreement (GPA) on government procurement practices in the European Union (EU). We analyse empirically whether the WTO GPA is effective in promoting non-discriminatory, open, transparent, competitive, and cost-effective government procurement. To study this question, we use a unique data set recently released by the EU, covering more than three million tenders conducted in the European Economic Area, Switzerland, and Macedonia during the years 2006–2016. We find that the WTO GPA promotes competition by increasing the probability of awarding a contract to a foreign firm. In addition, the WTO GPA significantly lowers corruption risk by decreasing the number of contracts with single bidders, and by decreasing total number of wins by a single firm. Finally, the WTO GPA fosters cost-effective public procurement by lowering the probability that the procurement price is higher than estimated cost.

scholarly journals Prevention and assessment of infectious diseases among children and adult migrants arriving to the European Union/European Economic Association: a protocol for a suite of systematic reviews for public health and health systems

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e014608 ◽  
Author(s):  
Kevin Pottie ◽  
Alain D Mayhew ◽  
Rachael L Morton ◽  
Christina Greenaway ◽  
Elie A Akl ◽  
...  
Keyword(s):  
European Union ◽  
Open Access ◽  
Infectious Diseases ◽  
Systematic Reviews ◽  
Search Strategy ◽  
Interdisciplinary Teams ◽  
Economic Evaluations ◽  
European Economic Area ◽  
The European Union ◽  
European Economic

IntroductionThe European Centre for Disease Prevention and Control is developing evidence-based guidance for voluntary screening, treatment and vaccine prevention of infectious diseases for newly arriving migrants to the European Union/European Economic Area. The objective of this systematic review protocol is to guide the identification, appraisal and synthesis of the best available evidence on prevention and assessment of the following priority infectious diseases: tuberculosis, HIV, hepatitis B, hepatitis C, measles, mumps, rubella, diphtheria, tetanus, pertussis, poliomyelitis (polio),Haemophilus influenzadisease, strongyloidiasis and schistosomiasis.Methods and analysisThe search strategy will identify evidence from existing systematic reviews and then update the effectiveness and cost-effectiveness evidence using prospective trials, economic evaluations and/or recently published systematic reviews. Interdisciplinary teams have designed logic models to help define study inclusion and exclusion criteria, guiding the search strategy and identifying relevant outcomes. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Ethics and disseminationThere are no ethical or safety issues. We anticipate disseminating the findings through open-access publications, conference abstracts and presentations. We plan to publish technical syntheses as GRADEpro evidence summaries and the systematic reviews as part of a special edition open-access publication on refugee health. We are following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols reporting guideline. This protocol is registered in PROSPERO: CRD42016045798.

scholarly journals Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

1996 ◽  
Vol 3 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Afaf Girgis ◽  
Philip Clarke ◽  
Robert C Burton ◽  
Rob W Sanson—Fisher
Keyword(s):  
Cost Effectiveness ◽  
Screening Programme ◽  
Cost Effective ◽  
Economic Assessment ◽  
Screening Tests ◽  
Family Practitioners ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Primary Health Care Physicians ◽  
Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

scholarly journals Design Strategies for Electrochemical Aptasensors for Cancer Diagnostic Devices

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 736
Author(s):  
Kamila Malecka ◽  
Edyta Mikuła ◽  
Elena E. Ferapontova
Keyword(s):  
Cancer Diagnosis ◽  
Cost Effective ◽  
Quality Of Healthcare ◽  
Cancer Diagnostics ◽  
Screening Tests ◽  
Design Strategies ◽  
Excellent Thermal Stability ◽  
Electrochemical Biosensing ◽  
Equipment Size

Improved outcomes for many types of cancer achieved during recent years is due, among other factors, to the earlier detection of tumours and the greater availability of screening tests. With this, non-invasive, fast and accurate diagnostic devices for cancer diagnosis strongly improve the quality of healthcare by delivering screening results in the most cost-effective and safe way. Biosensors for cancer diagnostics exploiting aptamers offer several important advantages over traditional antibodies-based assays, such as the in-vitro aptamer production, their inexpensive and easy chemical synthesis and modification, and excellent thermal stability. On the other hand, electrochemical biosensing approaches allow sensitive, accurate and inexpensive way of sensing, due to the rapid detection with lower costs, smaller equipment size and lower power requirements. This review presents an up-to-date assessment of the recent design strategies and analytical performance of the electrochemical aptamer-based biosensors for cancer diagnosis and their future perspectives in cancer diagnostics.

Square Pegs and Round Holes (Continued): Financial Market Surveillance Authorities and Internal Market Association

2020 ◽  
Vol 22 ◽  
pp. 32-59
Author(s):  
GEORGES S BAUR
Keyword(s):  
Financial Market ◽  
Financial Services ◽  
Internal Market ◽  
Trade Association ◽  
European Economic Area ◽  
The European Union ◽  
Services Sector ◽  
The United Kingdom ◽  
European Free Trade Association ◽  
The One

AbstractAfter the financial crisis of 2008, the European Union (‘EU’) not only increased its substantial legislation regarding financial services, but also built up a strong and unified system of financial market supervision. In particular, central surveillance authorities were created. These were given far-reaching competences with regard to substituting dysfunctional national authorities or players in the financial services sector. The three European Economic Area (‘EEA’) and European Free Trade Association (‘EFTA’) States—Iceland, Liechtenstein, and Norway—participate in the EU's internal market through their membership of the EEA. In order to continue participating on an equal footing in the internal market for financial services and to honour their duty to maintain homogeneity, the EEA EFTA States also had to incorporate the new institutional setup regarding financial services supervision. This obligation, however, in particular relating to certain intrusive powers of the new surveillance authorities, collided with some constitutional reservations, above all of the two Nordic EEA EFTA States. This article will show how these conflicting aims could be merged into a system that on the one hand guarantees the unified overall approach needed for strengthened surveillance of the internal market for financial services, and on the other hand safeguards certain constitutional reservations of the EEA EFTA States. It also looks at how third countries that do not (fully) participate in the internal market, such as the United Kingdom and Switzerland, are likely to be treated in this context by the EU.

scholarly journals Comparative Assessment of the Built-Up Area Expansion Based on Corine Land Cover and Landsat Datasets: A Case Study of a Post-Socialist City

2020 ◽  
Vol 12 (13) ◽  
pp. 2137 ◽  
Author(s):  
Ilinca-Valentina Stoica ◽  
Marina Vîrghileanu ◽  
Daniela Zamfir ◽  
Bogdan-Andrei Mihai ◽  
Ionuț Săvulescu
Keyword(s):  
Land Cover ◽  
Urban Expansion ◽  
Ground Truth ◽  
Cost Effective ◽  
Planning System ◽  
The European Union ◽  
Scale Level ◽  
Corine Land Cover ◽  
Macro Scale ◽  
Area Expansion

Monitoring uncontained built-up area expansion remains a complex challenge for the development and implementation of a sustainable planning system. In this regard, proper planning requires accurate monitoring tools and up-to-date information on rapid territorial transformations. The purpose of the study was to assess built-up area expansion, comparing two freely available and widely used datasets, respectively, Corine Land Cover and Landsat, to each other, as well as the ground truth, with the goal of identifying the most cost-effective and reliable tool. The analysis was based on the largest post-socialist city in the European Union, the capital of Romania, Bucharest, and its neighboring Ilfov County, from 1990 to 2018. This study generally represents a new approach to measuring the process of urban expansion, offering insights about the strengths and limitations of the two datasets through a multi-level territorial perspective. The results point out discrepancies between the datasets, both at the macro-scale level and at the administrative unit’s level. On the macro-scale level, despite the noticeable differences, the two datasets revealed the spatiotemporal magnitude of the expansion of the built-up area and can be a useful tool for supporting the decision-making process. On the smaller territorial scale, detailed comparative analyses through five case-studies were conducted, indicating that, if used alone, limitations on the information that can be derived from the datasets would lead to inaccuracies, thus significantly limiting their potential to be used in the development of enforceable regulation in urban planning.

The EU Influence on Norwegian Domestic Legislation for the Protection of the Arctic Marine Environment

2018 ◽  
Vol 33 (2) ◽  
pp. 415-435 ◽  
Author(s):  
Elise Johansen
Keyword(s):  
European Union ◽  
Marine Environment ◽  
The Arctic ◽  
European Economic Area ◽  
The European Union ◽  
Environmental Legislation ◽  
Economic Area ◽  
Domestic Legislation ◽  
Marine Areas ◽  
The Eu

Abstract In the last several decades, the European Union (EU) has demonstrated its intention to play an important role in supporting Arctic cooperation and helping to meet the challenges now facing the region. Norway, one of the five Arctic coastal states, and the EU have cooperated closely in this regard, particularly through the Agreement on the European Economic Area (EEA Agreement). This article examines how Norway’s domestic legislation applicable to its Arctic marine areas has been influenced by the development of EU environmental legislation. Specifically, this paper provides a discussion and analysis of the relevant Norwegian laws and mechanisms used to regulate how EU environmental legislation has been incorporated into Norway’s domestic legislation through the EEA Agreement.

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