Mandatory Public Health Measures for Coronavirus-19 Are Associated With Improved Mortality, Equity and Economic Outcomes

The impact of public health measures on the coronavirus-2019 pandemic was analyzed by comparing mandatory versus voluntary nonpharmaceutical interventions between 2 comparable European countries and among 3 U.S. states. Using an ecological retrospective cohort study design, we examine differences in mortality, economic impact, and equity. Compared to voluntary policies, mandatory shelter-in-place policies were associated with a 3- to 5-fold lower population-adjusted mortality in the U.S. model and between 11- to 12-fold lower in the European one. Voluntary shelter-in-place measures were associated with overall increased mortality cost, as measured by value of a statistical life; somewhat greater decreases in gross domestic product; and substantial negative impacts on minority communities, who experienced markedly increased mortality rates (the percentage of minority deaths was 2.3 and 4 times greater in the U.S. model and 14.5 times higher in the European one) and mortality cost (2.7- and 4.5-fold higher in the U.S. model and 11.1-fold higher in the European one). We conclude that voluntary policies are less effective than mandatory ones, based on historical precedent and the current analysis. Negative effects on health equity mirrored the increased mortality outcomes of voluntary policies, and there was no apparent economic benefit associated with voluntary measures.

Screening for cancer of the colon and rectum A review on incidence, mortality, cost and benefit

Key words: Colorectal cancer, Screening, Incidence, Mortality, Cost-effectiveness In this article the incidence and mortality for cancer of the colon and rectum in Iceland is discussed. The two most common screening methods, faecal immunochemical test (FIT) and colonoscopy are compared and an estimate of cost and benefits for the Icelandic society will be made. The incidence of cancer of the colon and rectum has been increasing in Iceland in last decades but mortality has decreased and survival improved. However, more individuals die from cancer of the colon and rectum than from both breast- and cervical cancer added together. It is likely that screening for cancer of the colon and rectum, could prevent at least 6 of the 28 deaths related to those cancers, occurring yearly in Iceland in screening age, given a screening ages of 50-74 years. The extra cost for the Icelandic community due to the implementation of screening for cancer of the colon and rectum will be acceptable due to the lower cost of simpler treatments, lower cancer incidence and reduced mortality.

Screening for cancer of the colon and rectum A review on incidence, mortality, cost and benefit

Key words: Cardioneuroablation, Atrioventricular block, Syncope, Arrhythmia According to clinical guidelines a symptomatic atrioventricular block (AV block) is treated with a pacemaker. For young individuals such a therapy can be difficult due to possible long term complications such as infections, lead disruptions and pacemaker induced cardiomyopathy. We describe a twenty year old man with recurrent syncopes due to intermittent parasympathetic caused AV block of grade 2. The patient underwent cardioneuroablation where parasympathetic ganglia in the right atrium were ablated. After the procedure the PR interval normalized. This procedure has never been performed in Iceland before and there is a limited amount of case reports in the literature.

The mortality cost of carbon

Many studies project that climate change can cause a significant number of excess deaths. Yet, in integrated assessment models (IAMs) that determine the social cost of carbon (SCC) and prescribe optimal climate policy, human mortality impacts are limited and not updated to the latest scientific understanding. This study extends the DICE-2016 IAM to explicitly include temperature-related mortality impacts by estimating a climate-mortality damage function. We introduce a metric, the mortality cost of carbon (MCC), that estimates the number of deaths caused by the emissions of one additional metric ton of CO2. In the baseline emissions scenario, the 2020 MCC is 2.26 × 10‒4 [low to high estimate −1.71× 10‒4 to 6.78 × 10‒4] excess deaths per metric ton of 2020 emissions. This implies that adding 4,434 metric tons of carbon dioxide in 2020—equivalent to the lifetime emissions of 3.5 average Americans—causes one excess death globally in expectation between 2020-2100. Incorporating mortality costs increases the 2020 SCC from $37 to $258 [−$69 to $545] per metric ton in the baseline emissions scenario. Optimal climate policy changes from gradual emissions reductions starting in 2050 to full decarbonization by 2050 when mortality is considered.

Changing social burden of Japan’s three major diseases including Long-term Care due to aging

PurposeThe purpose of this article is to clarify the social burden of Japan’s three major diseases including Long-term Care (LTC) burden.Design/methodology/approachA modification of the Cost of Illness (COI)—the Comprehensive-COI (C-COI) was utilized to estimate three major diseases: cancer, heart disease, and cerebrovascular diseases (CVD). The C-COI consists of five parts: medical direct cost, morbidity cost, mortality cost, formal LTC cost and informal LTC cost. The latter was calculated by two approaches: opportunity cost approach (OC) and replacement approach (RA), which assumed that informal caregivers were substituted by paid caregivers.FindingsThe C-COI of cancer, heart disease and CVD in 2017 amounted to 10.5 trillion JPY, 5.2 trillion JPY, and 6.7 trillion JPY, respectively (110 JPY= 1 US$). The mortality cost was preponderant for cancer (61 percent) and heart disease (47.9 percent); while the informal LTC cost was preponderant for CVD (27.5 percent). The informal LTC cost of the CVD in OC amounted to 1.8 trillion JPY; while the RA amounted to 3.0 trillion JPY.Social implicationsThe LTC burden accounted for a significant proportion of the social burden of chronic diseases. The informal care was maintained by unsustainable structures such as the elderly providing care for the elderly. This result can affect health policy decisions.Originality/valueThe C-COI is more appropriate for estimating the social burden of chronic diseases including the LTC burden and can be calculated using governmental statistics.

Patient Outcomes, Cost, and Length of Stay Associated With Biventricular Assist Devices in the United States (2009-2015)

Objectives: With recent advances in left ventricular assist device (LVAD) technology, the utilization of LVADs has increased while mortality, cost, and length of stay (LOS) have significantly decreased. This study sought to determine the national trends of surgically implanted biventricular assist devices (BiVADs). Methods: This is a retrospective analysis of the National Inpatient Sample (NIS) database for internal BiVADs (n = 538) and external BiVADs (n = 727) from 2009 to 2015. Results: Utilization of all surgically implanted BiVADs decreased (4.8% per year, p < 0.001), and was driven by a decline in utilization of external BiVADs (9.4% per year, p < 0.001). There was no significant change in BiVAD-associated mortality. However, cost and LOS increased significantly, and these trends were isolated to patients who died during their hospitalization. Patients with internal BiVADs incurred higher cost than external BiVAD patients but were more likely to survive. Conclusions: The decline in surgically implanted BiVAD utilization may be due to an improvement in LVAD technology as well as an increase in the availability of percutaneous temporary circulatory support. Future prospective studies are needed to compare various BiVAD configuration strategies and to optimize BiVAD patient selection and perioperative care.

Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding

Background and study aims Current guidelines conditionally recommend performing early colonoscopy (EC) (< 24 hours) in patients admitted with acute lower gastrointestinal bleeding (LGIB). It remains unclear whether this practice is implemented widely. Therefore, we used the Nationwide Inpatient Sample to investigate trends for timing of colonoscopy in patients admitted with acute LGIB. We also assessed trend of hospitalization and mortality in patients with LGIB. Patients and methods Adult patients with LGIB admitted from 2005 to 2014 were examined. ICD-9-CM codes were used to extract LGIB discharges. Trends were assessed using Cochrane-Armitage test. Factors associated with mortality, cost of hospitalization, and length of stay (LOS) were assessed by multivariable mixed-effects and exact-matched logistic, linear regression, and accelerated-failure time models, respectively. Results A total of 814,647 patients with LGIB were included. The most common etiology of LGIB was diverticular bleeding (49 %) and 45 % of patients underwent EC. Over the study period, there was no change in the trend of colonoscopy timing. Although admission with LGIB increased over the study period, the mortality rate decreased for patients undergoing colonoscopy. Independent predictors of mortality were age, surgery (colostomy/colectomy) during admission, intensive care unit admission, acute kidney injury, and blood transfusion requirement. Timing of colonoscopy was not associated with mortality benefit. However, cost of hospitalization was $ 1,946 lower and LOS was 1.6 days shorter with EC. Conclusion Trends in colonoscopy timing in management of LGIB have not changed over the years. EC is associated with lower LOS and cost of hospitalization but it does not appear to improve inpatient mortality.

Cost of premature mortality attributable to smoking in the Middle East and North Africa

Background: Tobacco smoking is a leading cause of premature mortality, incurring substantial economic costs. Aims: To estimate the rate and cost of premature mortality attributable to smoking in the 24 Middle East and North Africa (MENA) countries in 2015. Methods: Smoking attributable fractions were estimated. Twenty-four smoking-related diseases were included in the analysis. For each country, the total number of deaths by disease, age, and gender among individuals aged ≥ 15 years were derived from a World Health Organization database. Human capital approach was used in calculating cost of premature mortality. Results: Smoking was responsible for 465 285 deaths in MENA countries, resulting in 7 122 706 years of potential life lost, or an average of 15.23 years lost per smoking-related death. Of the total 465 285 smoking-related deaths, 412 415 (88.6%) occurred in men, accounting for 37% of all deaths from the diseases considered in this analysis among men. The total mortality cost attributable to smoking was estimated at US$ 29.7 billion in 2015 (0.76% of MENA’s gross domestic product). Turkey was the country most affected by the tobacco epidemic, representing 41% of smoking-related mortality cost in the whole region, followed by Saudi Arabia (8.76%) and Egypt (7.88%). Conclusion: Smoking is an important preventable cause of premature mortality in MENA countries. Substantial decline in smoking-attributable deaths and significant economic cost saving can be achieved in this region through more effective tobacco control policies.

Estimasi Premature Mortality Cost (PMC) Penyakit Kanker Akibat Perokok Pasif di Indonesia

Indonesia merupakan salah satu negara dengan prevalensi perokok terbesar di dunia. Tingginya angka perokok di Indonesia mengakibatkan risiko peningkatan jumlah orang terpapar atau menghirup asap rokok sebagai secondhand smoke. Secondhand smokemerupakan salah satu faktor risiko penyakit kanker. Penelitian mengenai estimasi beban penyakit kanker ini bertujuan untuk melihat seberapa besar angka kematian dan prematuremortality cost penyakit kanker akibat secondhand smokedi Indonesia. Estimasi beban penyakit kanker akibat secondhand smokemerupakan penelitian epidemiologi deskriptif dan estimasi berdasarkan prevalence-baseddengan indikator yang digunakan yaitu angka kematian penyakit kanker akibatsecondhand smokedan premature mortality cost. Angka kematian penyakit kanker akibat secondhand smoke (SAM) diperoleh dengan mengalikan nilai Secondhand smokeAttributable Fractions (SAFs) dengan angka kematian tiap penyakit kanker, dimana nilai SAFs diperoleh dari rumus perhitungan menggunakan data prevalensi secondhand smokedan relative risk tiap penyakit. Premature mortality cost diperoleh dengan mengalikan angka kematian penyakit kanker akibat perokok pasif, angka harapan hidup, dan rata-rata pendapatan masyarakat Indonesia. Jumlah angka kematian tertinggi untuk penyakit kanker akibat secondhand smoke adalah kanker paru (949 kematian), kanker kolon (771 kematian), dan kanker pankreas (371 kematian). Nilai tertinggi dari premature mortality costadalah Rp 56.882.000.000 untuk kanker paru, Rp 51.398.000.000 untuk kanker kolon, dan Rp 22.850.000.000 untuk kanker pankreas. Estimasi beban penyakit kanker akibat secondhand smokeperlu dilakukan untuk membantu pemerintah dalam menentukan program kesehatan dan untuk mengurangi beban penyakit kanker akibat secondhand smokedi Indonesia.