🇸🇪 🫎Global health ⚕️ research & education, Spanning human health in Scandinavia and around the world. Climate, infections, social factors, NCDs all matter! Situated in Umeå, on Sápmi land & part of Umeå university
https://www.umu.se/en/department-of-epidemiology-and-global-health/
| Field | Public Health |
| Purpose | Education & research |
| Place | Umeå, Sweden |
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Miguel San Sebastian
Osvaldo Fonseca Rodriguez
Isabel Goicolea
https://dx.doi.org/10.36368/jcsh.v1i1.1035
Funder: Public Health Agency
The Journal of Community Systems for Health - JCSH Publication of Umeå University Library
Background As prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in smoking initiation among adolescents. We evaluated whether a multicomponent school-based prevention programme with parental involvement has differential effects on smoking initiation across socioeconomic groups and affects the magnitude of socioeconomic inequalities in smoking initiation. Methods A secondary analysis of data from a 3-year cluster randomised controlled trial, the TOPAS study, conducted in Sweden from 2018 to 2021. Schools were randomised either to the full programme (Tobacco-Free Duo, T-DUO) or minimal intervention (EDU). The analysis was conducted according to intention to treat for the primary outcome, the probability of remaining a non-user of cigarettes at the end of compulsory school (ages 15–16). Parents’ educational attainment was the socioeconomic variable. Differential effects were analysed by comparing adolescents exposed to T-DUO with those exposed to EDU within each socioeconomic group. The effect of the intervention on the magnitude of inequalities was analysed by comparing several measures of absolute and relative inequalities between T-DUO and EDU. Results At the end of follow-up, the full programme had a similar, at most moderate effect on smoking initiation in all socioeconomic groups (relative risk 1.13 (95% CI 1.02 to 1.25) in the middle group). The programme did not significantly affect the magnitude of inequalities (Slope Index of Inequality difference 1.49 (95% CI −15.34 to 18.32)). Discussion Socioeconomic inequalities in smoking initiation remain substantial. Our results indicate the absence of an effect of the programme T-DUO on these inequalities. Data are available on reasonable request. Anonymised data from the TOPAS study can be accessed from the second author, MRG, on reasonable request and in line with the data share policy as described in the study protocol. The data share policy includes a formal written agreement with the requesting investigators and agencies to commit themselves to the same confidentiality levels as the leader institution.
Objective This study was conducted with the objective of exploring the usage of health-related quality of life (HRQOL) outcomes and willingness of health technology assessment (HTA) and public health stakeholders to use the EQ-5D-5L instrument in healthcare decision-making processes in Vietnam. Method In this qualitative study, 11 interviews were held with key stakeholders involved in healthcare decision-making for HTA between June 2021 and June 2022. The interviewees included members of the Vietnamese pharmacoeconomic council and public-health professionals from a diverse array of regions of Vietnam. The data collection involved obtaining verbal consent, warm-up discussions and interviews conducted via Zoom, with subsequent verification by interviewees. The analysis employed a theoretical thematic approach, adopting a deductive methodology to identify and analyse underlying ideas and meanings within the empirical data. Results This study highlights the general importance and viability of HRQOL measures, and more particularly the EQ-5D-5L instrument, in healthcare decision-making in Vietnam. Challenges have been identified, including insufficient recognition, interpretation, standardisation and educational initiatives relating to HRQOL measurements. This study advocates for official training programmes on HRQOL measurements, guidelines for the application of the EQ-5D-5L and an open HRQOL database in Vietnam. Concerns regarding validity and outcome variation in HRQOL measurements underline the necessity for continuous psychometric properties assessments and regular updates to national HRQOL data in the Vietnamese context. Conclusion HRQOL outcomes are important, and Vietnamese stakeholders express a readiness to employ the EQ-5D-5L in healthcare decision-making, especially HTA. Nevertheless, HRQOL measurements, including the EQ-5D-5L, are currently inadequately used in Vietnam, and further efforts are required to improve utilisation. Data are available on reasonable request.
Background Relapsed or refractory classic Hodgkin lymphoma (RRcHL) associates with poor prognosis and heavy disease burden to patients. This study evaluated the cost-effectiveness of brentuximab vedotin (BV) in comparison to conventional chemotherapy in patients with RRcHL, from a Chinese healthcare perspective. Methods The lifetime cost and quality adjusted life years (QALYs) were estimated through a partitioned survival model with three health states (progression free, post progression, and death). Two cohorts for each BV arm and chemotherapy arm were built, representing patients with and without transplant after BV or chemotherapy, respectively. Clinical parameters were retrieved from BV trials and the literature. Resource utilization data were mainly collected from local expert surveys and cost parameters were reflecting local unit prices. Utility values were sourced from the literature. A discount rate of 5% was employed according to the Chinese guideline. A series of deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness and uncertainty associated with the model. Results Results of the base case analysis showed that the incremental cost-effectiveness ratio (ICER) for BV versus chemotherapy was $2,867 (¥19,774). The main model driver was the superior progression-free and overall survival benefits of BV. The ICERs were relatively robust in a series of sensitivity analyses, all under a conventional decision threshold (1 time of Chinese per capita GDP). With this conventional threshold, the probability of BV being cost-effective was 100%. Conclusions Brentuximab vedotin can be considered a cost-effective treatment versus conventional chemotherapy in treating relapsed or refractory classic Hodgkin lymphoma in China.