Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Tufts J[original query] |
---|
Preventing Leading Causes of Death: Systematic Review of Cost-Utility Literature
Khushalani JS , Song S , Calhoun BH , Puddy RW , Kucik JE . Am J Prev Med 2021 62 (2) 275-284 INTRODUCTION: Heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke are the 5 leading causes of death in the U.S. The objective of this review is to examine the economic value of prevention interventions addressing these 5 conditions. METHODS: Tufts Medical Center Cost-Effectiveness Analysis Registry data were queried from 2010 to 2018 for interventions that addressed any of the 5 conditions in the U.S. Results were stratified by condition, prevention stage, type of intervention, study sponsorship, and study perspective. The analyses were conducted in 2020, and all costs were reported in 2019 dollars. RESULTS: In total, 549 cost-effectiveness analysis studies examined interventions addressing these 5 conditions in the U.S. Tertiary prevention interventions were assessed in 61.4%, whereas primary prevention was assessed in 8.6% of the studies. Primary prevention studies were predominantly funded by government, whereas industry sources funded more tertiary prevention studies, especially those dealing with pharmaceutical interventions. The median incremental cost-effectiveness ratio for the 5 conditions combined was $68,500 per quality-adjusted life year. Median incremental cost-effectiveness ratios were lowest for primary prevention and highest for tertiary prevention. DISCUSSION: Primary prevention may be more cost effective than secondary and tertiary prevention interventions; however, research investments in primary prevention interventions, especially by industry, lag in comparison. These findings help to highlight the gaps in the cost-effectiveness analysis literature related to the 5 leading causes of death and identify understudied interventions and prevention stages for each condition. |
Evaluation of standardized sample collection, packaging, and decontamination procedures to assess cross-contamination potential during Bacillus anthracis incident response operations
Calfee MW , Tufts J , Meyer K , McConkey K , Mickelsen L , Rose L , Dowell C , Delaney L , Weber A , Morse S , Chaitram J , Gray M . J Occup Environ Hyg 2016 13 (12) 0 Sample collection procedures and primary receptacle (sample container and bag) decontamination methods should prevent contaminant transfer between contaminated and non-contaminated surfaces and areas during bio-incident operations. Cross-contamination of personnel, equipment, or sample containers may result in the exfiltration of biological agent from the exclusion (hot) zone and have unintended negative consequences on response resources, activities and outcomes. The current study was designed to 1) evaluate currently recommended sample collection and packaging procedures to identify procedural steps that may increase the likelihood of spore exfiltration or contaminant transfer, 2) evaluate the efficacy of currently recommended primary receptacle decontamination procedures, and 3) evaluate the efficacy of outer packaging decontamination methods. Wet- and dry-deposited fluorescent tracer powder was used in contaminant transfer tests to qualitatively evaluate the currently-recommended sample collection procedures. Bacillus atrophaeus spores, a surrogate for Bacillus anthracis, were used to evaluate the efficacy of spray- and wipe-based decontamination procedures. Both decontamination procedures were quantitatively evaluated on three types of sample packaging materials (corrugated fiberboard, polystyrene foam, and polyethylene plastic), and two contamination mechanisms (wet or dry inoculums). Contaminant transfer results suggested that size-appropriate gloves should be worn by personnel, templates should not be taped to or removed from surfaces, and primary receptacles should be selected carefully. The decontamination tests indicated that wipe-based decontamination procedures may be more effective than spray-based procedures; efficacy was not influenced by material type but was affected by the inoculation method. Incomplete surface decontamination was observed in all tests with dry inoculums. This study provides a foundation for optimizing current B. anthracis response procedures to minimize contaminant exfiltration. |
Cost-utility analysis of cancer prevention, treatment, and control: a systematic review
Winn AN , Ekwueme DU , Guy GP Jr , Neumann PJ . Am J Prev Med 2015 50 (2) 241-8 CONTEXT: Substantial innovation related to cancer prevention and treatment has occurred in recent decades. However, these innovations have often come at a significant cost. Cost-utility analysis provides a useful framework to assess if the benefits from innovation are worth the additional cost. This systematic review on published cost-utility analyses related to cancer care is from 1988 through 2013. Analyses were conducted in 2013-2015. EVIDENCE ACQUISITION: This review analyzed data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), a comprehensive registry with detailed information on 4,339 original cost-utility analyses published in the peer-reviewed medical and economic literature through 2013. EVIDENCE SYNTHESIS: There were 721 cancer-related cost-utility analyses published from 1998 through 2013, with roughly 12% of studies focused on primary prevention and 17% focused on secondary prevention. The most often studied cancers were breast cancer (29%); colorectal cancer (11%); and prostate cancer (8%). The median reported incremental cost-effectiveness ratios (in 2014 U.S. dollars) were $25,000 for breast cancer, $24,000 for colorectal cancer, and $34,000 for prostate cancer. CONCLUSIONS: The current evidence indicates that there are many interventions that are cost effective across cancer sites and levels of prevention. However, the results highlight the relatively small number of cancer cost-utility analyses devoted to primary prevention compared with secondary or tertiary prevention. |
Evaluation of sampling methods for Bacillus spore-contaminated HVAC filters
Calfee MW , Rose LJ , Tufts J , Morse S , Clayton M , Touati A , Griffin-Gatchalian N , Slone C , McSweeney N . J Microbiol Methods 2014 96 1-5 The objective of this study was to compare an extraction-based sampling method to two vacuum-based sampling methods (vacuum sock and 37mm cassette filter) with regards to their ability to recover Bacillus atrophaeus spores (surrogate for Bacillus anthracis) from pleated heating, ventilation, and air conditioning (HVAC) filters that are typically found in commercial and residential buildings. Electrostatic and mechanical HVAC filters were tested, both without and after loading with dust to 50% of their total holding capacity. The results were analyzed by one-way ANOVA across material types, presence or absence of dust, and sampling device. The extraction method gave higher relative recoveries than the two vacuum methods evaluated (p≤0.001). On average, recoveries obtained by the vacuum methods were about 30% of those achieved by the extraction method. Relative recoveries between the two vacuum methods were not significantly different (p>0.05). Although extraction methods yielded higher recoveries than vacuum methods, either HVAC filter sampling approach may provide a rapid and inexpensive mechanism for understanding the extent of contamination following a wide-area biological release incident. |
Economic analyses of genetic tests in personalized medicine: clinical utility first, then cost utility.
Grosse SD . Genet Med 2013 16 (3) 225-7 In the current issue of Genetics in Medicine, Phillips et al.1 report a thorough systematic review of published cost-utility analyses (CUAs) of clinical molecular genetic tests, or personalized medicine tests as the authors refer to them. By analyzing the Tufts Cost-Effectiveness Analysis Registry, the authors identified 59 CUAs published from 1995 through to 2011 that were considered to fulfill the study criteria. One of those, however, evaluated the use of a biomarker, transferrin saturation, to test for hereditary hemochromatosis and was published in 1995,2 before the discovery of HFE in 1996. All the studies in the Cost-Effectiveness Analysis Registry use quality-adjusted life-years (QALYs) as the metric of health outcomes. The Cost-Effectiveness Analysis Registry is a comprehensive database of published CUAs that lends itself to systematic reviews with a high degree of completeness of coverage. The Cost-Effectiveness Analysis Registry has been used in numerous published analyses to study the evolution of economic evaluation in various areas of health, but this is the first analysis of the registry to focus on genomic or personalized medicine. Previous systematic reviews on economic evaluations of genetic testing have included other methods of economic evaluations in addition to CUA but may have had lesser sensitivity in identifying relevant publications. | The authors report that 20% (n = 12) of the 59 CUA studies in their sample (including a CUA of phenotypic cascade screening for hemochromatosis)2 reported negative incremental direct medical costs, i.e., cost saving. This is similar to the fraction of clinical preventive services recommended by the US Preventive Services Task Force calculated to be cost saving.3 An additional 60% of incremental cost-effectiveness ratios (ICERs) were positive, i.e., not cost saving, and less than US$100,000 per QALY, a threshold for assessing the cost effectiveness commonly cited in the US publications. |
Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older
Durazo-Arvizu RA , Dawson-Hughes B , Sempos CT , Yetley EA , Looker AC , Cao G , Harris SS , Burt VL , Carriquiry AL , Picciano MF . J Nutr 2010 140 (3) 595-9 The concentration or threshold of 25-hydroxyvitamin D [25(OH)D] needed to maximally suppress intact serum parathyroid hormone (iPTH) has been suggested as a measure of optimal vitamin D status. Depending upon the definition of maximal suppression of iPTH and the 2-phase regression approach used, 2 distinct clusters for a single 25(OH)D threshold have been reported: 16-20 ng/mL (40-50 nmol/L) and 30-32 ng/mL (75-80 nmol/L). To rationalize the apparently disparate published results, we compared thresholds from several regression models including a 3-phase one to estimate simultaneously 2 thresholds before and after adjusting for possible confounding for age, BMI, glomerular filtration rate, dietary calcium, and season (April-September vs. October-March) within a single data set, i.e. data from the Tufts University Sites Testing Osteoporosis Prevention/Intervention Treatment study, consisting of 181 men and 206 women (total n = 387) ages 65-87 y. Plasma 25(OH)D and serum iPTH concentrations were (mean +/- SD) 22.1 +/- 7.44 ng/mL (55.25 +/- 18.6 nmol/L) and 36.6 +/- 16.03 pg/mL (3.88 +/- 1.7 pmol/L), respectively. The 3-phase model identified 2 thresholds of 12 ng/mL (30 nmol/L) and 28 ng/mL (70 nmol/L); similar results were found from the 2-phase models evaluated, i.e. 13-20 and 27-30 ng/mL (32.5-50 and 67.5-75 nmol/L) and with previous results. Adjusting for confounding did not change the results substantially. Accordingly, the 3-phase model appears to be superior to the 2-phase approach, because it simultaneously estimates the 2 threshold clusters found from the 2-phase approaches along with estimating confidence limits. If replicated, it may be of both clinical and public health importance. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 13, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure