The impact of the COVID-19 pandemic on people living with HIV in Zimbabwe

The COVID-19 pandemic was reported from March 2020 in Zimbabwe. COVID-19 containment measures which included repeated lockdowns have disrupted community interactions, reduced working hours, restricted travel and restricted HIV services for people living with HIV (PLHIV), among others. The study adopted a cross-sectional design. Both qualitative and quantitative data were collected in all the 10 provinces and analysed. A sample size of 480 was calculated for the cross-sectional survey. Secondary data on HIV early warning indicators from 2018 to 2021 were extracted from 20 randomly selected health facilities and used for modelling. Mathematical modelling was conducted to assess the impact of COVID-19 on PLHIV. AIDS-related deaths increased from 20 100 in 2019 to 22 200 in 2020. In addition, there were significant years of life lost (yLLs) from premature mortality and years of life lost due to disability (yLDs) from COVID-19. Prevalence of COVID-19 among PLHIV was 4%. COVID-19 vaccination coverage was 64%, which is higher than the national average of 42%. Stress and breach of confidentiality as ARV medicines were given out in open spaces and fear of contracting COVID-19 were the perceived psychological issues. COVID-19 disrupted HIV service provision, increased AIDS-related deaths and caused psychological challenges

Cost-effectiveness analysis of insulin aspart 30 versus insulin glargine in patients with type 2 diabetes in China / 中国药学杂志

OBJECTIVE: To evaluate the long-term cost-effectiveness of once-daily biphasic insulin aspart (BIAsp 30) versus insulin glargine (IGlarg) in patients with type 2 diabetes (T2DM) in China. METHODS: The validated and peer-reviewed CORE Diabetes Model was employed to simulate disease progression and determine the total direct medical cost, life years (LYs) and quality-adjusted life years (QALYs) over 30 years. Simulated cohorts and treatment effects were based on the Chinese subgroup (n=422) in the Easymix study (identifier in ClinicalTrials. gov: NCT01123980) which was an open-label, randomized, two-arm and multicenter trial among insulin-naive people with T2DM. Treatment costs were based on insulin doses in the trial and market retail prices in China. Management and complication costs were obtained from Chinese published data in 2011 and adjusted to the price level of 2013 with consumer price index. An annual discounting rate of 3% was used for both costs and health outcomes. One-way sensitivity analyses and probability sensitivity analyses were performed. RESULTS: Treatment with BIAsp 30 is associated with LY gain of 0.11 (13.72 vs 13.60) and QALY gain of 0.10 (9.66 vs 9.56) compared with IGlarg over 30 years. In terms of total average cost per patient, BIAsp 30 was less costly than IGlarg (CNY-46 809, CNY 197 496 vs 244 305). Sensitivity analyses demonstrated robustness of the results. CONCLUSION: Compared with once daily IGlarg, treatment with BIAsp 30 is projected to be associated with improved life expectancy and reduces direct medical cost, represents a dominant treatment option among patients with T2DM.

Los QALYs y DALYs como indicadores sintéticos de salud / QALYs and DALYs as synthetic indicators of health

This article is a revision of the genesis and use of the health synthetic indicators QALYs and DALYs. The chronology of their appearance is shown and similarities and differences between them stated. DALYs (Disability-Adjusted Life-Years) correspond to years of life that are adjusted by a certain level of disability experienced during a particular period of time. DALYs, by studying disease burden, summarize the impact of mortality and disability related to specific disease in different communities. On the other hand, QALYs (Quality-Adjusted Life-Years) summarize health results in an indicator that combines the number of years lived with the quality of life experienced over those years. QALYs and DALYs play a crucial role as results measures in economic evaluation studies (cost-effectiveness and cost-utility analysis) measuring the impact of actions or specific interventions in the reversion of disease burden (DALYs) and/ or the improvement of the quality of life and life expectancy of patients (QALYs). Their generic character allows the comparison of the impact of health interventions for different diseases.

En el presente artículo se revisa la génesis y uso de los indicadores sintéticos de salud QALYs y DALYs. Se muestra la cronología de su aparición y se establecen las semejanzas y diferencias entre los mismos. Los DALYs (Disability Adjusted Life Years) corresponden a los años de vida ajustados por la Discapacidad o AVADs por su sigla en español. Los DALYs resumen, mediante estudios de carga de la enfermedad, el impacto de la mortalidad y discapacidad asociada a enfermedades especificas, en distintas comunidades; en cambio los QALYs (Quality Adjusted Life Years) sintetizan los resultados de salud en un indicador que combina el número de años vividos con la calidad de vida experimentada durante esos años. QALYs y DALYs cumplen hoy un papel esencial como medidas de resultado en los estudios de evaluación económica (análisis de costo efectividad y costo utilidad) midiendo el impacto de acciones o intervenciones especificas para revertir la carga de la enfermedad (DALYs) y/o mejorar la calidad y esperanza de vida de pacientes (QALYs). Su carácter genérico permite comparar el impacto de intervenciones de salud entre diferentes enfermedades.