Global versus focused isolation during the SARS-CoV-2 pandemic-A cost-effectiveness analysis

ObjectivesWhile highly effective in preventing SARS-CoV-2 spread, national lockdowns come with an enormous economic price. Few countries have adopted an alternative "testing, tracing, and isolation" approach to selectively isolate people at high exposure risk, thereby minimizing the economic impact. To assist policy makers, we performed a cost-effectiveness analysis of these two strategies. MethodsA modified Susceptible, Exposed, Infectious, Recovered and Deceased (SEIRD) model was employed to assess the situation in Israel, a small country with ~9 million people. The incremental cost-effectiveness ratio (ICER) of these strategies, as well as the expected number of infected individuals and deaths were calculated. ResultsA nationwide lockdown is expected to save on average 274 (median 124, interquartile range (IQR): 71-221) lives compared to the "testing, tracing, and isolation" approach. However, the ICER will be on average $45,104,156 (median $ 49.6 million, IQR: 22.7-220.1) to prevent one case of death. ConclusionsA national lockdown has a moderate advantage in saving lives with tremendous costs and possible overwhelming economic effects. These findings should assist decision-makers dealing with additional waves of this pandemic. HighlightsO_LIDrastic measures of national lockdowns are taken by many countries to slow-down SARS-CoV-2 spread. However, these measures have detrimental economic effects. C_LIO_LIHere we compare two strategies to control the epidemic using a modified SEIRD model: 1. Global national lockdown 2. Focused isolation of people at high exposure risk, following detailed epidemiological investigations. C_LIO_LIWe show that strategy 1 is modestly superior in saving lives compared to strategy 2, but with tremendous costs to prevent one case of death. This might result in overwhelming economic effects that are expected to increase future death toll. C_LI

Validation of New Symptom-Based Fibromyalgia Criteria for Irritable Bowel Syndrome Co-morbidity Studies

BACKGROUND/AIMS: There is significant co-morbidity between irritable bowel syndrome (IBS) and fibromyalgia syndrome (FMS). However, FMS is diagnosed by physical examination, which limits the conduct of co-morbidity studies in a large population-based study. The purpose of this study was to determine the diagnostic validity of a new symptom-based criteria in patients with FMS and/or IBS using the American College of Rheumatology (ACR) criteria as a gold standard. METHODS: The study participants consisted of women with FMS (n = 30), IBS (n = 27) and controls (n = 28). A new symptom-based diagnostic criteria for FMS comprised a regional pain scale and a visual analogue scale for fatigue. All subjects underwent a physical examination for FMS (ACR criteria) and structured questionnaires of regional pain scale and visual analogue scale for fatigue. A fibromyalgia intensity score was calculated and thresholds of tenderness were determined by a dolorimeter. RESULTS: The number of participants diagnosed with FMS in the entire study population (n = 85) was 31 by the new criteria. Compared to the ACR, the sensitivity of the new criteria was 82.9%, specificity 96.0%, positive predictive value 93.5% and negative predictive value 88.9%. In addition, new criteria were useful for the diagnosis of FMS among the subjects with IBS. A fibromyalgia intensity score was significantly correlated with the threshold of tenderness (r = -0.62, P < 0.001). CONCLUSIONS: The new symptom-based diagnostic criteria for the diagnosis of FMS can be used in large-scale clinical and epidemiological co-morbidity studies, in which physical examination is unfeasible. Gastroenterologists investigating the effects of co-morbid FMS in IBS patients can use these new ciriteria with confidence.

Do urea breath test (UBT) referrals for Helicobacter pylori testing match the clinical guidelines in primary care practice? A prospective observational study.

BACKGROUND: Various international guidelines recommend the use of non-endoscopic tests [such as urea breath test (UBT)] for the evaluation of dyspeptic patients, unless endoscopy is clinically indicated. AIM: To assess adherence with guidelines for UBT referrals among primary care doctors in Israel. METHODS: Patients referred by primary care doctors to an open-access UBT service were included in the study. Prior to the test, all patients were administered with a short questionnaire regarding their symptoms, previous and concomitant medications including previous Helicobacter pylori eradication. RESULTS: The study sample consisted of 209 patients, aged 18-94 years, M/F = 74/135. The UBT was judged to be appropriate in 94 (45%) subjects, inappropriate in 93 (44.5%) subjects and appropriate but avoidable in 22 (10.5%) subjects, most of them asymptomatic patients following anti H. pylori treatment. The inappropriate indications include 38 (18%) patients with suspected gastro-oesophageal reflux disease symptoms and 21 (10%) dyspeptic patients aged 45 years or more. CONCLUSION: Nearly 45% percent of UBT referrals in primary care practice were inappropriate, and a significant number of dyspeptic patients should have been referred to endoscopy. These findings show a substantial non-compliance with guidelines for H. pylori testing among primary care doctors.