Economic burden of Thalassemia treatment: An analysis from the Vietnam Social Security perspective.

OBJECTIVES: Thalassemia is a genetic disorder that significantly impacts the health and well-being of individuals in Vietnam. This study aimed to assess the economic burden of Thalassemia treatment in Lam-Dong Province from the perspective of the Vietnam Social Security and to develop a model to forecast these costs. METHODS: This study analyzed the medical records of all 288 health-insured Thalassemia patients who received treatment in Lam-Dong Province from 2019-2021. The annual economic burden was calculated as the total direct medical cost of treatment per patient over one year. Bayesian Model Averaging (BMA) was utilized to forecast economic burdens. The best fit model was selected based on evaluation criteria including the R2 value, the Bayesian information criterion (BIC), and posterior model probabilities. RESULTS: The study found that the average annual economic burden of Thalassemia treatment was VND 9,947,000 (±6,854,000), equivalent to approximately USD 426.7 (±294.0), with blood transfusions being the main contributor to costs (63%). Using BMA, the best fit model to forecast economic burdens included variables including patient age, sex, and length of hospitalization, with age being the key factor with the greatest impact on the increase in economic burden. CONCLUSION: These findings provided important information for policymakers in Vietnam, as they highlighted the significant economic burden of Thalassemia treatment in the country. By developing a model to forecast these costs, policymakers can make informed decisions on how to allocate resources and support individuals with Thalassemia and their families.

Prognosis of outcome in adult survivors of road accidents in France: one-year follow-Up in the ESPARR cohort.

OBJECTIVE: The consequences of road crashes are various, and few studies have dealt with the multidimensionality of outcomes. The aim of the present study was to assess the multidimensional nature of outcomes one year after a crash and to determine predictive factors that could help in adapting medical and social care to prevent such consequences to improve road crash victims' prognosis. METHODS: The study population was the 886 respondents to the one-year follow-up from the ESPARR (Etude et Suivi d'une Population d'Accidentés de la Route du Rhône) cohort, aged ≥ 16 years; the analysis was carried out only on the 616 subjects who fully completed a self-report questionnaire on health, social, emotional, and financial status one year after a crash. Multiple correspondence analysis and hierarchical clustering was implemented to produce homogeneous groups according to differences in outcome. Groups were compared using the World Health Organization Quality of Life Assessment (WHOQOL-BREF, a standard instrument of quality of life, assessing physical health, psychological health, social relationships, and environment) and the Injury Impairment Scale (IIS), a tool to predict road crash sequelae. Baseline predictive factors for group attribution were analyzed by weighted multinomial logistic regression models. RESULTS: Three hundred seventeen of the 616 subjects (60.1%) were men. Mean age was 36.9 years (SD = 16.5). Five victim groups were identified in terms of consequences at one year: one group (206 subjects, 33.4%) with few problems, one with essentially physical sequelae, one with problems that were essentially both physical and social, and 2 groups with a wider range of problems (one including psychological problems but fewer environmental problems; the last one reported negative physical, psychological, social, and environmental impact; notably, all had post-concussion syndrome [PCS]). There were significant differences between groups in terms of family status, injury severity, and certain types of injury (thorax, spine, lower limbs). Comparison on the WHOQOL-BREF confirmed that groups reporting more adverse outcomes had a lower quality of life. Description of the 5 groups by IIS indicators showed that IIS underestimated physical consequences one year after the crash. In addition to the known prognostic factors such as age, initial injury severity, and injury type, socioeconomic fragility and having a relative involved in the accident emerged as predictive of poor outcome at one year. CONCLUSIONS: One year after the crash, victims may still be experiencing multiple problems in terms of not only physical health but also of mental health, social life, and environment. Poor outcome may be predicted from both accident-related factors and socioeconomic fragility. Our results are useful in catching the attention of both clinicians and the public administration regarding victims at risk of suffering from important consequences after an accident. If those suffering head injuries are recognized, it would be very important to better consider and treat posttraumatic stress disorder (PTSD) or PCS. Furthermore, subjects from lower socioeconomic backgrounds, with or without lower limb injuries, have numerous difficulties after an accident, notably for returning to work. An objective would be to provide them with more specific support. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Quality of life one year after a road accident: results from the adult ESPARR cohort.

BACKGROUND: There are a few studies assessing repercussions in road accident victims, which reported their results in quality of life (QoL), on an epidemiologic point of view. METHODS: ESPARR (follow-up of victims of road accident in the Rhône) is a prospective cohort study of 1,168 individuals (age ≥ 16 years) involved in road traffic accidents, having been admitted to one of the hospitals in the Rhône département (France). The World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-Bref) was used to assess QoL at the 1-year follow-up. χ(2) analysis was performed to test differences between groups, logistic regression was performed to examine predictors of global QoL and health, and linear regression was performed to examine predictors of the four functioning domains of the WHOQOL-Bref. RESULTS: Lesion severity (New Injury Severity Index ≥ 16; odds ratio, 2.6; 95% confidence interval, 1.7-3.9) and presence of head lesions (odds ratio, 1.5; 95% confidence interval, 1.1-2.2) were predictive of unsatisfactory QoL. Female sex, educational level lower than school graduation, severe injury, intention to lodge a complaint, early postaccident medical complications were predictive of health dissatisfaction. Several factors seemed to be associated to a poor QoL; notably, posttraumatic stress disorder was associated with low scores in all four WHOQOL-Bref domains. Socioeconomic factors were also significant, notably financial problems. CONCLUSION: The strong points of the present study lie in the fact that it is based on a representative cohort of road accident victims in an area in which all those treated within the hospital system after a road accident have been registered. The present study shows the strong correlation between QoL and posttraumatic stress disorder. LEVEL OF EVIDENCE: Prognostic study, level II.

Outcomes one year after a road accident: Results from the ESPARR cohort.

OBJECTIVE: Reducing the rates of death, trauma and sequelae associated with road accidents is the prime goal of road safety authorities, and success requires having data on victims' outcomes in the long term. The present study examined the outcome of adult road accident victims one year after their accident. DESIGN: A follow-up study. METHODS: The cohort comprised 886 injured road-accident victims, aged ≥16 years, and living in the Rhône administrative Département, France (taken from the ESPARR Cohort). Data were collected on victim characteristics at the time of crash, and self-reported outcomes one year later. The population of respondents at the one-year questionnaire follow-up was divided into two categories according to injury severity, as mild-to-moderate (M.AIS<3) or severe (M.AIS 3+). Qualitative variables were compared between these 2 groups using Chi(2) or Fisher exact tests. RESULTS: At one year post-accident, 45% of the mild-to-moderate injury group versus only 20% of severely injured subjects reported full recovery of health (p<0.001). 20% of the cohort, as a whole, reported permanent pain. More than half of the severely injured subjects reported that the accident had had an impact on the everyday life of their family; this was twice as many as in the mild-to-moderate injury group (55% vs. 22%). Most of the severely injured reported impact on leisure, projects and emotional life: 20% reported relational difficulties in the couple, 16% reported impaired sexual life, and the rate of separation was significantly higher than in the mild-to-moderate injury group (5% vs. 1%; p<0.001). Mean time off work was significantly longer in the severe injury group: 245±158 days vs. 75±104 days (p<0.001); and 32% of the severe injury group (p<0.001) who had stopped work had not returned at 1 year, compared to 5% of the mild-to-moderate injury group. CONCLUSIONS: One year after a road accident, the consequences for victims remain significant. In terms of physical impact, pain frequently persists, impairing daily life for many. There is an elevated rate of chronic PTSD (post-traumatic stress disorder) and a non-negligible impact on affective and occupational life.

Evaluation of the injury impairment scale, a tool to predict road crash sequelae, in a French cohort of road crash survivors.

OBJECTIVE: The objective of the present study was to validate sequelae prediction by the Maximal Injury Impairment Score (M-IIS) in comparison with the Functional Independence Measure (FIM) assessed at 1-year follow-up of severe road crash victims. METHODS: The study population came from "the Etude et Suivi d'une Population d'Accidentés de la Route dans le Rhône" (ESPARR; Rhône Area Road Crash Victim Follow-up Study) cohort: 178 victims (with Maximal Abbreviated Injury Scale ≥ 3) of road crashes in the Rhône administrative department of France, aged ≥ 16 years and with medical examination including FIM scoring 1 year postaccident. Two thresholds were tested for both scores. Firstly, the relation between FIM and M-IIS was assessed on logistic regression models adjusted on age and presence of complications at 1 year postaccident. The predictive capacity of M-IIS was expressed as its negative and positive predictive values and was considered good when 80 percent or better. RESULTS: Sixty-three of the 178 adult subjects (mean age = 37.7 years; range = 16.1-82.9 years) showed postaccident complications. One-year sequelae prediction on M-IIS was greater in head, spine, and limb lesions but limited to slight impairments (M-IIS = 1). There was a significant correlation between FIM and M-IIS, although age and medical complications were confounding factors on certain multivariate models. The predictive capacity of M-IIS was low for all types of sequelae. CONCLUSIONS: M-IIS, in this severely injured population, failed to predict sequelae at 1 year as measured by the FIM, despite a good correlation between the two. Complications are to be taken into account in assessing the M-IIS's capacity to predict sequelae. Further evaluation will be needed on larger series or assessment of other indicators and measures of sequelae at 1 year to obtain a robust tool to predict road crash sequelae.

Predicting self-reported recovery one year after major road traffic accident trauma.

OBJECTIVE: The aim of this study was to examine the self-reported health status of road traffic accident victims and the predictors of self-assessed recovery 1 year after major trauma in a French population. DESIGN: A follow-up study. METHODS: The cohort comprised 276 seriously injured victims of road traffic accidents, aged > 16 years from the Rhône administrative department, France. Victim characteristics at the time of the crash and self-reported health status 1 year after trauma were collected. Predictive factors for self--assessed recovery were examined using a Poisson regression approach. RESULTS: The majority of victims were male (76%); most had severe injuries (76%), involving mainly the lower limbs and the head (68% and 55%, respectively). At 1-year follow-up, 80% reported being not fully recovered. Self-reported health status was not significantly associated with age, gender, being in employment, type of road user, or health status during the year preceding the accident, but rather with low socio-economic status, high injury severity, and presence of lower limb injury. CONCLUSION: Care for subjects who are at high risk of not fully recovering (manual workers, the very seriously injured, and those with lower limb injury) needs to be extended and improved. Longer follow-up studies on the risk factors for not fully recovering are needed in order to reduce harmful consequences for victims.