One-stage revision versus debridement, antibiotics, and implant retention (DAIR) for acute prosthetic knee infection: an exploratory cohort study.

INTRODUCTION: Studies have shown that debridement, antibiotics, and implant retention (DAIR) is an effective procedure for acute infection of total knee arthroplasty (TKA). This study aimed to explore DAIR and one-stage revision for homogenous cohorts with acute postoperative and acute hematogenous infection of TKA, without compelling indications to perform a staged revision. MATERIALS AND METHODS: This study was an exploratory analysis that used retrospective data from Queensland Health, Australia, for DAIR and one-stage revision of TKA between June 2010 and May 2017 (3-year average follow-up). The re-revision burden, mortality rate, and the cost of the interventions were explored. Costs were expressed in 2020 Australian dollars. RESULTS: There were 15 (DAIR) and 142 (one-stage) patients with homogenous characteristics in the sample. The re-revision burden for DAIR was 20%, while for one-stage revision it was 12.68%. Two deaths were associated with a one-stage revision and no death was associated with DAIR. The total cost since the index revision of DAIR, $162,939, was higher than for one-stage revision $130,924 (p value = 0.501), due to higher re-revision burden. CONCLUSIONS: This study would suggest the use of one-stage revision over DAIR for acute postoperative and acute hematogenous infection of TKA. It suggests that there could be other potential criteria which have not been ascertained that need to be considered for optimal DAIR selection. The study indicates the need for more research and, of note, high-quality randomized controlled trials to provide a well-defined treatment protocol with high level of evidence to guide patient selection for DAIR.

Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a systematic review.

OBJECTIVE: To systematically identify interventions that increase the use of mammography screening in women living in low-income and middle-income countries (LMICs). DESIGN: Systematic review. DATA SOURCES: MEDLINE, Embase, Global Health, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Google Scholar and African regional databases. ELIGIBILITY CRITERIA: Studies conducted in LMICs, published between 1 January 1990 and 30 June 2021, in the English language. Studies whose population included asymptomatic women eligible for mammography screening. Studies with a reported outcome of using mammography by either self-report or medical records. No restrictions were set on the study design. DATA EXTRACTION AND SYNTHESIS: Screening, data extraction and risk-of-bias assessment were conducted by two independent reviewers. A narrative synthesis of the included studies was conducted. RESULTS: Five studies met the inclusion criteria consisting of two randomised controlled trials, one quasi-experiment and two cross-sectional studies. All included studies employed client-oriented intervention strategies including one-on-one education, group education, mass and small media, reducing client out-of-pocket costs, reducing structural barriers, client reminders and engagement of community health workers (CHWs). Most studies used multicomponent interventions, resulting in increases in the rate of use of mammography than those that employed a single strategy. CONCLUSION: Mass and small media, group education, reduction of economic and structural barriers, client reminders and engagement of CHWs can increase use of mammography among women in LMICs. Promoting the adoption of these interventions should be considered, especially the multicomponent interventions, which were significantly effective relative to a single strategy in increasing use of mammography. PROSPERO REGISTRATION NUMBER: CRD42021269556.

Are joint replacement registries associated with burden of revision changes? A real-world panel data regression analysis.

OBJECTIVES: The association of joint replacement registries with outcomes such as revision burden is uncertain. This study aimed to evaluate whether joint replacement registries are associated with the burden of revision changes while controlling for confounders that could affect the association. DESIGN: A longitudinal study involving a combination of cross-sectional and time series data from 1980 to 2018. The study was a panel regression analysis using the difference-in-difference method. SETTING: Data from countries with joint replacement registries and countries without joint replacement registries were used. Registry data were obtained from joint replacement registries' annual reports, while non-registry data were obtained from each included country's pooled hospitals' annual revision burden reported in the literature. OUTCOME MEASURES: Changes in revision burden from 1980 to 2018 was the outcome measure. The revision burden in the registry periods of registry countries was compared with the non-registry periods of registry and non-registry countries. RESULTS: Data were obtained from 12 registry periods and 8 non-registry periods. The average difference in revision burden in the registry periods of registry countries relative to the non-registry periods of registry and non-registry countries was statistically significant for hip, -3.80 (95% CI (-2.50 to -5.10); p<0.001) percentage points and knee, -1.63 (95% CI (-1.00 to -2.30); p<0.001) percentage points. This translates to a 19.30%, and 21.85% reduction in revision burden for hip and knee registries, for the whole sampling period. CONCLUSION: Joint replacement registries are associated with a significant reduction in the burden of revision. Although revision burden reduces over time even without the registries, the establishment of joint replacement registries is associated with an increased reduction. The establishment of joint replacement registries in non-registry countries would be a worthwhile decision as it will further improve the outcomes of arthroplasty surgeries.

Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a protocol for a systematic review.

INTRODUCTION: Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women in low and middle-income countries (LMICs), including sub-Saharan Africa. Mammography screening is the most effective screening method for the early detection of breast cancers in asymptomatic individuals and the only screening test that decreases the risk of breast cancer mortality. Despite the perceived benefits, it has a low utilisation rate in comparison with breast self-examination and clinical breast examination. Several interventions to increase the uptake of mammography have been assessed as well as systematic reviews on mammography uptake. Nonetheless, none of the published systematic reviews focused on women living in LMICs. The review aims to identify interventions that increase mammography screening uptake among women living in LMICs. METHODS AND ANALYSIS: Relevant electronic databases will be systematically searched from 1 January 1990 to 30 June 2021 for published and grey literature, including citation and reference list tracking, on studies focusing on interventions to increase mammography screening uptake carried out in LMICs and written in the English language. The search will incorporate the key terms: mammography, interventions, low- and middle-income countries and their associated synonyms. Randomised controlled trials, observational studies and qualitative and mixed methods studies of interventions (carried out with and without comparison groups) reporting interventions to increase mammography screening uptake in LMICs will be identified, data extracted and assessed for methodological quality by two independent reviewers with disagreements to be resolved by consensus or by a third author. We will use narrative synthesis and/or meta-analysis depending on the characteristics of the data. ETHICS AND DISSEMINATION: Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021269556.

Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria.

BACKGROUND: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD: A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT: The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION: The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION: This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).

Introducing Rotavirus Vaccination in Nigeria: Economic Evaluation and Implications.

BACKGROUND: As Nigeria prepares to introduce a rotavirus vaccine, the Gavi board has approved the extension of the transition period for the country until 2028. The current position of the country on Gavi's funding profile calls for a pragmatic step in planning and implementation so that sustainability at the fully self-financing phase will be feasible. OBJECTIVE: This study aimed to inform the decisions of the country's health policymakers on the costs, benefits, and implications of the introduction of rotavirus vaccine. METHODS: This study was an economic evaluation using a simulation-based Markov model. It compared four approaches: 'no vaccination' and vaccination with ROTARIX, ROTAVAC, or ROTASIIL. Ten cohorts from the year 2021 to 2030 were used in the analysis. Primary measures were the benefit-cost ratio (BCR) and the incremental cost-effectiveness ratio (ICER). Future costs and outcomes were discounted to 2019 values. RESULTS: The adjusted vaccine cost of ROTARIX was the highest, followed by ROTAVAC and ROTASIIL, whereas the immunization delivery cost was in the reverse order. All the vaccines were very cost effective, with ROTARIX being the optimal choice for the 10-year period, having a BCR of 27 and an ICER of $US100 (95% confidence interval [CI] 71-130)/disability-adjusted life-year averted. Adopting ROTARIX was the optimal choice from 2021 to 2027, whereas ROTAVAC was optimal from 2028 to 2030. The net budget impact of the programme was $US76.9 million for the 10-year period. The opportunity cost of a late introduction was about $US8 million per annum from 2021 to 2028. CONCLUSIONS: The rotavirus vaccine ROTARIX should be implemented in Nigeria at the earliest opportunity. A switch to ROTAVAC should be considered from the year 2028. Cost-minimization measures are imperative to ensure the sustainability of the programme after the transition out of Gavi support.

Cost of Revision Total Knee Replacement: A Protocol for Systematic Review and Meta-Analysis.

BACKGROUND: A major limitation of total knee replacement (TKR), as with other joint replacements, is the risk of revision. Revision TKR is associated with high risk and economic burden to patients, healthcare providers, and societies. It will be worthwhile to assess the economic burden of revision TKR across countries or different study settings. This study aims to review the literature on the cost of revision TKR to assess costs across countries and studies, estimate a pooled cost estimate for homogenous data, and identify major cost components that contribute to the cost burden. METHODS: We will conduct a search of the MEDLINE (OvidSp), EMBASE, Web of Science, Cochrane Library, EconLit, and Google Scholar databases to identify relevant studies, and will use an optimally designed search approach to search for relevant studies. EndNote library will be used to manage the searched studies. Selection will be undertaken in two phases-screening and eligibility. Study selection, data extraction, and assessment of the risk of bias will be performed in duplicate, after which the data will be analysed narratively and a meta-analysis performed for homogenous studies, if possible. DISCUSSION: This protocol provides a proposed stepwise plan for conducting a systematic review and meta-analysis of the cost of revision TKR. Findings from this systematic review will provide information about the cost across settings and identify the major cost drivers of revision TKR, which will, in turn, stimulate efforts to minimize the cost. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020171988.