Suchergebnisse

Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated mass treatment with ivermectin in 16 sub-Saharan countries (Angola, Burundi, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Liberia, Malawi, Nigeria, North Sudan, South Sudan, Uganda, and the United Republic of Tanzania) with the aim to control morbidity due to infection with Onchocerca volvulus, a filarial nematode. Recently, we predicted trends in prevalence of infection, visual impairment, blindness, and troublesome itch due to onchocerciasis in APOC countries for the period 1995–2015, based on extensive data on pre-control infection levels, population coverage of ivermectin mass treatment, and the association between infection and morbidity. We also estimated the associated health impact, expressed in disability-adjusted life years (DALYs).

Objectives: To project the number of people aged 45–64 years with lost productive life years (PLYs) due to diabetes and related costs (lost income, extra welfare payments, lost taxation revenue); and lost gross domestic product (GDP) attributable to diabetes in Australia from 2015 to 2030. Design: A simulation study of how the number of people aged 45–64 years with diabetes increases over time (based on population growth and disease trend data) and the economic losses incurred by individuals and the government. Cross-sectional outputs of a microsimulation model (Health&WealthMOD2030) which used the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers 2003 and 2009 as a base population and integrated outputs from two microsimulation models (Static Incomes Model and Australian Population and Policy Simulation Model), Treasury's population and labour force projections, and chronic disease trends data. Setting: Australian population aged 45–64 years in 2015, 2020, 2025 and 2030. Outcome measures: Lost PLYs, lost income, extra welfare payments, lost taxation revenue, lost GDP. Results: 18 100 people are out of the labour force due to diabetes in 2015, increasing to 21 400 in 2030 (18% increase). National costs consisted of a loss of $A467 million in annual income in 2015, increasing to $A807 million in 2030 (73% increase). For the government, extra annual welfare payments increased from $A311 million in 2015 to $A350 million in 2030 (13% increase); and lost annual taxation revenue increased from $A102 million in 2015 to $A166 million in 2030 (63% increase). A loss of $A2.1 billion in GDP was projected for 2015, increasing to $A2.9 billion in 2030 attributable to diabetes through its impact on PLYs. Conclusions: Individuals incur significant costs of diabetes through lost PLYs and lost income in addition to disease burden through human suffering and healthcare costs. The government incurs extra welfare payments, lost taxation revenue and lost GDP, along with direct healthcare costs ; Full Text

Objectives: To project the number of older workers with lost productive life years (PLYs) due to chronic disease and resultant lost income; and lost taxes and increased welfare payments from 2015 to 2030. Design, setting and participants: Using a microsimulation model, Health&WealthMOD2030, the costs of chronic disease in Australians aged 45–64 were projected to 2030. The model integrates household survey data from the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers (SDACs) 2003 and 2009, output from long-standing microsimulation models (STINMOD (Static Incomes Model) and APPSIM (Australian Population and Policy Simulation Model)) used by various government departments, population and labour force growth data from Treasury, and disease trends data from the Australian Burden of Disease and Injury Study (2003). Respondents aged 45–64 years in the SDACs 2003 and 2009 formed the base population. Main outcome measures: Lost PLYs due to chronic disease; resultant lost income, lost taxes and increased welfare payments in 2015, 2020, 2025 and 2030. Results: We projected 380 000 (6.4%) people aged 45–64 years with lost PLYs in 2015, increasing to 462 000 (6.5%) in 2030—a 22% increase in absolute numbers. Those with lost PLYs experience the largest reduction in income than any other group in each year compared to those employed full time without a chronic disease, and this income gap widens over time. The total economic loss due to lost PLYs consisted of lost income modelled at $A12.6 billion in 2015, increasing to $A20.5 billion in 2030—a 62.7% increase. Additional costs to the government consisted of increased welfare payments at $A6.2 billion in 2015, increasing to $A7.3 billion in 2030—a 17.7% increase; and a loss of $A3.1 billion in taxes in 2015, increasing to $A4.7 billion in 2030—a growth of 51.6%. Conclusions: There is a need for greater investment in effective preventive health interventions which improve workers' health and work capacity. ; Full Text

BACKGROUND: Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015. METHODS AND FINDINGS: With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million. CONCLUSIONS: Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.