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  1. Article ; Online: Cost analysis of lurasidone for the treatment of schizophrenia in adolescents and adults within the United Kingdom.

    Dymond, Amy / Afonso, Daniela / Green, Will

    BMC health services research

    2022  Volume 22, Issue 1, Page(s) 1084

    Abstract: Background: Schizophrenia is a serious mental health condition characterised by distortions in thought processes, perception, mood, sense of self, and behaviour. Lurasidone, a second-generation atypical antipsychotic, represents an additional treatment ... ...

    Abstract Background: Schizophrenia is a serious mental health condition characterised by distortions in thought processes, perception, mood, sense of self, and behaviour. Lurasidone, a second-generation atypical antipsychotic, represents an additional treatment option alongside existing antipsychotics for adolescents and adults with schizophrenia. An economic model was developed to evaluate the incremental costs of lurasidone as a first-line treatment option compared to existing antipsychotics.
    Methods: A Markov model was developed to estimate the cost impact of lurasidone as a first-line treatment option for both adolescents and adults. The sequence-based model incorporated the following health states: stable (no relapse or discontinuation), discontinuation (due to adverse events or other reasons), and relapse. Data used to determine the movement of patients between health states were obtained from network meta-analyses (NMAs). The time horizon ranged from three to five years (depending on the patient population) and a six-weekly cycle length was used. Unit costs and resource use were reflective of the UK NHS and Personal Social Services and consisted of the following categories: outpatient, adverse events, primary and residential care. Extensive deterministic sensitivity analysis was undertaken to assess the level of uncertainty associated with the base case results.
    Results: Lurasidone is demonstrated to be cost-saving as a first-line treatment within the adolescent and adult populations when compared to second-line and third-line respectively. Lurasidone is more expensive in terms of treatment costs, resource use (in the stable health state) and the treatment of adverse events. However, these costs are outweighed by the savings associated with the relapse health state. Lurasidone remains cost-saving when inputs are varied in sensitivity analysis and scenario analysis.
    Conclusions: Lurasidone is a cost-saving first-line treatment for schizophrenia for both adolescents and adults.
    MeSH term(s) Adolescent ; Adult ; Antipsychotic Agents/therapeutic use ; Chronic Disease ; Cost-Benefit Analysis ; Humans ; Lurasidone Hydrochloride/therapeutic use ; Recurrence ; Schizophrenia/drug therapy ; United Kingdom
    Chemical Substances Antipsychotic Agents ; Lurasidone Hydrochloride (O0P4I5851I)
    Language English
    Publishing date 2022-08-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-022-08436-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Economic Evaluation of Tirbanibulin for the Treatment of Actinic Keratosis in Scotland.

    Dymond, Amy / Green, Will / Edwards, Mary / Pont, Maria Angeles Lopez / Gupta, Girish

    PharmacoEconomics - open

    2023  Volume 7, Issue 3, Page(s) 443–454

    Abstract: Background: Tirbanibulin 1% ointment is a new treatment for actinic keratosis (AK) on the face or scalp. A health economic model was developed as part of a submission to the Scottish Medicines Consortium to evaluate the cost-effectiveness of ... ...

    Abstract Background: Tirbanibulin 1% ointment is a new treatment for actinic keratosis (AK) on the face or scalp. A health economic model was developed as part of a submission to the Scottish Medicines Consortium to evaluate the cost-effectiveness of tirbanibulin compared to the most frequently prescribed treatments.
    Methods: A decision tree approach was used to calculate the costs and benefits of different treatment strategies for AK on the face or scalp over a one-year time horizon. Data on the relative efficacy of treatments, which were based on the probability of complete clearance of AK, were obtained from a network meta-analysis. Sensitivity and scenario analyses were performed to determine the robustness of the model results.
    Results: Tirbanibulin is estimated to be cost saving versus diclofenac sodium 3%, imiquimod 5% and fluorouracil 5%. Tirbanibulin remains cost saving when inputs are varied in sensitivity and scenario analyses. While the complete clearance rates are deemed similar across comparators, tirbanibulin is associated with a lower rate of severe local skin reactions, and a shorter treatment duration, which may improve treatment adherence.
    Conclusions: Tirbanibulin is a cost saving intervention for the treatment of AK from the perspective of the Scottish Healthcare System.
    Language English
    Publishing date 2023-04-03
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2874287-4
    ISSN 2509-4254 ; 2509-4262
    ISSN (online) 2509-4254
    ISSN 2509-4262
    DOI 10.1007/s41669-023-00410-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: An anchored matching-adjusted indirect comparison of fixed-dose combination calcipotriol and betamethasone dipropionate (Cal/BDP) cream versus Cal/BDP foam for the treatment of psoriasis.

    Bewley, Anthony / Barker, Erin / Baker, Hannah / Green, Will / Avey, Brooke / Pi-Blanque, Aina / Galván, Jordi / Trebbien, Paw / Praestegaard, Morten

    The Journal of dermatological treatment

    2022  , Page(s) 1–8

    Abstract: Objectives: To undertake a comparison of Cal/BDP cream versus foam for the treatment of plaque psoriasis, with cross-trial population differences accounted for.: Materials and methods: An anchored matching-adjusted indirect comparison was undertaken, ...

    Abstract Objectives: To undertake a comparison of Cal/BDP cream versus foam for the treatment of plaque psoriasis, with cross-trial population differences accounted for.
    Materials and methods: An anchored matching-adjusted indirect comparison was undertaken, using individual patient data for Cal/BDP cream and published aggregated data for Cal/BDP foam. Altogether, 11 outcomes were analyzed, including PGA success, mPASI75, DLQI-related outcomes and treatment satisfaction across numerous domains. For each outcome an odds ratio or mean difference was calculated to represent the relative efficacy of Cal/BDP cream versus foam. Methods were guided by NICE Decision Support Unit recommendations.
    Results: After adjustment, baseline characteristics were balanced across treatment arms in each analysis. There were no statistically significant differences in PGA success, mPASI75 or DLQI outcomes between Cal/BDP cream and foam when they were compared after their recommended treatment durations (8 weeks for cream and 4 weeks for foam). For treatment satisfaction after 1 week of treatment, Cal/BDP cream was significantly superior to the Cal/BDP foam in all but one domain of the questionnaire.
    Conclusions: Cal/BDP cream and Cal/BDP foam have equivalent efficacy and HRQoL (measured in DLQI) outcomes when used for the topical treatment of plaque psoriasis at their recommended treatment durations. A comparison of treatment satisfaction assessments after 1 week of treatment demonstrated that patients find Cal/BDP cream to be more convenient than foam.
    Language English
    Publishing date 2022-09-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1036299-x
    ISSN 1471-1753 ; 0954-6634
    ISSN (online) 1471-1753
    ISSN 0954-6634
    DOI 10.1080/09546634.2022.2116924
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Molecular mechanisms of urolithiasis.

    Green, Will / Ratan, Hari

    Urology

    2013  Volume 81, Issue 4, Page(s) 701–704

    MeSH term(s) Basement Membrane/pathology ; Calcium Oxalate/metabolism ; Humans ; Loop of Henle/pathology ; Oxidative Stress ; Urolithiasis/genetics ; Urolithiasis/physiopathology
    Chemical Substances Calcium Oxalate (2612HC57YE)
    Language English
    Publishing date 2013-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2012.12.039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Building a global schistosomiasis alliance: an opportunity to join forces to fight inequality and rural poverty.

    Savioli, Lorenzo / Albonico, Marco / Colley, Daniel G / Correa-Oliveira, Rodrigo / Fenwick, Alan / Green, Will / Kabatereine, Narcis / Kabore, Achille / Katz, Naftale / Klohe, Katharina / LoVerde, Philip T / Rollinson, David / Stothard, J Russell / Tchuem Tchuenté, Louis-Albert / Waltz, Johannes / Zhou, Xiao-Nong

    Infectious diseases of poverty

    2017  Volume 6, Issue 1, Page(s) 65

    Abstract: Schistosomiasis, one of the 17 neglected tropical diseases listed by the World Health Organization, presents a substantial public health and economic burden. Of the 261 million people requiring preventive chemotherapy for schistosomiasis in 2013, 92% of ... ...

    Abstract Schistosomiasis, one of the 17 neglected tropical diseases listed by the World Health Organization, presents a substantial public health and economic burden. Of the 261 million people requiring preventive chemotherapy for schistosomiasis in 2013, 92% of them lived in sub-Saharan Africa and only 12.7% received preventive chemotherapy. Moreover, in 2010, the WHO reported that schistosomiasis mortality could be as high as 280 000 per year in Africa alone.In May 2012 delegates to the sixty-fifth World Health Assembly adopted resolution WHA65.21 that called for the elimination of schistosomiasis, and foresees the regular treatment of at least 75% of school age children in at-risk areas. The resolution urged member states to intensify schistosomiasis control programmes and to initiate elimination campaigns where possible.Despite this, in June 2015, schistosomiasis was indicated to have the lowest level of preventive chemotherapy implementation in the spectrum of neglected tropical diseases. It was also highlighted as the disease most lacking in progress. This is perhaps unsurprising, given that it was also the only NTD with access to drug donations but without a coalition of stakeholders that collaborates to boost commitment and implementation.As a consequence, and to ensure that the WHO NTDs Roadmap Targets of 2012 and World Health Assembly Resolution WHA65.21 are met, the Global Schistosomiasis Alliance (GSA) has been set up. Diverse and representative, the GSA aims to be a partnership of endemic countries, academic and research institutions, international development agencies and foundations, international organizations, non-governmental development organizations, private sector companies and advocacy and resource mobilisation partners. Ultimately, the GSA calls for a partnership to work for the benefit of endemic countries by addressing health inequity and rural poverty.
    MeSH term(s) Africa South of the Sahara/epidemiology ; Disease Eradication/organization & administration ; Endemic Diseases ; Global Health ; Healthcare Disparities/statistics & numerical data ; Humans ; Poverty/statistics & numerical data ; Prevalence ; Public Health/methods ; Rural Population ; Schistosomiasis/economics ; Schistosomiasis/epidemiology ; Schistosomiasis/mortality ; Schistosomiasis/prevention & control ; Socioeconomic Factors ; Tropical Climate ; World Health Organization
    Language English
    Publishing date 2017-03-23
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2689396-4
    ISSN 2049-9957 ; 2049-9957
    ISSN (online) 2049-9957
    ISSN 2049-9957
    DOI 10.1186/s40249-017-0280-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Estimates of the severity of coronavirus disease 2019: a model-based analysis.

    Verity, Robert / Okell, Lucy C / Dorigatti, Ilaria / Winskill, Peter / Whittaker, Charles / Imai, Natsuko / Cuomo-Dannenburg, Gina / Thompson, Hayley / Walker, Patrick G T / Fu, Han / Dighe, Amy / Griffin, Jamie T / Baguelin, Marc / Bhatia, Sangeeta / Boonyasiri, Adhiratha / Cori, Anne / Cucunubá, Zulma / FitzJohn, Rich / Gaythorpe, Katy /
    Green, Will / Hamlet, Arran / Hinsley, Wes / Laydon, Daniel / Nedjati-Gilani, Gemma / Riley, Steven / van Elsland, Sabine / Volz, Erik / Wang, Haowei / Wang, Yuanrong / Xi, Xiaoyue / Donnelly, Christl A / Ghani, Azra C / Ferguson, Neil M

    The Lancet. Infectious diseases

    2020  Volume 20, Issue 6, Page(s) 669–677

    Abstract: Background: In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring ... ...

    Abstract Background: In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases.
    Methods: We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation.
    Findings: Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9-19·2) and to hospital discharge to be 24·7 days (22·9-28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56-3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23-1·53), with substantially higher ratios in older age groups (0·32% [0·27-0·38] in those aged <60 years vs 6·4% [5·7-7·2] in those aged ≥60 years), up to 13·4% (11·2-15·9) in those aged 80 years or older. Estimates of case fatality ratio from international cases stratified by age were consistent with those from China (parametric estimate 1·4% [0·4-3·5] in those aged <60 years [n=360] and 4·5% [1·8-11·1] in those aged ≥60 years [n=151]). Our estimated overall infection fatality ratio for China was 0·66% (0·39-1·33), with an increasing profile with age. Similarly, estimates of the proportion of infected individuals likely to be hospitalised increased with age up to a maximum of 18·4% (11·0-37·6) in those aged 80 years or older.
    Interpretation: These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death.
    Funding: UK Medical Research Council.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Child ; Child, Preschool ; China/epidemiology ; Coronavirus Infections/mortality ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Infant ; Infant, Newborn ; Middle Aged ; Models, Statistical ; Pandemics/statistics & numerical data ; Pneumonia, Viral/mortality ; SARS-CoV-2 ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-03-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2061641-7
    ISSN 1474-4457 ; 1473-3099
    ISSN (online) 1474-4457
    ISSN 1473-3099
    DOI 10.1016/S1473-3099(20)30243-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Evidence of initial success for China exiting COVID-19 social distancing policy after achieving containment.

    Ainslie, Kylie E C / Walters, Caroline E / Fu, Han / Bhatia, Sangeeta / Wang, Haowei / Xi, Xiaoyue / Baguelin, Marc / Bhatt, Samir / Boonyasiri, Adhiratha / Boyd, Olivia / Cattarino, Lorenzo / Ciavarella, Constanze / Cucunuba, Zulma / Cuomo-Dannenburg, Gina / Dighe, Amy / Dorigatti, Ilaria / van Elsland, Sabine L / FitzJohn, Rich / Gaythorpe, Katy /
    Ghani, Azra C / Green, Will / Hamlet, Arran / Hinsley, Wes / Imai, Natsuko / Jorgensen, David / Knock, Edward / Laydon, Daniel / Nedjati-Gilani, Gemma / Okell, Lucy C / Siveroni, Igor / Thompson, Hayley A / Unwin, H Juliette T / Verity, Robert / Vollmer, Michaela / Walker, Patrick G T / Wang, Yuanrong / Watson, Oliver J / Whittaker, Charles / Winskill, Peter / Donnelly, Christl A / Ferguson, Neil M / Riley, Steven

    Wellcome open research

    2020  Volume 5, Page(s) 81

    Abstract: ... ...

    Abstract Background
    Keywords covid19
    Language English
    Publishing date 2020-10-01
    Publishing country England
    Document type Journal Article
    ISSN 2398-502X
    ISSN 2398-502X
    DOI 10.12688/wellcomeopenres.15843.2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: SARS-CoV-2 infection prevalence on repatriation flights from Wuhan City, China.

    Thompson, Hayley A / Imai, Natsuko / Dighe, Amy / Ainslie, Kylie E C / Baguelin, Marc / Bhatia, Sangeeta / Bhatt, Samir / Boonyasiri, Adhiratha / Boyd, Olivia / Brazeau, Nicholas F / Cattarino, Lorenzo / Cooper, Laura V / Coupland, Helen / Cucunuba, Zulma / Cuomo-Dannenburg, Gina / Djaafara, Bimandra / Dorigatti, Ilaria / van Elsland, Sabine / FitzJohn, Richard /
    Fu, Han / Gaythorpe, Katy A M / Green, Will / Hallett, Timothy / Hamlet, Arran / Haw, David / Hayes, Sarah / Hinsley, Wes / Jeffrey, Benjamin / Knock, Edward / Laydon, Daniel J / Lees, John / Mangal, Tara D / Mellan, Thomas / Mishra, Swapnil / Mousa, Andria / Nedjati-Gilani, Gemma / Nouvellet, Pierre / Okell, Lucy / Parag, Kris V / Ragonnet-Cronin, Manon / Riley, Steven / Unwin, H Juliette T / Verity, Robert / Vollmer, Michaela / Volz, Erik / Walker, Patrick G T / Walters, Caroline / Wang, Haowei / Wang, Yuanrong / Watson, Oliver J / Whittaker, Charles / Whittles, Lilith K / Winskill, Peter / Xi, Xiaoyue / Donnelly, Christl A / Ferguson, Neil M

    Journal of travel medicine

    2020  Volume 27, Issue 8

    MeSH term(s) Air Travel/statistics & numerical data ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; COVID-19 Nucleic Acid Testing/methods ; COVID-19 Nucleic Acid Testing/statistics & numerical data ; China/epidemiology ; Communicable Disease Control/methods ; Epidemiologic Measurements ; Epidemiological Monitoring ; Humans ; International Health Regulations/organization & administration ; Prevalence ; SARS-CoV-2/isolation & purification ; Travel Medicine/methods ; Travel Medicine/trends ; United Kingdom/epidemiology
    Keywords covid19
    Language English
    Publishing date 2020-07-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1212504-0
    ISSN 1708-8305 ; 1195-1982
    ISSN (online) 1708-8305
    ISSN 1195-1982
    DOI 10.1093/jtm/taaa135
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries.

    Walker, Patrick G T / Whittaker, Charles / Watson, Oliver J / Baguelin, Marc / Winskill, Peter / Hamlet, Arran / Djafaara, Bimandra A / Cucunubá, Zulma / Olivera Mesa, Daniela / Green, Will / Thompson, Hayley / Nayagam, Shevanthi / Ainslie, Kylie E C / Bhatia, Sangeeta / Bhatt, Samir / Boonyasiri, Adhiratha / Boyd, Olivia / Brazeau, Nicholas F / Cattarino, Lorenzo /
    Cuomo-Dannenburg, Gina / Dighe, Amy / Donnelly, Christl A / Dorigatti, Ilaria / van Elsland, Sabine L / FitzJohn, Rich / Fu, Han / Gaythorpe, Katy A M / Geidelberg, Lily / Grassly, Nicholas / Haw, David / Hayes, Sarah / Hinsley, Wes / Imai, Natsuko / Jorgensen, David / Knock, Edward / Laydon, Daniel / Mishra, Swapnil / Nedjati-Gilani, Gemma / Okell, Lucy C / Unwin, H Juliette / Verity, Robert / Vollmer, Michaela / Walters, Caroline E / Wang, Haowei / Wang, Yuanrong / Xi, Xiaoyue / Lalloo, David G / Ferguson, Neil M / Ghani, Azra C

    Science (New York, N.Y.)

    2020  Volume 369, Issue 6502, Page(s) 413–422

    Abstract: The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform ... ...

    Abstract The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being, and economies of these countries.
    MeSH term(s) COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Developing Countries ; Global Health ; Humans ; Pandemics/prevention & control ; Patient Acceptance of Health Care ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Poverty ; Public Health
    Keywords covid19
    Language English
    Publishing date 2020-06-12
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 128410-1
    ISSN 1095-9203 ; 0036-8075
    ISSN (online) 1095-9203
    ISSN 0036-8075
    DOI 10.1126/science.abc0035
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Estimates of the severity of COVID-19 disease

    Verity, Robert / Okell, Lucy C / Dorigatti, Ilaria / Winskill, Peter / Whittaker, Charles / Imai, Natsuko / Cuomo-Dannenburg, Gina / Thompson, Hayley / Walker, Patrick / Fu, Han / Dighe, Amy / Griffin, Jamie / Cori, Anne / Baguelin, Marc / Bhatia, Sangeeta / Boonyasiri, Adhiratha / Cucunuba, Zulma M / Fitzjohn, Rich / Gaythorpe, Katy A M /
    Green, Will / Hamlet, Arran / Hinsley, Wes / Laydon, Daniel / Nedjati-Gilani, Gemma / Riley, Steven / van-Elsand, Sabine / Volz, Erik / Wang, Haowei / Wang, Yuanrong / Xi, Xiayoue / Donnelly, Christl / Ghani, Azra / Ferguson, Neil

    Abstract: Background: A range of case fatality ratio (CFR) estimates for COVID 19 have been produced that differ substantially in magnitude. Methods: We used individual-case data from mainland China and cases detected outside mainland China to estimate the time ... ...

    Abstract Background: A range of case fatality ratio (CFR) estimates for COVID 19 have been produced that differ substantially in magnitude. Methods: We used individual-case data from mainland China and cases detected outside mainland China to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the CFR by relating the aggregate distribution of cases by dates of onset to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for the demography of the population, and age and location-based under ascertainment. We additionally estimated the CFR from individual linelist data on 1,334 cases identified outside mainland China. We used data on the PCR prevalence in international residents repatriated from China at the end of January 2020 to obtain age-stratified estimates of the infection fatality ratio (IFR). Using data on age stratified severity in a subset of 3,665 cases from China, we estimated the proportion of infections that will likely require hospitalisation. Findings: We estimate the mean duration from onset-of-symptoms to death to be 17.8 days (95% credible interval, crI 16.9,19.2 days) and from onset-of-symptoms to hospital discharge to be 22.6 days (95% crI 21.1,24.4 days). We estimate a crude CFR of 3.67% (95% crI 3.56%,3.80%) in cases from mainland China. Adjusting for demography and under-ascertainment of milder cases in Wuhan relative to the rest of China, we obtain a best estimate of the CFR in China of 1.38% (95% crI 1.23%,1.53%) with substantially higher values in older ages. Our estimate of the CFR from international cases stratified by age (under 60 or 60 and above) are consistent with these estimates from China. We obtain an overall IFR estimate for China of 0.66% (0.39%,1.33%), again with an increasing profile with age. Interpretation: These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and demonstrate a strong age-gradient in risk.
    Keywords covid19
    Publisher MedRxiv; WHO
    Document type Article ; Online
    DOI 10.1101/2020.03.09.20033357
    Database COVID19

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