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Book: Lifestyle modification to control heart disease

Shepard, Donald S.

evidence and policy

2010

Author's details	ed. by Donald S. Shepard
Keywords	Coronary Disease / prevention & control ; Life Style ; Health Behavior ; Risk Reduction Behavior
Language	English
Size	XXIX, 232 S. : Ill., graph. Darst.
Publisher	Jones and Bartlett
Publishing place	Sudbury, Mass
Publishing country	United States
Document type	Book
HBZ-ID	HT016015755
ISBN	978-0-7637-4947-7 ; 0-7637-4947-8
Database	Catalogue ZB MED Medicine, Health

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2009 A 5871	order for loan	Magazin

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Article ; Online: Smart financial incentives to promote cardiovascular health.

Shepard, Donald S

Journal of cardiology & current research

2020 Volume 13, Issue 1, Page(s) 11–13

Language	English
Publishing date	2020-01-16
Document type	Journal Article
ISSN	2373-4396
ISSN (online)	2373-4396
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Cost-Effectiveness of Cardiac Rehabilitation in Older Adults With Coronary Heart Disease.

Shepard, Donald S / Zakir, Shehreen / Gaalema, Diann E / Ades, Philip A

Journal of cardiopulmonary rehabilitation and prevention

2023 Volume 44, Issue 2, Page(s) 107–114

Abstract: Purpose: While cardiac rehabilitation (CR) is recommended and effective following acute cardiac events, it remains underutilized, particularly in older adults. A study of 601 099 Medicare beneficiaries ≥65 yr hospitalized for coronary heart disease ... ...

Abstract	Purpose: While cardiac rehabilitation (CR) is recommended and effective following acute cardiac events, it remains underutilized, particularly in older adults. A study of 601 099 Medicare beneficiaries ≥65 yr hospitalized for coronary heart disease compared 5-yr mortality in users and nonusers of CR. Using instrumental variables (IV), CR improved mortality by 8.0% ( P < .001). A validation analysis based on 70 040 propensity-based (PB) matched pairs gave a similar gain (8.3%, P < .0001). The present cost-effectiveness analysis builds on these mortality results. Methods: Using the framework of the Second Panel on Cost-Effectiveness Analysis, we calculated the incremental cost-effectiveness ratio (ICER) gained due to CR. We accessed the costs from this cohort, inflated to 2022 prices, and assessed the relationship of quality-adjusted life years (QALY) to life years from a systematic review. We estimated the ICER of CR by modeling lifetime costs and QALY from national life tables using IV and PB. Results: Using IV, CR added 1.344 QALY (95% CI, 0.543-2.144) and $40 472 in costs over the remaining lifetimes of participants. The ICER was $30 188 (95% CI, $18 175-$74 484)/QALY over their lifetimes. Using the PB analysis, the corresponding lifetime values were 2.018 (95% CI, 1.001-3.035) QALY, $66 590, and an ICER of $32 996 (95% CI, $21 942-$66 494)/QALY. Conclusions: Cardiac rehabilitation was highly cost-effective using guidelines established by the World Health Organization and the US Department of Health and Human Services. The favorable clinical effectiveness and cost-effectiveness of CR, along with low use by Medicare beneficiaries, support the need to increase CR use.
MeSH term(s)	Humans ; Aged ; United States ; Cardiac Rehabilitation ; Cost-Effectiveness Analysis ; Cost-Benefit Analysis ; Medicare ; Coronary Disease ; Quality-Adjusted Life Years
Language	English
Publishing date	2023-10-04
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	2272063-7
ISSN	1932-751X ; 1932-7501
ISSN (online)	1932-751X
ISSN	1932-7501
DOI	10.1097/HCR.0000000000000827
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Article ; Online: Enrollment of dengue patients in a prospective cohort study in Umphang District, Thailand, during the COVID-19 pandemic: Implications for research and policy.

Shepard, Donald S / Agarwal-Harding, Priya / Jiamton, Sukhum / Undurraga, Eduardo A / Kongsin, Sukhontha

Health science reports

2023 Volume 6, Issue 11, Page(s) e1657

Abstract: Background and aims: Dengue is endemic in Thailand and imposes a high burden on the health system and society. We conducted a prospective cohort study in Umphang District, Tak Province, Thailand, to investigate the share of dengue cases with long ... ...

Abstract	Background and aims: Dengue is endemic in Thailand and imposes a high burden on the health system and society. We conducted a prospective cohort study in Umphang District, Tak Province, Thailand, to investigate the share of dengue cases with long symptoms and their duration. Here we present the results of the enrollment process during the COVID-19 pandemic with implications and challenges for research and policy. Methods: In a prospective cohort study conducted in Umphang District, Thailand, we examined the prevalence of persistent symptoms in dengue cases. Clinically diagnosed cases were offered free laboratory testing, We enrolled ambulatory dengue patients regardless of age who were confirmed through a highly sensitive laboratory strategy (positive NS1 and/or IgM), agreed to follow-up visits, and gave informed consent. We used multivariate logistic regressions to assess the probability of clinical dengue being laboratory confirmed. To determine the factors associated with study enrollment, we analyzed the relationship of patient characteristics and month of screening to the likelihood of participation. To identify underrepresented groups, we compared the enrolled cohort to external data sources. Results: The 150 clinical cases ranged from 1 to 85 years old. Most clinical cases (78%) were confirmed by a positive laboratory test, but only 19% of those confirmed enrolled in the cohort study. Women, who were half as likely to enroll as men, were underrepresented in the cohort. Conclusions: The Thai physicians' clinical diagnoses at this rural district hospital had good agreement with laboratory diagnoses. By identifying underrepresented groups and disparities, future studies can ensure the creation of statistically representative cohorts to maximize their scientific value. This involves recruiting and retaining underrepresented groups in health research, such as women in this study. Promising strategies for meaningful inclusion include multi-site enrollment, offering in-home or virtual services, and providing in-kind benefits like childcare for underrepresented groups.
Language	English
Publishing date	2023-11-08
Publishing country	United States
Document type	Journal Article
ISSN	2398-8835
ISSN (online)	2398-8835
DOI	10.1002/hsr2.1657
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Cost-Effectiveness of Expanding Access to Primary Health Care in Rural Rwanda by Adding Laboratory-Equipped Health Posts: A Prospective, Controlled Study.

Shepard, Donald S / Halasa-Rappel, Yara A / Zeng, Wu / Rowlands, Katharine R / Musange, Sabine F

The American journal of tropical medicine and hygiene

2023 Volume 108, Issue 5, Page(s) 1042–1051

Abstract: To improve access to affordable primary health care and preventive services, in 2019 Rwanda's Ministry of Health inaugurated eight laboratory-equipped second-generation health posts (SGHPs) in the Bugesera District. Patient fees through Rwanda's ... ...

Abstract	To improve access to affordable primary health care and preventive services, in 2019 Rwanda's Ministry of Health inaugurated eight laboratory-equipped second-generation health posts (SGHPs) in the Bugesera District. Patient fees through Rwanda's insurance system (mutuelles) funded most operational costs through a public-private partnership. This prospective, controlled trial evaluated the posts' impact and cost-effectiveness. Our evaluation matched the rural cells containing these posts to eight control cells in Bugesera without formal health posts. We assessed costs using 2 years of financial data; accessed use statistics at SGHPs, health centers, and in the international literature; interviewed 1,952 randomly selected residents; conducted eight focus groups; and performed difference-in-differences regressions and survival analyses. Second-generation health posts increased primary care use by 1.83 outpatient visits per person per year (P < 0.0001). Of the 10 prevention indicators compared with trends, two improved significantly with SGHPs (two showed nonsignificant improvements), and one indicator experienced a significant deterioration. Second-generation health posts generated health improvements at a low cost and achieved a small, but favorable, 5% margin of revenues over financial costs. Second-generation health posts produced a very favorable incremental cost-effectiveness ratio of only $101 per disability-adjusted life year averted-only 13% of Rwanda's per-capita gross national income. In conclusion, SGHPs improved substantially the quantity of affordable outpatient care per person. However, net impacts on quality and completeness of care and prevention, although favorable, were small. For further improvements in access and quality of care, Rwanda's health authorities may wish to incentivize quality and strengthen coordination with other health system components.
MeSH term(s)	Humans ; Cost-Benefit Analysis ; Government Programs ; Primary Health Care ; Prospective Studies ; Rwanda
Language	English
Publishing date	2023-03-20
Publishing country	United States
Document type	Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.22-0519
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Article ; Online: Corrigendum to "Decreasing smoking during pregnancy: Potential economic benefit of reducing sudden unexpected infant death" [Preventive Medicine 140 (2020) 106238].

Higgins, Stephen T / Slade, Eric P / Shepard, Donald S

Preventive medicine

2021 Volume 154, Page(s) 106889

Language	English
Publishing date	2021-11-21
Publishing country	United States
Document type	Published Erratum
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2021.106889
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Book: Analysis of hospital costs

Shepard, Donald S. / Hodgkin, Dominic / Anthony, Yvonne E.

a manual for managers

2000

Author's details	Donald S. Shepard ; Dominic Hodgkin ; Yvonne E. Anthony
Keywords	Krankenhaus ; Kostenanalyse ; Kostenmanagement
Subject	Kostenlenkung ; Unternehmen ; Klinik ; Klinikum ; Krankenanstalt ; Krankenhauswesen ; Spital ; Kostenauswertung
Language	English
Size	VIII, 92 S.
Publisher	World Health Organization
Publishing place	Geneva
Publishing country	Switzerland
Document type	Book
HBZ-ID	HT012745909
ISBN	92-4-154528-3 ; 978-92-4-154528-0
Database	Catalogue ZB MED Medicine, Health

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2000 A 2154	order for loan	Magazin

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Article: The potential impact of dengue vaccination with, and without, pre-vaccination screening

Coudeville, Laurent / Baurin, Nicolas / Shepard, Donald S

Vaccine. 2020 Feb. 05, v. 38, no. 6

2020

Abstract: The World Health Organization defined a ‘screen and vaccinate’ strategy as its recommended policy for the licensed dengue vaccine (Dengvaxia, Sanofi Pasteur), so that only individuals with previous dengue infection are vaccinated. The objectives of the ... ...

Abstract	The World Health Organization defined a ‘screen and vaccinate’ strategy as its recommended policy for the licensed dengue vaccine (Dengvaxia, Sanofi Pasteur), so that only individuals with previous dengue infection are vaccinated. The objectives of the present study were to build upon a recently published analysis of the benefits and risks associated with dengue vaccination to evaluate the public health impact and cost-effectiveness of a screen and vaccinate strategy.The current analysis was based on a previously reported transmission model and added, for the screening part, three rapid diagnostic tests with identical specificity (99%) but alternative sensitivities (50-70-90%) in the detection of prior dengue infection. The impact of a screen-and-vaccinate strategy considered nine settings representing different levels of transmission intensity. Outcomes (dengue-related hospitalizations, severe dengue, and symptomatic dengue) were assessed according to the level of transmission setting. The cost-effectiveness of vaccination in 10 endemic countries was also assessed.Although associated, in most cases, with a lower population impact than a ‘no-screening’ approach, a screen and vaccinate strategy is more effective in reducing the number of hospitalized and severe cases prevented per vaccination performed and generates positive health benefits for individuals screened and subsequently vaccinated. As a result, this intervention is cost-effective in all countries considered except for very low transmission settings. The overall population impact of a screen and vaccinate approach is also likely to be improved by the use of several rounds of screening (up to 48% reduction in dengue hospitalization over 10 years with 5 rounds).WHO recommended option of a screen and vaccinate policy is likely to have a positive impact both at the individual and population level across a wide range of transmission settings and has the potential to be as, if not more, cost-effective than a no screening strategy.
Keywords	cost effectiveness ; dengue ; diagnostic techniques ; issues and policy ; models ; public health ; risk ; screening ; vaccination ; vaccines
Language	English
Dates of publication	2020-0205
Size	p. 1363-1369.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2019.12.012
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Medical Respite for People Experiencing Homelessness: Financial Impacts with Alternative Levels of Medicaid Coverage.

Shetler, Dan / Shepard, Donald S

Journal of health care for the poor and underserved

2018 Volume 29, Issue 2, Page(s) 801–813

Abstract: Medical respite (MR) programs provide medical care, social services, and a safe place to recuperate for people experiencing homelessness after hospital discharge. We examined the financial impact of MR on hospitals and insurers in states with varying ... ...

Abstract	Medical respite (MR) programs provide medical care, social services, and a safe place to recuperate for people experiencing homelessness after hospital discharge. We examined the financial impact of MR on hospitals and insurers in states with varying Medicaid coverage. Urban case-study hospitals were selected from a state with Medicaid expansion under the Affordable Care Act (Connecticut) and without expansion (Florida). We calculated costs and savings from MR to hospitals and payers from the hospitals' financial data. These hospitals currently incur losses of 26% (Conn.) to 48% (Fla.) on inpatient care costs of patients experiencing homelessness. Medical respite would reduce these losses by reducing the index length of stay by two days, subsequent emergency department visits by 45%, and subsequent inpatient admissions by 35%, offsetting $1.81 in hospital costs for each dollar invested in MR. With appropriate sharing of costs between hospitals and payers, both would save money from MR.
MeSH term(s)	Connecticut ; Emergency Service, Hospital/statistics & numerical data ; Florida ; Homeless Persons ; Hospitalization/economics ; Hospitalization/statistics & numerical data ; Humans ; Insurance Coverage/statistics & numerical data ; Medicaid/economics ; Patient Discharge ; Patient Protection and Affordable Care Act ; Respite Care/economics ; United States
Language	English
Publishing date	2018-05-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1142637-8
ISSN	1548-6869 ; 1049-2089
ISSN (online)	1548-6869
ISSN	1049-2089
DOI	10.1353/hpu.2018.0059
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Article ; Online: Cost-Effectiveness of PBO versus Conventional Long-Lasting Insecticidal Bed Nets in Preventing Symptomatic Malaria in Nigeria: Results of a Pragmatic Randomized Trial.

Shepard, Donald S / Odumah, John U / Awolola, Samson T

The American journal of tropical medicine and hygiene

2020 Volume 104, Issue 3, Page(s) 979–986

Abstract: Insecticide treated nets (ITNs) have been the major tool in halving malaria's burden since 2000, but pyrethroid insecticide resistance threatens their ongoing effectiveness. In 2017, the WHO concluded that long-lasting ITNs (LLINs) with a synergist, ... ...

Abstract	Insecticide treated nets (ITNs) have been the major tool in halving malaria's burden since 2000, but pyrethroid insecticide resistance threatens their ongoing effectiveness. In 2017, the WHO concluded that long-lasting ITNs (LLINs) with a synergist, piperonyl butoxide (PBO), provided additional public health benefit over conventional (pyrethroid-only) LLINs alone in areas of moderate insecticide resistance and endorsed them as a new class of vector control products. We performed an economic appraisal of PBO nets compared with conventional LLINs in 2019 US$ from prevention and health systems perspectives (including treatment cost offsets). We used data from a pragmatic randomized 2012-2014 trial in Nigeria with epidemiological outcomes in an area with confirmed pyrethroid resistance. Each village had 50 months of epidemiologic data, analyzed by village by month, using negative binomial regression. Compared with LLINs, although adding $0.90 per net delivered, PBO nets reduced symptomatic malaria cases by 33.4% (95% CI 10.2-50.6%). From a prevention perspective, the incremental cost-effectiveness ratio was $11 (95% CI $8-$37) per disability-adjusted life year averted. From the health systems perspective, PBO nets were significantly cost-saving relative to conventional LLINs. The benefit-cost analysis found that the added economic benefits of PBO nets over LLINs were $201 (95% CI $61-$304) for every $1 in incremental costs. Growing pyrethroid resistance is likely to strengthen the economic value of PBO nets over LLINs. Beyond their contribution to reducing malaria, PBO nets deliver outstanding economic returns for a small additional cost above conventional LLINs in locations with insecticide resistance.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Anopheles/drug effects ; Child ; Child, Preschool ; Cost-Benefit Analysis ; Female ; Humans ; Infant ; Insecticide Resistance ; Insecticide-Treated Bednets ; Insecticides/pharmacology ; Malaria/epidemiology ; Malaria/prevention & control ; Male ; Middle Aged ; Nigeria/epidemiology ; Piperonyl Butoxide/economics ; Piperonyl Butoxide/pharmacology ; Pyrethrins/economics ; Pyrethrins/pharmacology ; Young Adult
Chemical Substances	Insecticides ; Pyrethrins ; Piperonyl Butoxide (LWK91TU9AH)
Language	English
Publishing date	2020-12-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.20-0956
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