PLOS Medicine

BackgroundBacille Calmette-Guerin (BCG) is the most commonly-used vaccination globally, but multi-country cost-effectiveness analyses are outdated and have not considered sequelae in tuberculosis survivors. A rationale is lacking to guide the size of safety stocks. MethodsFor the 110 countries using universal neonatal BCG vaccination, we used a decision tree model to compare the costs and health benefits of status-quo BCG vaccination for children aged 0-4 years in 2023 to a counterfactual where...

AimsWe aimed to elicit preferences for weight and harm outcomes of glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment. We examined heterogeneity across key patient subgroups to support tailored treatment decisions to identify patients most likely to benefit with minimal risks. Material and MethodsWe conducted a best-worst scaling survey of adults with overweight or obesity in 15 European countries, assessing 21 GLP-1 RA outcomesincluding 5% and 10% weight gain (to align with harms) a...

ObjectivesTo examine associations between cardiometabolic conditions and health-related quality of life (HRQoL) and to evaluate whether condition-associated HRQoL changed from 2001 to 2022. MethodsWe analyzed nationally representative data from U.S. adults aged [≥]18 years in the Medical Expenditure Panel Survey, 2001-2022. Survey years without BMI data (2017, 2019, 2021) were excluded. EQ-5D utilities were mapped from SF-12 scores using a validated algorithm. For each survey year, survey-we...

ObjectiveIn England, since 2022, large businesses providing food in the out-of-home sector are required to display calorie information for non-prepacked food and non-alcoholic drink items. This study estimates long-term cost-effectiveness of the policy by extrapolating real-world evidence on short-term policy effects in England. DesignThe lifetime health economic impacts of calorie labelling were simulated using a microsimulation model. The analysis adopted a health systems perspective to compa...

BackgroundMetabolic vulnerability index (MVX), a novel biomarker of systemic inflammation and metabolic malnutrition, is associated with mortality in patients with cardiovascular diseases. Nevertheless, little is known about its association with cardiometabolic diseases (CMDs) and multimorbidity (CMM). We aimed to examine the associations of MVX with the risk of individual CMDs, their progression to CMM, and all-cause mortality in the general population. MethodsIn a prospective cohort of 218,63...

BackgroundRandomized trials have shown that a healthy Nordic diet (HND) improves liver steatosis, but there is limited evidence on the effects of Nordic dietary patterns on the risk of major adverse liver outcomes (MALO). We specified a hypothetical target trial protocol to estimate the effects of adhering to a HND or the Nordic Nutrition Recommendations 2023 (NNR23) on the 24-year risk of MALO in a middle-aged to elderly Swedish population. MethodsTwo pooled population-based cohorts including ...

BackgroundSex hormone alterations, such as estrogen deficiency or testosterone excess, substantially increase cardiovascular disease (CVD) risk in females. Dietary fibre and its microbial by-products, short-chain fatty acids (SCFAs), have cardioprotective effects, but it remains unclear whether these benefits extend to females with an altered sex hormone profile. In this study, we aim to investigate whether dietary fibre intake, measured via plasma acetate--the most abundant SCFA--is associated ...

ObjectiveThe main objective was to estimate the potential public health impact and cost-effectiveness of an annual dose of mRNA-1273 (2025/2026 formula) in the United States (US) for the 2025-2026 season compared with no vaccination in the mRNA-1273 licensed population (6 months-64 years with underlying medical conditions and all [≥]65 years). mRNA-1273 was also compared to BNT162b2 in high-risk adults ages 18-64 years and all [≥]65 years. MethodsAnalyses were conducted using a previously...

BackgroundHigh-dose inactivated influenza vaccination (HD-IIV) demonstrates superior effectiveness versus standard-dose vaccination (SD-IIV) in adults aged [≥]60 years. A recent meta-analysis integrated complementary evidence sources of representing over 85 million individuals across 14 influenza seasons. MethodsA previously developed model was updated using life-time horizon and societal perspective. Updated parameters included demographics, costs, hospitalization rates, and relative vaccin...

ObjectiveTo assess contemporary UK population-level trends in second-line glucose-lowering therapy initiation and explore treatment outcome trends across age and frailty groups in people with type 2 diabetes (T2D). MethodsWe studied 117,064 adults with T2D who initiated major second-line glucose-lowering drug classes after metformin between 2019-2024 in population-representative UK data (Clinical Practice Research Datalink). Outcomes were assessed in three groups: age [≤]70 years (n=84,589 [...

BackgroundDuring the COVID-19 pandemic period, healthcare systems substantially reorganized their management of several diseases, including acute cardiovascular diseases (ACVD) such as heart failure, stroke, myocardial infarction, and pulmonary embolism. While previous studies have reported changes in hospitalization rates and clinical outcomes, the economic impact of the pandemic on healthcare expenditures for patients with ACVD remains poorly documented. This study aimed to quantify disruption...

BackgroundDisease-modifying therapies (DMTs) for Alzheimers disease, including lecanemab and donanemab, have received regulatory approval in multiple jurisdictions. These therapies require complex diagnostic workup and safety monitoring, raising significant budget impact concerns for healthcare payers. No budget impact analysis specific to Ireland or comparable small European healthcare systems has been published. ObjectiveTo estimate the 5-year budget impact of introducing DMTs for early-stage...

ObjectiveTo examine dose-response associations of vigorous intermittent lifestyle physical activity micropatterns (VILPA; bouts [≤]1 minute) and its moderate-to-vigorous equivalent (MV-ILPA; bouts [≤]3 minutes) with incident type 2 diabetes. Research Design and MethodsProspective data from UK Biobank accelerometry sub-study participants who reported no leisure-time exercise and had no type 2 diabetes at baseline were analysed. Daily duration and frequency of VILPA and MV-ILPA were derived...

ObjectivesAn update to the NICE Type 2 diabetes (T2DM) guideline in February 2022 recommended an SGLT2 inhibitor be offered to people with heart failure (HF) or cardiovascular disease (CVD) as comorbidities and considered for people at high CVD risk. We report uptake of this guideline in England by September 2023. DesignObservational cohort study. SettingGeneral practices contributing to the Clinical Practice Research Data Link, linked to hospital admission records. Participants587,826 people...

COVID-19 remains a substantial public health challenge in the Netherlands. Next-generation COVID-19 vaccine, mRNA-1283, is approved in the European Union, with potential for higher relative vaccine efficacy compared with originally-licensed COVID-19 vaccines. Its potential public health and economic impact, in adults [≥]60 years and high-risk 18-59 years, was modelled versus no vaccination and originally-licensed mRNA-1273 and BNT162b2, adapting a published static Markov model with 1-year tim...

ImportanceAs the population of older people with HIV (PWH) in the US is growing, costs to Medicare are expected to rise substantially. ObjectivesTo project the number of Medicare beneficiaries with HIV aged 65y+ on ART in the US from 2026-2035 and the budget impact on Medicare. Design, Setting, and ParticipantsWe developed the novel CHARMED simulation model and projected the number of Medicare beneficiaries with HIV aged 65y+ on ART and associated costs from 2026 to 2035; we populated the mode...

BackgroundThe United Nations General Assembly High-level Meeting on Antimicrobial Resistance (UNGA HLM-AMR) committed to a target that 70% of global human antibiotic use (ABU) should be from the Access group of the WHO AWaRe system. MethodsWe used 2019 IQVIA MIDAS(R) global ABU Quarterly value sales, volumes (kg/SU) and average ex-manufacturer prices to evaluate price per daily defined dose (DDD) by AWaRe group across countries. IQVIA MIDAS volumes/value data reflect public, private, or mixed s...

ObjectivesDigital biomarkers offer scalable screening for type 2 diabetes, yet adoption is stalled by uncertainty regarding economic viability. This study evaluates the cost-effectiveness and budget impact of digital screening compared to opportunistic screening from a Swiss payer perspective. MethodsA probabilistic Markov cohort model was developed to simulate at-risk Swiss adults (age [≥]45, BMI [≥]25 kg/m{superscript 2}) over a 40-year horizon. The model incorporates a digital attritio...

BackgroundEvidence on how leisure-time physical activity (LTPA) improves lifetime body mass index (BMI) remains fragmented and prone to confounding. MethodsWe pooled 14,993 adults (30-90 y; 52.7% women; cohorts: REGICOR-ACRISC, ILERVAS, ARTPER) with baseline estimated LTPA (moderate-to-vigorous LTPA [MVLTPA] in REGICOR-ACRISC), genotype, and repeated BMI values from electronic health records (1990-2024, 36,157 measures). LTPA was categorized into cohort-specific quartiles; MVLTPA in 0, <100, <2...

PurposeBody dissatisfaction is common, particularly among those with higher BMIs. Issues with BMI as an adiposity measure may limit our understanding of body dissatisfaction determinants. We investigate the association of childhood trajectories of BMI, fat mass index (FMI), and fat-free mass index (FFMI) with body dissatisfaction at age 14, and sex differences in these associations. MethodsWe used latent class growth analysis to model trajectories of BMI (3-14 years), FMI and FFMI (7-14 years) ...