Gene therapy is a potential cure for sickle cell disease (SCD). Conventional cost-effectiveness analysis (CEA) does not capture the effects of treatments on disparities in SCD, but distributional CEA (DCEA) uses equity weights to incorporate these considerations. To compare gene therapy versus standard of care (SOC) in patients with SCD by using conventional CEA and DCEA. Markov model. Claims data and other published sources. Birth cohort of patients with SCD. Lifetime. U.S. health system. Gene therapy at age 12 years versus SOC. Incremental cost-effectiveness ratio (ICER) (in dollars per quality-adjusted life-years [QALYs] gained) and threshold inequality aversion parameter (equity weight). Gene therapy versus SOC for females yielded 25.5 versus 15.7 (males: 24.4 vs. 15.5) discounted lifetime QALYs at costs of $2.8 million and $1.0 million (males: $2.8 million and $1.2 million), respectively, with an ICER of $176 000 per QALY (full SCD population). The inequality aversion parameter would need to be 0.90 for the full SCD population for gene therapy to be preferred per DCEA standards. SOC was favored in 100.0% (females) and 87.1% (males) of 10 000 probabilistic iterations at a willingness-to-pay threshold of $100 000 per QALY. Gene therapy would need to cost less than $1.79 million to meet conventional CEA standards. Benchmark equity weights (as opposed to SCD-specific weights) were used to interpret DCEA results. Gene therapy is cost-ineffective per conventional CEA standards but can be an equitable therapeutic strategy for persons living with SCD in the United States per DCEA standards. Yale Bernard G. Forget Scholars Program and Bunker Endowment.

Background. Mexico City Metropolitan Area (MCMA) has the largest number of COVID-19 (coronavirus disease 2019) cases in Mexico and is at risk of exceeding its hospital capacity in early 2021. Methods. We used the Stanford-CIDE Coronavirus Simulation Model (SC-COSMO), a dynamic transmission model of COVID-19, to evaluate the effect of policies considering increased contacts during the end-of-year holidays, intensification of physical distancing, and school reopening on projected confirmed cases and deaths, hospital demand, and hospital capacity exceedance. Model parameters were derived from primary data, literature, and calibrated. Results. Following high levels of holiday contacts even with no in-person schooling, MCMA will have 0.9 million (95% prediction interval 0.3–1.6) additional COVID-19 cases between December 7, 2020, and March 7, 2021, and hospitalizations will peak at 26,000 (8,300–54,500) on January 25, 2021, with a 97% chance of exceeding COVID-19-specific capacity (9,667 beds). If MCMA were to control holiday contacts, the city could reopen in-person schools, provided they increase physical distancing with 0.5 million (0.2–0.9) additional cases and hospitalizations peaking at 12,000 (3,700–27,000) on January 19, 2021 (60% chance of exceedance). Conclusion. MCMA must increase COVID-19 hospital capacity under all scenarios considered. MCMA’s ability to reopen schools in early 2021 depends on sustaining physical distancing and on controlling contacts during the end-of-year holiday.

Rising global temperatures and seawater temperatures have led to an increase in extreme weather patterns leading to droughts and floods. These natural phenomena, in turn, affect the supply of drinking water in some communities, which causes an increase in the prevalence of diseases related to the supply of drinking water. The objective of this work is to demonstrate the effects of global warming on human health in the population of Monterrey, Mexico after Hurricane Alex. We interpolated data using statistical downscaling of climate projection data for 2050 and 2080 and correlated it with disease occurrence. We found a remarkable rise in the incidence of transmissible infectious disease symptoms. Gastrointestinal symptoms predominated and were associated with drinking of contaminated water like tap water or water from communal mobile water tanks, probably because of the contamination of clean water, the disruption of water sanitation, and the inability to maintain home hygiene practices.

BACKGROUND: In January 2014, the American College of Cardiology/American Heart Association released a policy statement arguing for the inclusion of cost-effectiveness analysis (CEA) and value assessments in clinical practice guidelines. It is unclear whether subsequent guidelines changed how they incorporated such concepts. METHODS: We analyzed guidelines of cardiovascular disease subconditions with a guideline released before and after 2014. We counted the words (total and per page) for 8 selected value- or CEA-related terms and compared counts and rates of terms per page in the guidelines before and after 2014. We counted the number of recommendations with at least 1 reference to a CEA or a CEA-related article to compare the ratios of such recommendations to all recommendations before and after 2014. We looked for the inclusion of the value assessment system recommended by the writing committee of the American College of Cardiology/American Heart Association policy statement of 2014. RESULTS: We analyzed 20 guidelines of 10 different cardiovascular disease subconditions. Seven of the 10 cardiovascular disease subconditions had guidelines with a greater term per page rate after 2014 than before 2014. Across all 20 guidelines, the proportion of recommendations with at least 1 reference to a CEA changed from 0.44% to 1.99% ( P <0.01). The proportion of recommendations with at least 1 reference to a CEA-related article changed from 1.02% to 3.34% ( P <0.01). Only 3 guidelines used a value assessment system. CONCLUSIONS: The proportion of recommendations with at least 1 reference to a CEA or CEA-related article was low before and after 2014 for most of the subconditions, however, with substantial variation in this finding across the guidelines included in our analysis. There is a need to organize existing CEA information better and produce more policy-relevant CEAs so guideline writers can more easily make recommendations that incentivize high-value care and caution against using low-value care.

Background: With more than 20 million residents, Mexico City Metropolitan Area (MCMA) has the largest number of Covid-19 cases in Mexico and is at risk of exceeding its hospital capacity in late December 2020. Methods: We used SC-COSMO, a dynamic compartmental Covid-19 model, to evaluate scenarios considering combinations of increased contacts during the holiday season, intensification of social distancing, and school reopening. Model parameters were derived from primary data from MCMA, published literature, and calibrated to time-series of incident confirmed cases, deaths, and hospital occupancy. Outcomes included projected confirmed cases and deaths, hospital demand, and magnitude of hospital capacity exceedance. Findings: Following high levels of holiday contacts even with no in-person schooling, we predict that MCMA will have 1·0 million (95% prediction interval 0·5 – 1·7) additional Covid-19 cases between December 7, 2020 and March 7, 2021 and that hospitalizations will peak at 35,000 (14,700 – 67,500) on January 27, 2021, with a >99% chance of exceeding Covid-19-specific capacity (9,667 beds). If holiday contacts can be controlled, MCMA can reopen in-person schools provided social distancing is increased with 0·5 million (0·2 – 1·0) additional cases and hospitalizations peaking at 14,900 (5,600 – 32,000) on January 23, 2021 (77% chance of exceedance). Interpretation: MCMA must substantially increase Covid-19 hospital capacity under all scenarios considered. MCMA’s ability to reopen schools in mid-January 2021 depends on sustaining social distancing and that contacts during the end-of-year holiday were well controlled. Funding: Society for Medical Decision Making, Gordon and Betty Moore Foundation, and Wadhwani Institute for Artificial Intelligence Foundation. Declaration of Interests: All authors are part of the SC-COSMO consortium. FAE and YP report funds from the Society for Medical Decision Making (SMDM) funded by the Gordon and Betty Moore Foundation and a grant from Open Society Foundations (OSF). JGF reports a gift from the Wadhwani Institute for Artificial Intelligence Foundation. Dr. Salomon report funds from the Centers for Disease Control and Prevention though the Council of State and Territorial Epidemiologists (NU38OT000297-02) and the National Institute on Drug Abuse (3R37DA01561217S1).

Objectives: Given steady increases in age-standardized colorectal cancer incidence, health authorities in Mexico could consider implementing a colorectal cancer screening program. To inform program design, we evaluated the cost-effectiveness of fecal immunochemical testing (FIT) among a hypothetical cohort of 45-year-old residents of Mexico City. We adapted a validated US microsimulation model of colorectal cancer to reflect epidemiological outcomes in Mexico City. Methods: Using the adapted model, we estimated the lifetime health outcomes and costs associated with no screening and with FIT strategies that varied by the start age, end age, screening interval, and hemoglobin threshold for colonoscopy referral. We obtained costs from published reports and formularies. We calculated incremental cost-effectiveness ratios and identified the cost-effective FIT strategy as the strategy with the highest ratio below the willingness-to-pay threshold of 381,000 MXN per quality-adjusted life-year (QALY) gained (i.e., three times Mexico's per-capita Gross Domestic Product). Results: Compared with no screening, the effectiveness of FIT screening ranged from 23 to 49 QALYs gained per 1000 45-year-olds. Biennial FIT from age 50 to 70 with the most lenient threshold for colonoscopy referral (10 μg of hemoglobin/g of feces) was the cost-effective strategy. The starting age of screening was sensitive to assumptions about the cost of unreturned test kits, outreach costs, and colorectal cancer risk. Conclusions: Screening for colorectal cancer with FIT may be cost-effective in Mexico City. Additional studies are needed to assess whether the colonoscopy capacity is sufficient to support a lenient referral threshold.