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OP92 The Hidden Burden Of Patients And Families In Rare Diseases: A Scoping Review Of Economic Evaluations
- Gillian Currie, Brittany Gerber, Diane Lorenzetti, Karen MacDonald, Riley Jewel Bohach, Deborah Marshall
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 39 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 14 December 2023, p. S25
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- Article
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Introduction
There are more than 7,000 rare diseases (RDs), which are individually rare but have a large collective impact on patients and families, the health system, and society. There are few treatments for RD; where treatments do exist, they are often exceptionally expensive. Understanding the socioeconomic burden (SEB) of RD is crucial to properly valuing these treatments and informing health technology assessment. Our team has developed a framework of cost elements for inclusion in studies of the costs of RDs using an evidence-informed consensus-based approach.
MethodsWe conducted a scoping review to identify published economic evaluations studies in RD, searching five electronic databases to identify English language RD studies published 2010-2021. We applied our framework of cost elements to assess studies regarding what cost elements were included.
ResultsOf 4,890 records identified, 48 studies were screened for inclusion. Most were from the US (n=27), UK (n=6), and Canada (n=6), and focused on hemophilia (n=14) or cystic fibrosis (n=11). Healthcare system and payer perspectives were most often reported (n=41), with only seven studies reporting a societal perspective. Cost elements most often included were medications (n=41), hospitalizations (n=35), surgery (n=20) medical tests (n=16), and outpatient (unspecified) visits (n=16). Costs to patients, families, and society were less commonly included: productivity (n=5), travel/accommodation (n=3), government benefits (n=2), family impacts (n=0), or other costs relevant to RD (n=1). While unsurprising, given that most analyses focused on healthcare or payer perspectives, this finding illustrates the extent to which the burden of RD is largely unstudied.
ConclusionsOur scoping review demonstrated that most studies are conducted from a healthcare system/payer perspective, and largely consider only medical costs. These studies undercount the hidden burden of rare disease borne by patients and families leading to a gap in our global understanding of the full impact of rare diseases on families. To properly account for the these and value emerging treatments for RD, patient- and family-borne costs must be considered in economic evaluations for health technology assessment.
Improving Team Performance for Public Health Preparedness
- Megan Peck, Mickey Scullard, Craig Hedberg, Emily Moilanen, Deborah Radi, William Riley, Paige Anderson Bowen, Cheryl Petersen-Kroeber, Louise Stenberg, Debra K. Olson
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 11 / Issue 1 / February 2017
- Published online by Cambridge University Press:
- 11 August 2016, pp. 7-10
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Objective
Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response.
MethodsParticipants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises.
ResultsDifferences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period.
ConclusionsFindings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7–10)
Challenges in Integrating the High-K Gate Dielectric Film to the Conventional Cmos Process Flow
- Avinash Agarwal, Michael Freiler, Pat Lysaght, Loyd Perrymore, Renate Bergmann, Chris Sparks, Bill Bowers, Joel Barnett, Deborah Riley, Yudong Kim, Billy Nguyen, Gennadi Bersuker, Eric Shero, Jae E. Lim, Steven Lin, Jerry Chen, Robert W. Murto, Howard R. Huff
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- Journal:
- MRS Online Proceedings Library Archive / Volume 670 / 2001
- Published online by Cambridge University Press:
- 21 March 2011, K2.1
- Print publication:
- 2001
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ZrO2 and HfO2 and their alloys with SiO2 are currently among the leading high-k materials for replacing SiOxNy as the gate dielectric for the sub-100 nm technology nodes. International SEMATECH (ISMT) is currently investigating integration issues associated with this required change in materials. Our work has focused on the integration of ALCVD deposited ZrO2 and HfO2 with an industry standard conventional MOSFET process flow with poly-Si electrode. Since the impact of contamination by these new high-k materials introduced in a production fab has not yet been established, it becomes very critical to prevent cross- contamination through the process tools in the fab. A baseline study was completed within ISMT's fab and appropriate protocols for handling high-k materials have been established. The integrated high-k gate stack in a conventional transistor flow should not only meet all the performance requirements of scaled transistors, but the gate dielectric film should be able withstand high-temperature anneal steps. Reactions between ZrO2 and Si have been observed at temperatures as low as 560°C (during the amorphous Si deposition process). Various wet chemistries were also evaluated for removing the high-k film inadvertently deposited on wafer backside, and it was found that ZrO2 etches at extremely slow rates in the majority of the common wet etch chemistries available in a fab. A new hot HF based process was found to be successful in lowering Zr contamination on the wafer backside to as low as 1.8 E10 atoms/cm2. The patterning of a high-k gate stack with poly-Si electrode is another area that required considerable focus. Various dry (plasma) etch and wet etch chemistries were evaluated for etching ZrO2 using both blanket films as well as wafers with patterned poly-Si gate over the high-k films. On the full CMOS flow device wafers, most of these wet chemistries resulted in severe pitting in the ZrO2 film remaining over the source/drain (S/D) areas, as well as in the Si substrate and the field oxide. A poly-Si gate over ZrO2 gate dielectric film was successfully patterned using the standard poly-Si gate etch (Cl2/HBr) for the main etch, followed by a combination of HF and H2SO4 clean for removing all of the ZrO2 remaining over the S/D area. This allowed the fabrication of low-resistance contacts to transistor S/D areas, which ultimately resulted in demonstration of functional transistors with high-k gate dielectric films.