Aim: To assess the cost-effectiveness of treatment sequences for patients with intermediate- to poor-risk advanced renal cell carcinoma. Patients & methods: A discrete event simulation model was developed to estimate patients' lifetime costs and survival. Efficacy inputs were derived from the CheckMate 214 and CheckMate 025 studies and network meta-analyses. Safety and cost data were obtained from the published literature. Results: The estimated average quality-adjusted life-years (QALYs) gained was the highest on nivolumab + ipilimumab-initiated sequences (3.6-5.3 QALYs) versus tyrosine kinase inhibitor (TKI)-initiated sequences (2.1-3.7 QALYs). Incremental cost per QALY gained for nivolumab + ipilimumab-initiated sequences was below the willingness-to-pay threshold of $150,000 versus other sequences. Conclusion: Immuno-oncology combination therapy followed by TKIs is cost-effective versus TKI sequences followed by immuno-oncology or sequencing TKIs.
Poor Economics.epub
"Banker to the Poor is Muhammad Yunus's memoir of how he decided to change his life in order to help the world's poor. In it he traces the intellectual and spiritual journey that led him to fundamentally rethink the economic relationship between rich and poor, and the challenges he and his colleagues faced in founding Grameen. He also provides wise, hopeful guidance for anyone who would like to join him in "putting homelessness and destitution in a museum so that one day our children will visit it and ask how we could have allowed such a terrible thing to go on for so long." The definitive history of micro-credit direct from the man that conceived of it, Banker to the Poor is necessary and inspirational reading for anyone interested in economics, public policy, philanthropy, social history, and business." Banker To The Poor: Micro-Lending and the Battle Against World Poverty
"Amartya Sen won the 1988 Nobel Prize in Economics, and has now introduced an essential and paradigm-altering framework for understanding economic development - for both rich and poor - in the twenty-first century. Freedom, Sen argues, is both the end and most efficient means of sustaining economic life and the key to securing the general welfare of the world's entire population. Releasing the idea of individual freedom from association with any particular historical, intellectual, political, or religious tradition, Sen clearly demonstrates its current applicability and possibilities. In the new global economy, where, despite unprecedented increases in overall opulence, the contemporary world denies elementary freedoms to vast numbers--perhaps even the majority of people--he concludes, it is still possible to practically and optimistically restain a sense of social accountability." Development as Freedom
"The poorest people in the world do not just survive--they thrive lavishly. They enjoy rich family relationships, build vibrant communities and exude deep faith. They have much to teach us about life and inspire us with their ingenuity, persistence, generosity and self-reliance. Mark Lutz has visited families living in cardboard huts, hiked dusty paths to isolated African villages, and tiptoed across putrid open sewers on makeshift bridges. UnPoverty relays those astonishing encounters with unforgettable people: desperately poor, yet abundantly rich. When we hear about the billions of people living on a few dollars a day, do we visualize what that means? These stories put individual faces on unimaginable statistics and bring their reality to life. You may even see yourself in them." UnPoverty: Rich Lessons from the Working Poor
"In the universally acclaimed and award-winning The Bottom Billion, Paul Collier reveals that fifty failed states--home to the poorest one billion people on Earth--pose the central challenge of the developing world in the twenty-first century. The book shines much-needed light on this group of small nations, largely unnoticed by the industrialized West, that are dropping further and further behind the majority of the world's people, often falling into an absolute decline in living standards. Collier has spent a lifetime working to end global poverty. In The Bottom Billion, he offers real hope for solving one of the great humanitarian crises facing the world today." The Bottom Billion: Why the Poorest Countries are Failing and What Can Be Done About It
"Nearly forty percent of humanity lives on an average of two dollars a day or less. If you've never had to survive on an income so small, it is hard to imagine. How would you put food on the table, afford a home, and educate your children? How would you handle emergencies and old age? Every day, more than a billion people around the world must answer these questions.Portfolios of the Poor is the first book to systematically explain how the poor find solutions to their everyday financial problems." Portfolios of the Poor: How the World's Poor Live on $2 a Day
As 83% of the included studies are cross-sectional, it is difficult to ascertain the directionality of the association between disability and poverty in their analyses. The thirteen cohort studies and one pre-post study however, provide some indication. In all these studies, the focus was on how economic poverty impacted the risk of developing disability and all but one found that lower financial status was associated with an increased risk of developing a disability. Nine studies focused on development of mental disorders among different economic groups, with all but one finding a positive association. Additionally, three studies found a positive link between lower household income and developmental delay in children. Two studies on older adults reported individuals from poorer backgrounds were more prone to functional decline and dementia than their wealthier peers.
Third, Nakua et al. found arthritis/joint pain was more common in higher SES groups in Ghana; however this findings is likely explained by the measure of disability, which was self-report of a clinical diagnosis [27]. As poverty and poorer access to healthcare are linked [30], the observed association may be more reflective of the relationship between wealth and receiving needed medical attention. Fourth, Islam et al report an increase in psychiatric disorders with rising per capita household expenditures in Bangladesh [28]; the authors attributed this finding as potentially due to less familiarity and comfort with interview schedules used to ascertain psychiatric disorders among lower individuals from lower SES groups. Finally, Gureje et al. found a negative association between depression and asset ownership [29]; however, the analysis did not control for any potential confounders.
Similarly, the strength of the relationship between disability and economic poverty differed slightly by age group. Analyses focused on older adults were slightly less likely to be positive (69%), compared to working-age adults (86%) and children (78%). In particular, dementia and cognitive impairment in older adults was not highly correlated with economic poverty (8 of 16 studies finding a positive association). If onset of disability occurs later in life, these individuals may have established more safeguards to protect against sliding into poverty than individuals who develop disabilities earlier life and face exclusion throughout the life course. Additionally, as economic poverty has been linked consistently to lower life-expectancy [24], poorer individuals who survive into older age may be healthier than their wealthier counterparts.
Urbanization has long been associated with human development and progress, but recent studies have shown that urban settings can also lead to significant inequalities and health problems. This paper is concerned with the adverse impact of urbanization on both developed and developing nations and both wealthy and poor populations within those nations, addressing issues associated with public health problems in urban areas. The discussion in this paper will be of interest to policy makers. The paper advocates policies that improve the socio-economic conditions of the urban poor and promote their better health. Further, this discussion encourages wealthy people and nations to become better informed about the challenges that may arise when urbanization occurs in their regions without the required social supports and infrastructure.
Some of the major health problems resulting from urbanization include poor nutrition, pollution-related health conditions and communicable diseases, poor sanitation and housing conditions, and related health conditions. These have direct impacts on individual quality of life, while straining public health systems and resources [6].
Urbanization has a major negative impact on the nutritional health of poor populations. Because they have limited financial resources and the cost of food is higher in cities, the urban poor lack nutritious diets and this leads to illness, which contributes to loss of appetite and poor absorption of nutrients among those affected. Furthermore, environmental contamination also contributes to undernutrition; street food is often prepared in unhygienic conditions, leading to outbreaks of food-borne illnesses (e.g., botulism, salmonellosis, and shigellosis) [6]. Urban dwellers also suffer from overnutrition and obesity, a growing global public health problem. Obesity and other lifestyle conditions contribute to chronic diseases (such as cancers, diabetes, and heart diseases). Although obesity is most common among the wealthy, international agencies have noted the emergence of increased weight among the middle class and poor in recent years [7].
Populations in poor nations that suffer from protein-energy malnutrition [8] have increased susceptibility to infection [9] through the impact of micronutrient deficiency on immune system development and function [10]. Around 168 million children under 5 are estimated to be malnourished and 76% of these children live in Asia [11]. At the same time, the World Health Organization is concerned that there is an emerging pandemic of obesity in poor countries that leads to non-communicable diseases such as diabetes, cardiovascular disease, cancer, hypertension, and stroke [12]. 2ff7e9595c
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