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Group antenatal care (GANC) is an alternative to traditional individual antenatal care (IANC), which combines health assessment, interactive learning, and community building in group sessions. GANC has been associated with positive health outcomes. To scale up GANC, more evidence is needed on the financial implications of its initial implementation and (long-term) cost-effectiveness. This study aims to review and synthesise the available evidence on the economics of GANC. We searched for observational and experimental studies assessing the cost aspects of implementing and running GANC with or without comparison with IANC. We searched PubMed, EMBASE, and Ovid Emcare up to 22 August 2024 using keywords and controlled vocabulary without restriction by year of publication. CASP Economic Evaluation Checklist. Narrative synthesis. A limited number of studies (n = 9) addressing the costs and/or benefits of GANC were eligible to be included in the review. These studies varied considerably in setting, design, quality, type of cost data, cost categories included and perspective used. Evidence on the costs of GANC is sparse. Future studies of the lifetime costs and health outcomes of GANC compared with IANC are needed to gain insight into the cost implications and cost-effectiveness of GANC and to scale up its implementation. PROSPERO 2023 CRD42023454379.

The study assessed the health and economic implications as well as the cost-utility of implementing universal alcohol use disorder (AUD) screening in 15-74 years population at the primary healthcare level compared with the current practice of diagnosis and management of symptomatic AUD patients seeking formal healthcare. Model-based cost-utility analysis using a hybrid model comprising a decision tree and lifetime age- and gender-specific Markov models for alcohol attributable conditions, including road traffic accident injuries, alcohol-related liver disease and head and neck cancers. The analysis was undertaken from both an abridged societal (consideration of direct cost of care) and a societal (consideration of direct and indirect costs) perspective. India (national and sub-national level analysis). 15-74 years population segregated by gender. The intervention was 10-year annual population-based screening for alcohol use disorders using alcohol use disorder identification test by community health workers at primary care facilities. The comparator was 'usual care' scenario of diagnosis and management of symptomatic AUD patients, considering care seeking patterns in India. Differences in life years, quality-adjusted life years (QALYs), alcohol attributable deaths and morbidities, direct costs and indirect costs in the comparative scenarios, along with incremental cost-utility ratio (ICUR), benefit-cost ratio and net monetary benefit. ICUR was evaluated using the per-capita gross domestic product (GDP) threshold of ₹171 498 (US$2182), as per Indian economic evaluation guidelines. Probabilistic and deterministic sensitivity analysis was conducted to identify the parameters that are likely to have an impact on efficiency of the screening programme. The AUD universal screening programme was associated with a gain of 71.16 million QALYs at population level, with approximately one-fourth reduction in the incidence of alcohol-attributable conditions. The ICUR value indicated that the programme is likely to be cost-effective from an abridged societal perspective. The intervention is projected to generate a gain of ₹8.21 (US$1.03) trillion, equivalent to per year gain of 0.59% of GDP, based on the abridged societal perspective. The deterministic sensitivity analysis indicated that reductions in diagnostic accuracy of the screening method, prevalence of AUD and treatment coverage had an inverse impact on the ICURs and could impact efficiency of the programme. There is good health and economic evidence to support the integration of alcohol use disorder screening and management within routine primary care. It would be essential to deploy measures for effectiveness of the screening tool and continuity of care to enhance efficiency of the programme.

Contouring of target volumes and organs-at-risk (OARs) is among the most time-intensive steps in radiation therapy planning. Artificial intelligence (AI)-based autocontouring has the potential to improve efficiency and reduce clinician workload, particularly in high-volume settings. This multi-center study evaluated time and labor cost savings following implementation of an AI-powered autocontouring solution (AI-Rad Companion Organs RT, Siemens Healthineers) across 18 oncology centers in a low- and middle-income country. Six physicians assessed 116 radiotherapy planning cases across multiple anatomical sites. Time required for manual contouring and post-autocontour editing was recorded. Time savings were converted into monetary value using three clinician cost scenarios, accounting for a notional software usage cost. Mean time savings across all cases was 13.8 minutes. After accounting for software costs, net savings ranged from INR 37 to INR 670 per case depending on clinician cost assumptions. AI-based autocontouring significantly reduces clinician workload and delivers measurable labor cost savings in routine radiation oncology practice, supporting adoption in LMIC settings.

Non-melanoma skin cancer (NMSC), comprising basal-cell carcinoma (BCC) and cutaneous squamous-cell carcinoma (cSCC), represents the most common malignancy worldwide. Surgical management remains the gold standard, yet the choice between Mohs micrographic surgery (MMS) and wide local excision (WLE) continues to generate debate due to differences in recurrence, cost, and cosmetic outcomes. To systematically compare MMS and WLE across three domains: long-term recurrence rates, cost-effectiveness, and aesthetic outcomes. A contemporary synthesis of prospective cohorts, registries, randomized trials, and economic models was performed. Outcomes included 5-year recurrence, incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALYs), and validated patient-reported scar assessments. For high-risk facial BCC and cSCC, MMS reduced 5-year recurrence to ≤ 1% compared with 3-5% after WLE (number-needed-to-treat = 28). Tissue-sparing margins yielded scars 1-2 mm narrower and 38% smaller in surface area, increasing the probability of "good/excellent" cosmesis by 12% per mm saved. Economic analyses demonstrated that, despite higher upfront procedural costs, MMS dominated WLE by saving ≈ $330 per patient and gaining 0.04 QALY over five years. Population-level adoption for intermediate-risk cSCC projected an annual payer surplus of ≈ $200 million and >25,000 QALYs. Patient-reported outcomes (POSAS, SCAR-Q, and FACE-Q) consistently favored MMS, with ≥ 90% rating scars as "good/excellent" versus 74% after WLE. MMS provides superior oncologic control, cosmetic outcomes, and cost-effectiveness compared with WLE for high-risk NMSC. Expanding MMS capacity and embedding patient-centered decision aids could optimize value-based care and deliver durable clinical and economic benefits.

BackgroundSepsis affects an estimated 166 million people annually. Short-term survival has been the primary focus of research to date, yet individuals who survive acute sepsis face substantial long-term challenges, including chronic illness, physical disability, cognitive impairment, chronic organ dysfunction, cardiovascular events, and psychological disorders. These complications contribute to personal economic hardship, high healthcare utilization, frequent rehospitalization, and significant mortality rates.ObjectivesWe aimed to identify and summarize key interventions for sepsis survivors' post-hospital discharge - including physical rehabilitation, psychological care, provider assessments, monitoring, medication, and education - and to identify gaps in current evidence to elucidate future research priorities.MethodsA systematic scoping review was completed across five databases, supplemented with hand searching. Two reviewers independently screened and extracted data. Eligible studies focused on adult survivors of sepsis, where interventions were implemented after discharge from acute care, and included any research design.ResultsThirteen studies with four follow-up papers were included. Five reported on the impact of simultaneous intervention protocols, four on physical rehabilitation alone, and two on provider assessment and follow-up. The final two focused on psychological care, and pharmacotherapy. Mortality and readmission rates were the most common outcomes measured; satisfaction with care services, mental health outcomes, and cardiovascular event incidence were also evaluated. Qualitative study data was limited. Four studies mentioned intervention costs, but none completed a cost-benefit analysis. Based on a limited pool of evidence, protocolized multi-intervention approaches, provider assessment and follow-up, and physical rehabilitation show some promise in reducing hospital readmissions and improving long-term survival from sepsis. No interventions positively impacted sepsis survivors' mental health. Further, no studies evaluating educational interventions alone were identified.ConclusionsThis review highlights the need for more comprehensive, multidisciplinary post-sepsis care interventions. Future research should focus on patient education, mental health support, and cost-effectiveness analyses to inform evidence-based post-sepsis care strategies.

This study examined the relationships between medication adherence and demographic and clinical characteristics in American Indian adults with Type 2 diabetes who live on tribal lands and receive medication at no cost to them. From tribal electronic health record data, we constructed a cross-sectional cohort of 3042 adults with Type 2 diabetes. Tribal citizens of a federally recognized tribe were included if aged &#x2265;&#x2009;18 years, had Type 2 diabetes, had &#x2265;&#x2009;1 Choctaw Nation of Oklahoma healthcare encounter in 2018, and were on antihypertensive, glucose- and lipid-lowering medications in 2018. Proportion of days covered (PDC) was used to assess medication adherence with a threshold of &#x2265;&#x2009;80%. The cohort mean age was 59.3 &#xb1; 11.6&#x2009;years; the majority were male (52%), married (52%), BMI &#x2265; 30 (74%), and lived in a rural setting (87%). Overall, 63% of patients were adherent to their medications with a mean PDC across all medication classes of 0.81 &#xb1; 0.18. Patients aged >&#x2009;55 years had a significantly higher PDC across all three medication classes compared with those aged &#x2264;&#x2009;55 years (84% vs. 77%, p < 0.001). Also, BMI &#x2265; 30 (&#x3b2; = 0.033, p < 0.001) or having a comorbid condition (&#x3b2; = 0.040, p < 0.001) were each associated with higher overall PDC. Whereas insulin use (&#x3b2; = -0.023, p = 0.001) and rural residence (&#x3b2; = -0.020, p = 0.03) were associated with lower overall PDC. Additionally, patients with comorbid kidney or heart disease had a higher overall PDC compared with those without these conditions (p < 0.001). In a setting with access to no-cost medication, nearly two-thirds of our sample were considered adherent to their medications. Older adults and those with comorbid conditions or BMI &#x2265; 30 had higher overall adherence to medications, whereas those residing in rural areas or using insulin had lower overall medication adherence.

The menstrual cup is a sustainable, cost-effective, and eco-friendly alternative to traditional menstrual hygiene products, offering long-term comfort and protection. This study aims to assess knowledge and perception regarding menstrual cups among healthcare personnel and explore their perception of the menstrual cup. A cross-sectional mixed-method study was conducted among 248 female healthcare personnel at a tertiary care institute in northern India. A semi-structured questionnaire was used to collect quantitative data and an in-depth interview guide among 31 participants was used to explore perceptions about the cup. Knowledge was assessed across eight domains, and a score was calculated. A score of "8" was considered as having adequate knowledge and any score between "1-7" was considered partial knowledge and a score of "0" as no knowledge. Categorical variables were presented as frequency (%) and continuous variables as mean (&#xb1;SD). A Chi-square test was conducted to see the association of sociodemographic characteristics with adequate knowledge. A P-value < 0.05 was considered significant. The qualitative data were coded, thematically analyzed, and triangulated with quantitative data. Very few (1.7%) of the participants had adequate knowledge about the cup regarding its size, type of material, method of insertion and removal, cleaning, duration of use, and source of obtaining the cup. The perceived barriers to cup usage were limited knowledge, pain in using a menstrual cup, fear of infection, sudden expulsion of the cup from the body, retention in the body, or loss of virginity. Current users reported cups as a better alternative to sanitary napkins, being free of side effects, cheaper, convenient, and eco-friendly. There is a need to equip healthcare professionals with adequate knowledge about the menstrual cup and address their misconceptions. This will potentially help women adopt safe, cost-effective, and eco-friendly menstrual hygiene methods like a menstrual cup.

Alzheimer's disease and related dementias (ADRD) are progressive neurodegenerative conditions where early detection is critical for timely intervention and care planning. However, current diagnostic methods are often inaccessible, costly, and delayed, especially for underserved populations. There is a growing need for scalable, noninvasive tools that can support timely diagnosis. Spontaneous speech contains rich acoustic and linguistic markers that can serve as noninvasive behavioral markers for cognitive decline. Foundation models, pretrained on large-scale audio or text data, generate high-dimensional embeddings that encode rich contextual and acoustic information. This study benchmarks open-source foundation language and speech models to evaluate their effectiveness in detecting ADRD from spontaneous speech as a potential solution for early, noninvasive, and scalable ADRD detection. In this study, we used the Pioneering Research for Early Prediction of Alzheimer's and Related Dementias EUREKA (PREPARE) Challenge dataset, which consists of audio recordings from over 1600 participants with 3 distinct categories of cognitive decline: healthy control (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD). We further excluded samples that are non-English, nonspontaneous speech, or of poor quality. Our final samples included 703 (59.13%) HC, 81 (6.81%) MCI, and 405 (34.06%) AD cases. We systematically benchmarked 18 open-source foundation speech and language models to classify cognitive status into 3 categories (HC, MCI, or AD). Post hoc interpretability analysis was performed for the best-performing model using Shapley additive explanations linking high-dimensional embeddings with explainable acoustic and linguistic markers. Whisper-medium model achieved the highest performance among speech models at 0.731 accuracy and 0.802 area under the curve, while Bidirectional Encoder Representations from Transformers with pause annotation achieved the top accuracy of 0.662 and 0.744 area under the curve among language models. Overall, ADRD detection based on state-of-the-art automatic speech recognition model-generated audio-embeddings outperformed other models, and the inclusion of nonsemantic information, such as pause patterns, consistently improved the classification performance of text-embedding-based models. Our work presents a comprehensive comparative evaluation of state-of-the-art speech and language models for AD and MCI detection on a large, clinically relevant dataset. Embeddings derived from acoustic models, which capture both semantic and acoustic information, show promising performance and highlight the potential for developing a more scalable, noninvasive, and cost-effective early detection tool for ADRD.

Respiratory viruses pose a persistent threat to human health, demanding effective strategies to block airborne transmission at the individual protection level. Traditional personal protective materials often lack intrinsic virucidal activity or suffer from cytotoxicity, failing to address the risk of secondary transmission. Herein, we highlight an H-type zeolite (H-Zeo) as a cost-effective, biocompatible, and inorganic antibody-mimetic inhibitor that efficiently inactivates SARS-CoV-2. The core antiviral mechanism relies on E340-targeted zeolite-protein biorecognition (ZPB): surface-localized H+ ions of H-Zeo form stable coordination bonds with the E340 residue of the SARS-CoV-2 spike protein receptor-binding domain (RBD), with an interaction energy (-1080.2 &#xb1; 66.7 kJ&#xb7;mol-1) far exceeding that of the RBD-angiotensin-converting enzyme 2 (ACE2) interaction (-570.7 &#xb1; 69.4 kJ&#xb7;mol-1). This strong competitive binding potently blocks the RBD-ACE2 protein-protein interaction, the initial step of viral entry into host cells. Based on this mechanism, we developed an H-Zeo-based antiviral gauze (H-ZG) for personal protection, which achieves >99.99% inactivation of authentic SARS-CoV-2. Notably, H-Zeo maintains >90% cell viability across all tested concentrations, overcoming the cytotoxicity limitations of metal-exchanged zeolites (e.g., Cu-zeolite). As a low-cost, scalable, and biocompatible material, H-Zeo provides a practical solution for mitigating airborne SARS-CoV-2 transmission, with broad potential for application in personal protective equipment and public health interventions.

The electrocatalytic chlorine evolution reaction (CER) is essential to modern chlor-alkali industry, yet conventional RuO2 catalysts suffer from parasitic oxygen evolution. High-entropy ruthenium oxides (Ru-HEO) are promising alternatives, but their practical design is hindered by complex composition-structure-performance relationship. Herein, we construct a Pareto-guided multi-objective Bayesian optimization framework to enable autonomous high-throughput exploration of quinary Ru-HEO system. Through this trade-off strategy, we identify compositions that efficiently balance mass activity, Cl2 selectivity and material cost. The leading Ru-HEO catalyst with only 8.4 at% Ru achieves a remarkable activity of 5083&#xa0;A g-1 Ru at 1.50&#xa0;V versus RHE and maintains excellent 100-h stability, outperforming commercial RuO2 and the state-of-the-art catalysts reported. Integrated into a photovoltaic-electrochemical (PV-EC) prototype device and tested under simulated diurnal illumination, it sustains >95% selectivity, a maximum solar-to-chemical (STC) efficiency of 14.6% and projected Cl2 production costs as low as $0.177 per kg. Our work establishes a closed-loop, AI-accelerated research paradigm that integrates multi-objective optimization with robotic experimentation, offering a generalizable and expedited pathway toward high-performance electrocatalysts for sustainable chemicals manufacturing.

Qualitative data helps explore factors surrounding patients' decisions with orthodontic treatment. The objectives were (1) to understand patients' motivation to undertake orthodontic treatment, (2) to understand their choices of a specific treatment modality, and (3) to determine the kinds of information provided to patients prior to receiving treatment. The study was an exploratory case study design. Thirty adults who completed orthodontic treatment with three different treatment modalities within the last twelve months in New Zealand were recruited. Patients undergoing treatment and those who had orthognathic surgery were excluded. Semi-structured, one-to-one interviews were conducted. The transcripts were analysed with NVivo software using a qualitative thematic analysis inductive approach. Three principal themes were identified in the data: Motivation for orthodontic treatment, the decision for treatment with a specific treatment modality, and patient information and education. Self-consciousness, aesthetics, relapse of previous orthodontic treatment, cleanability, and a previous financial barrier to seeking orthodontic treatment were motivating factors. Patients opted for traditional fixed appliances due to recommendation and trust; clear aligners due to age, working environment, and aesthetics; and direct-to-consumer clear aligners due to low cost. All participants had little knowledge about orthodontics prior to commencing treatment, and the provision of information for informed consent was not equal for each of the three groups. The primary motivators of individuals seeking treatment were self-consciousness, aesthetics, and previous financial constraints. Cost had the most significant impact when selecting a specific treatment modality.

Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening complement-mediated thrombotic microangiopathy (TMA) associated with high morbidity, mortality, and substantial healthcare resource utilization (HCRU). Although complement inhibitors such as eculizumab and ravulizumab have dramatically improved outcomes, aHUS continues to impose significant economic and operational burden on healthcare systems. In the Gulf region, payers and health systems face increasing pressures driven by rising costs, delayed diagnosis, fragmented access, and limited real-world evidence necessary for informed resource allocation decisions. This manuscript summarizes the findings of a payer-focused regional expert meeting, which included three presentations: (1) the role and value of HCRU studies for payers, (2) the clinical and economic burden of aHUS, and (3) existing global evidence on HCRU in aHUS and gaps relevant to the Gulf. The meeting concluded with an expert panel discussion and a survey assessing feasibility and priorities for a collaborative real-world study. Consensus highlighted urgent needs to establish regional incidence and prevalence, quantify utilization and cost burden, evaluate treatment patterns and outcomes, and design a standardized multicenter study. Priority research directions include retrospective chart review with prospective follow-up and unified data collection across Gulf institutions. These findings provide a payer-informed roadmap for building evidence that can support sustainable, equitable, and value-based decision making for aHUS care in the region.