***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Evidence on economically efficient strategies to lower  blood pressure ( BP )  from low- and middle-income countries remains scarce . The Control of Blood Pressure and Risk Attenuation ( COBRA ) trial r and omized 1341 hypertensive subjects in 12 r and omly selected communities in Karachi , Pakistan , to 3 intervention programs : ( 1 ) combined home health education ( HHE ) plus trained general practitioner ( GP ) ; ( 2 ) HHE only ; and ( 3 ) trained GP only . The comparator was no intervention ( or usual care ) . The reduction in BP was most pronounced in the combined group . The present study examined the cost-effectiveness of these strategies . Methods and Results — Total costs were assessed at baseline and 2 years to estimate incremental cost-effectiveness ratios based on ( 1 ) intervention cost ; ( 2 ) cost of physician consultation , medications , diagnostics , changes in lifestyle , and productivity loss ; and ( 3 ) change in systolic BP . Precision of the incremental cost-effectiveness ratio estimates was assessed by 1000 bootstrapping replications . Bayesian probabilistic sensitivity analysis was also performed . The annual costs per participant associated with the combined HHE plus trained GP , HHE alone , and trained GP alone were $ 3.99 , $ 3.34 , and $ 0.65 , respectively . HHE plus trained GP was the most cost-effective intervention , with an incremental cost-effectiveness ratio of $ 23 ( 95 confidence interval , 6–99 ) per mm Hg reduction in systolic BP compared with usual care , and remained so in 97.7 of 1000 bootstrapped replications . Conclusions — The combined intervention of HHE plus trained GP is potentially affordable and more cost-effective for BP control than usual care or either strategy alone in some communities in Pakistan , and possibly other countries in Indochina with similar healthcare infrastructure . Clinical Trial Registration — http://www . clinical trials.gov . Unique identifier : NCT00327574 Objective : To estimate and compare the cost-effectiveness and safety of nebivolol with sustained-release metoprolol in reducing blood pressure by 1 mm of Hg per day in hypertensive patients . Material s and Methods : This was a prospect i ve , r and omized , open label , observational analysis of cost-effectiveness , in a question naire-based fashion to compare the cost of nebivolol ( 2.5 mg , 5 mg , 10 mg ) and sustained released metoprolol succinate ( 25 mg , 50 mg , 100 mg ) in hypertensive patients using either of the two drugs . A total of 60 newly detected drug naïve hypertensive patients were considered for the comparison , of which 30 patients were prescribed nebivolol and the other 30 were prescribed metoprolol succinate as per the recommended dosage . Based on the data , statistical analysis was carried out using GraphPad Prism 5 and MS Excel Spreadsheet 2007 . Result : The cost of reducing 1 mm of Hg blood pressure per day with nebivolol was 0.60 , 0.70 , and 1.06 INR , whereas that of metoprolol succinate was 0.93 , 1.18 , and 1.25 INR at their respective equivalent doses , hence significantly lower with the nebivolol group as compared to the metoprolol group ( P < 0.05 ) . Conclusion : This pharmacoeconomic analysis shows that nebivolol is more cost-effective as compared to metoprolol when the cost per reduction in blood pressure per day is considered . This may affect the patients economically during their long-term use of these molecules for the treatment of hypertension Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Background Like a growing number of rapidly developing countries , India has begun to develop a system for large-scale community-based screening for diabetes . We sought to identify the implication s of using alternative screening instruments to detect people with undiagnosed type 2 diabetes among diverse population s across India . Methods and Findings We developed and vali date d a microsimulation model that incorporated data from 58 studies from across the country into a nationally representative sample of Indians aged 25–65 y old . We estimated the diagnostic and health system implication s of three major survey-based screening instruments and r and om glucometer-based screening . Of the 567 million Indians eligible for screening , depending on which of four screening approaches is utilized , between 158 and 306 million would be expected to screen as “ high risk ” for type 2 diabetes , and be referred for confirmatory testing . Between 26 million and 37 million of these people would be expected to meet international diagnostic criteria for diabetes , but between 126 million and 273 million would be “ false positives . ” The ratio of false positives to true positives varied from 3.9 ( when using r and om glucose screening ) to 8.2 ( when using a survey-based screening instrument ) in our model . The cost per case found would be expected to be from US$ 5.28 ( when using r and om glucose screening ) to US$ 17.06 ( when using a survey-based screening instrument ) , presenting a total cost of between US$ 169 and US$ 567 million . The major limitation of our analysis is its dependence on published cohort studies that are unlikely fully to capture the poorest and most rural areas of the country . Because these areas are thought to have the lowest diabetes prevalence , this may result in overestimation of the efficacy and health benefits of screening . Conclusions Large-scale community-based screening is anticipated to produce a large number of false-positive results , particularly if using currently available survey-based screening instruments . Re source allocators should consider the health system burden of screening and confirmatory testing when instituting large-scale community-based screening for diabetes Abstract Aims : The aim of this analysis was to assess the cost-effectiveness of switching from biphasic human insulin 30 ( BHI ) , insulin glargine ( IGlar ) , or neutral protamine Hagedorn ( NPH ) insulin ( all ± oral glucose-lowering drugs [ OGLDs ] ) to biphasic insulin aspart 30 ( BIAsp 30 ) in people with type 2 diabetes in India , Indonesia , and Saudi Arabia . Methods : The IMS CORE Diabetes Model was used to determine the clinical outcome , costs , and cost-effectiveness of switching from treatment with BHI , IGlar , or NPH to BIAsp 30 over a 30-year time horizon . A 1-year analysis was also performed based on quality -of-life data and treatment costs . Incremental cost-effectiveness ratios ( ICERs ) were expressed as a fraction of gross domestic product ( GDP ) per capita , and cost-effectiveness was defined as ICER < 3-times GDP per capita . Results : Switching treatment from BHI , IGlar , or NPH to BIAsp 30 was associated with an increase in life expectancy of > 0.7 years , reduction in all diabetes-related complications , and was considered as cost-effective or highly cost-effective in India , Indonesia , and Saudi Arabia ( BHI to BIAsp 30 , 0.26 in India , 1.25 in Indonesia , 0.01 in Saudi Arabia ; IGlar to BIAsp 30 , −0.68 in India , −0.21 in Saudi Arabia ; NPH to BIAsp 30 , 0.15 in India , −0.07 in Saudi Arabia ; GDP per head per annum/ quality -adjusted life-year ) . Cost-effectiveness was maintained in the 1-year analyses . Conclusions : Switching from treatment with BHI , IGlar , or NPH to BIAsp 30 ( all ± OGLDs ) was found to be cost-effective in India , Indonesia , and Saudi Arabia , both in the long and short term OBJECTIVE Intervention strategies are available for reducing the high global burden of hazardous alcohol use as a risk factor for disease , but little is known about their potential costs and effects at a population level . This study set out to estimate these costs and effects . METHOD Analyses were carried out for 12 epidemiological World Health Organization subregions of the world . A population model was used to estimate the impact of evidence -based personal and nonpersonal interventions --including brief physician advice , taxation , roadside r and om breath testing , restricted sales access and advertising bans . Costs were measured in international dollars ( I$ ) ; population -level intervention effects were gauged in terms of disability-adjusted life years ( DALYs ) averted . Average and incremental cost-effectiveness ratios ( CERs ) were computed . RESULTS The most costly interventions to implement are brief advice in primary care and roadside breath testing of drivers . In population s with a high prevalence of heavy drinkers ( more than 5 % , such as Europe and North America ) , the most effective and cost-effective intervention was taxation ( more than 500 DALYs averted per 1 million population ; CER < I$500 per DALY averted ) . In population s with a lower prevalence of heavy drinking , however , taxation is estimated to be less cost effective overall than other , more targeted strategies , such as brief physician advice , roadside breath testing and advertising bans . CONCLUSIONS The most efficient public health response to the burden of alcohol use depends on the prevalence of hazardous alcohol use , which is related to overall per capita consumption . Population -wide measures , such as taxation , are expected to represent the most cost-effective response in population s with moderate or high levels of drinking , whereas more targeted strategies are indicated in population s with lower rates of hazardous alcohol use OBJECTIVES Mathematical modeling is used widely in economic evaluations of pharmaceuticals and other health-care technologies . Users of models in government and the private sector need to be able to evaluate the quality of models according to scientific criteria of good practice . This report describes the consensus of a task force convened to provide modelers with guidelines for conducting and reporting modeling studies . METHODS The task force was appointed with the advice and consent of the Board of Directors of ISPOR . Members were experienced developers or users of models , worked in academia and industry , and came from several countries in North America and Europe . The task force met on three occasions , conducted frequent correspondence and exchanges of drafts by electronic mail , and solicited comments on three drafts from a core group of external review ers and more broadly from the membership of ISPOR . RESULTS Criteria for assessing the quality of models fell into three areas : model structure , data used as inputs to models , and model validation . Several major themes cut across these areas . Models and their results should be represented as aids to decision making , not as statements of scientific fact ; therefore , it is inappropriate to dem and that models be vali date d prospect ively before use . However , model assumptions regarding causal structure and parameter estimates should be continually assessed against data , and models should be revised accordingly . Structural assumptions and parameter estimates should be reported clearly and explicitly , and opportunities for users to appreciate the conditional relationship between inputs and outputs should be provided through sensitivity analyses . CONCLUSIONS Model-based evaluations are a valuable re source for health-care decision makers . It is the responsibility of model developers to conduct modeling studies according to the best practicable st and ards of quality and to communicate results with adequate disclosure of assumptions and with the caveat that conclusions are conditional upon the assumptions and data on which the model is built Background R and omized control trials from the developed world report that clinical decision support systems ( DSS ) could provide an effective means to improve the management of hypertension ( HTN ) . However , evidence from developing countries in this regard is rather limited , and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center ( PHC ) setting s. Methods and Results We performed a cluster r and omized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients ( between 35 and 64 years of age ) , wherein 16 PHC clusters from a district of Telangana state , India , were r and omized to receive either a DSS or a chart‐based support ( CBS ) system .  Each intervention arm had 8 PHC clusters , with a mean of 102 hypertensive patients per cluster ( n=845 in DSS and 783 in CBS groups 
    Output:
    
The cost-effectiveness evidence for CVD and DM interventions in South Asia is growing , but most evidence is from India and limited to decision modelled outcomes .