human
***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: HIV remains a major cause of preventable morbidity and mortality with 100000 new infections and an estimated 62000 deaths in 2011 . At the same time unhealthy alcohol consumption is an important risk factor for HIV acquisition and progression . Kenya has one of the highest rates of unhealthy alcohol use worldwide and as many as 13 % of new HIV infections in Kenya may be attributable to unhealthy alcohol use . R and omized controlled trials ( RCTs ) of cognitive behavioral therapy (CBT)-based interventions addressing unhealthy alcohol consumption in Kenya show promising results increasing abstinence by 45 % and decreasing risky sex . However alcohol remains conspicuously absent from programming in HIV and substance abuse . In low-re source setting s the benefits of scaling up an effective intervention must be balanced against the opportunity costs of using those re sources to scale up alternative interventions with potential benefit ( for example increasingly eligibility for first-line antiretroviral therapy ) . Accordingly the research ers used a published vali date d computer simulation of the HIV epidemic in Kenya incorporating HIV transmission and disease progression to evaluate the cost-effectiveness of the alcohol intervention reported by Papas et al. Given the uncertainty surrounding costs of scale-up they varied costing assumption over a wide range to identify the threshold at which its incremental cost-effectiveness ratio ( ICER ) descended below those of alternative re source uses ( e.g. when an alcohol intervention brought more “ health ” than alternative re source uses ) . [ excerpt AIMS To evaluate the cost-effectiveness of rapid hepatitis C virus ( HCV ) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs . DESIGN We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer , off-site HCV testing referral , on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer . Base case inputs included 11 % undetected chronic HCV , 0.4 % undetected HIV , 35 % HCV co-infection among HIV-infected , 53 % linked to HCV care after testing antibody-positive and 67 % linked to HIV care . Disease outcomes were estimated from established computer simulation models of HCV [ Hepatitis C Cost-Effectiveness ( HEP-CE ) ] and HIV [ Cost-Effectiveness of Preventing AIDS Complications ( CEPAC ) ] . SETTING AND PARTICIPANTS Data on test acceptance and costs were from a national r and omized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States . MEASUREMENTS Lifetime costs ( 2011 US$ ) and quality -adjusted life years ( QALYs ) discounted at 3 % annually ; incremental cost-effectiveness ratios ( ICERs ) . FINDINGS On-site rapid HCV testing had an ICER of $ 18,300/QALY compared with no testing , and was more efficient than ( dominated ) off-site HCV testing referral . On-site rapid HCV and HIV testing had an ICER of $ 64,500/QALY compared with on-site rapid HCV testing alone . In one- and two-way sensitivity analyses , the ICER of on-site rapid HCV and HIV testing remained < $ 100,000/QALY , except when undetected HIV prevalence was < 0.1 % or when we assumed frequent HIV testing elsewhere . The ICER remained < $ 100,000/QALY in 91 % of probabilistic sensitivity analyses . CONCLUSIONS On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a < $ 100,000/ quality -adjusted life year threshold Background Screening and brief intervention ( SBI ) is a comprehensive , integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care setting s. Although the SBI approach has shown promise for alcohol use , relatively little is known about its effectiveness for illicit drug use . We are evaluating the SBI approach for drug use using a rigorous r and omized controlled trial . The purpose of the report is to describe the overall trial and its programmatic and method ological strengths with a focus on health educator ( HE ) selection and training . In addition , the baseline characteristics of the recently enrolled multiethnic cohort are described . Methods / design A r and omized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group . Selection of bicultural paraprofessional HEs — their training in research concepts , comorbid mental health issues , special treatment of marijuana use , and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation — are among the features described . The HEs enrolled , consented , and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units . To be eligible , a participant needed to be an adult ( age ≥18 years ) , an English or Spanish speaker , awake and able to give consent , and reachable by telephone to schedule a six-month follow-up interview . Discussion A comprehensive HE training protocol combined with rigorous , ongoing process measurement result ed in skill mastery in many areas and a successful participant recruitment period . Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited . This trial will be among the first to provide information about the effectiveness of SBI  for illicit drug use . Outcome analysis has not yet been completed , but demonstrated programming and design successes have implication s for future research and service delivery . Trial registration AIMS To compare the effectiveness and cost-effectiveness of unobserved versus observed dosing of patients seeking treatment of heroin dependence . DESIGN R and omized controlled trial and cost-effectiveness analysis . Setting Specialist out-patient drug treatment centres in Australia . PARTICIPANTS Heroin users seeking maintenance treatment . INTERVENTION Participants were allocated r and omly to observed or unobserved dosing for 3 months . All subjects received buprenorphine-naloxone and weekly clinical review s. MEASUREMENTS Primary end-points were retention in treatment and heroin use at 3 months . Costs of treatment were measured ( in Australian dollars , AU$ ) and cost-effectiveness compared . Secondary outcomes included quality of life , psychological symptoms and use of non-opioid drugs . FINDINGS A total of 119 subjects were r and omized and analysed . At 3 months , 33/58 ( 57 % ) r and omized to unobserved treatment , and 37/61 ( 61 % ) observed were retained ( log-rank chi2 = 0.04 , df = 1 , P = 0.84 ) . On an intention-to-treat analysis , reductions in days of heroin use in the preceding month , from baseline to 3 months , did not differ significantly ; 18.5 days ( 95 % CI : 21.8 - 15.3 ) and 22.0 days ( 95 % CI : 24.3 - 19.7 ) , respectively ( Mann-Whitney U = 807.5 , P = 0.13 ) . The mean cost for the unobserved group was AU$1,663 ( 95 % CI 1308 - 2017 ) per treatment episode , significantly less than the mean cost for the observed group at AU$2,138 ( 95 % CI 1713 - 2562 ) . CONCLUSIONS Retention and heroin use was not significantly different between observed and unobserved dosing groups . Attendance for observed dosing was not associated with worse retention . Treatment with close clinical monitoring , but no observation of dosing , was significantly cheaper and therefore significantly more cost-effective Objectives To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels ( DRLs ) as defined by the WHO , and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases , injuries and deaths . Design Decision modelling using Markov chains compared costs and effects over 5 years . Setting The analysis was from the perspective of the National Health Service ( NHS ) in Engl and and Wales . Participants The model considered the licensed population for nalmefene , specifically adults with both alcohol dependence and high/very high DRLs , who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment . Data sources We modelled treatment effect using data from three clinical trials for nalmefene ( ESENSE 1 ( NCT00811720 ) , ESENSE 2 ( NCT00812461 ) and SENSE ( NCT00811941 ) ) . Baseline characteristics of the model population , treatment re source utilisation and utilities were from these trials . We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies . Health-related costs were from UK sources . Main outcome measures We measured incremental cost per quality -adjusted life year ( QALY ) gained and number of alcohol-attributable harmful events avoided .  Results Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio ( ICER ) of £ 5204 per QALY gained , and was therefore cost-effective at the £ 20 000 per QALY gained decision threshold . Sensitivity analyses showed that the conclusion was robust . Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to psychosocial support alone over the course of 5 years . Conclusions Nalmefene can be seen as a cost-effective treatment for alcohol dependence , with substantial public health benefits . Trial registration numbers This cost-effectiveness analysis was developed based on data from three r and omised clinical trials : ESENSE 1 ( NCT00811720 ) , ESENSE 2 ( NCT00812461 ) and SENSE ( NCT00811941 ) BACKGROUND Economic evaluations in health care involve the identification , measurement , valuation , and then comparison of the costs ( inputs ) and outcomes of treatments or preventive activities . The aim was to analyze the cost-utility of six-month methadone maintenance treatment program in a Lithuanian primary health care setting . METHODS A prospect i ve study design was used . All the information was obtained through the vali date d question naires at the baseline and 3- and 6-month follow-ups . WHOQOL-BREF was used to assess the quality of life ; the costs were assessed using the DATCAP methodology from the perspective of a patient and outpatient clinic during follow-up period . RESULTS A total of 102 opioid-dependent patients were recruited in the study ; 512 follow-up patient-months were obtained . The methadone maintenance treatment has significantly improved physical , psychological , and environmental components of quality of life during follow-up . Total program costs were 61 288.87 EUR . Cost paid by a patient comprised about 31 % of total program costs . Cost per quality -adjusted life-month ( QALM ) for physical domain was 2227.55 EUR ; for psychological domain , 1879.50 EUR ; for social domain , 5467.64 EUR ; and for environmental domain , 4626.47 EUR . Costs per QALM and quality -adjusted life-year ( QALY ) for total quality of life in the maintenance program were 2864.00 EUR and 34 368.00 EUR , respectively . CONCLUSIONS Our results showed that 6-month methadone maintenance program was effective in the terms of quality -of-life improvement .  Methadone maintenance treatment program was less effective in terms of cost per QALY Models for the economic evaluation of health technologies provide valuable information to decision makers . The choice of model structure is rarely discussed in published studies and can affect the results produced . Many papers describe good modelling practice , but few describe how to choose from the many types of available models . This paper develops a new taxonomy of model structures . The horizontal axis of the taxonomy describes assumptions about the role of expected values , r and omness , the heterogeneity of entities , and the degree of non-Markovian structure . Commonly used aggregate models , including decision trees and Markov models require large population numbers , homogeneous sub-groups and linear interactions . Individual models are more flexible , but may require replications with different r and om numbers to estimate expected values . The vertical axis of the taxonomy describes potential interactions between the individual actors , as well as how the interactions occur through time . Models using interactions , such as  system dynamics  , some  Markov models  , and  discrete event simulation  are fairly uncommon in the health economics but are necessary for modelling infectious diseases and systems with constrained re sources . The paper provides guidance for choosing a model , based on key requirements , including output requirements , the population size , and system complexity Abstract Background and aim : Buprenorphine offers an alternative to methadone in the treatment of heroin dependence , and has the advantage of allowing alternate-day dosing . This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a r and omised trial . Study design and methods : The study was a r and omised , open-label , 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone . Those who were currently on a methadone program ( n = 57 ; continuing therapy subgroup ) were analysed separately from new treatment recipients ( n = 82 ; initial therapy subgroup ) . The study took a broad societal perspective and included health , crime and personal costs . Data on re source use and outcomes were a combination of clinical records and self report 
    Output:
    
agent
Overall , the cohort Markov models remain the most popular approach , followed by decision trees , Individual based model and System dynamics model ( SD ) .
Conclusions This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions
***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: HIV remains a major cause of preventable morbidity and mortality with 100000 new infections and an estimated 62000 deaths in 2011 . At the same time unhealthy alcohol consumption is an important risk factor for HIV acquisition and progression . Kenya has one of the highest rates of unhealthy alcohol use worldwide and as many as 13 % of new HIV infections in Kenya may be attributable to unhealthy alcohol use . R and omized controlled trials ( RCTs ) of cognitive behavioral therapy (CBT)-based interventions addressing unhealthy alcohol consumption in Kenya show promising results increasing abstinence by 45 % and decreasing risky sex . However alcohol remains conspicuously absent from programming in HIV and substance abuse . In low-re source setting s the benefits of scaling up an effective intervention must be balanced against the opportunity costs of using those re sources to scale up alternative interventions with potential benefit ( for example increasingly eligibility for first-line antiretroviral therapy ) . Accordingly the research ers used a published vali date d computer simulation of the HIV epidemic in Kenya incorporating HIV transmission and disease progression to evaluate the cost-effectiveness of the alcohol intervention reported by Papas et al. Given the uncertainty surrounding costs of scale-up they varied costing assumption over a wide range to identify the threshold at which its incremental cost-effectiveness ratio ( ICER ) descended below those of alternative re source uses ( e.g. when an alcohol intervention brought more “ health ” than alternative re source uses ) . [ excerpt AIMS To evaluate the cost-effectiveness of rapid hepatitis C virus ( HCV ) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs . DESIGN We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer , off-site HCV testing referral , on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer . Base case inputs included 11 % undetected chronic HCV , 0.4 % undetected HIV , 35 % HCV co-infection among HIV-infected , 53 % linked to HCV care after testing antibody-positive and 67 % linked to HIV care . Disease outcomes were estimated from established computer simulation models of HCV [ Hepatitis C Cost-Effectiveness ( HEP-CE ) ] and HIV [ Cost-Effectiveness of Preventing AIDS Complications ( CEPAC ) ] . SETTING AND PARTICIPANTS Data on test acceptance and costs were from a national r and omized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States . MEASUREMENTS Lifetime costs ( 2011 US$ ) and quality -adjusted life years ( QALYs ) discounted at 3 % annually ; incremental cost-effectiveness ratios ( ICERs ) . FINDINGS On-site rapid HCV testing had an ICER of $ 18,300/QALY compared with no testing , and was more efficient than ( dominated ) off-site HCV testing referral . On-site rapid HCV and HIV testing had an ICER of $ 64,500/QALY compared with on-site rapid HCV testing alone . In one- and two-way sensitivity analyses , the ICER of on-site rapid HCV and HIV testing remained < $ 100,000/QALY , except when undetected HIV prevalence was < 0.1 % or when we assumed frequent HIV testing elsewhere . The ICER remained < $ 100,000/QALY in 91 % of probabilistic sensitivity analyses . CONCLUSIONS On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a < $ 100,000/ quality -adjusted life year threshold Background Screening and brief intervention ( SBI ) is a comprehensive , integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care setting s. Although the SBI approach has shown promise for alcohol use , relatively little is known about its effectiveness for illicit drug use . We are evaluating the SBI approach for drug use using a rigorous r and omized controlled trial . The purpose of the report is to describe the overall trial and its programmatic and method ological strengths with a focus on health educator ( HE ) selection and training . In addition , the baseline characteristics of the recently enrolled multiethnic cohort are described . Methods / design A r and omized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group . Selection of bicultural paraprofessional HEs — their training in research concepts , comorbid mental health issues , special treatment of marijuana use , and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation — are among the features described . The HEs enrolled , consented , and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units . To be eligible , a participant needed to be an adult ( age ≥18 years ) , an English or Spanish speaker , awake and able to give consent , and reachable by telephone to schedule a six-month follow-up interview . Discussion A comprehensive HE training protocol combined with rigorous , ongoing process measurement result ed in skill mastery in many areas and a successful participant recruitment period . Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited . This trial will be among the first to provide information about the effectiveness of SBI  for illicit drug use . Outcome analysis has not yet been completed , but demonstrated programming and design successes have implication s for future research and service delivery . Trial registration AIMS To compare the effectiveness and cost-effectiveness of unobserved versus observed dosing of patients seeking treatment of heroin dependence . DESIGN R and omized controlled trial and cost-effectiveness analysis . Setting Specialist out-patient drug treatment centres in Australia . PARTICIPANTS Heroin users seeking maintenance treatment . INTERVENTION Participants were allocated r and omly to observed or unobserved dosing for 3 months . All subjects received buprenorphine-naloxone and weekly clinical review s. MEASUREMENTS Primary end-points were retention in treatment and heroin use at 3 months . Costs of treatment were measured ( in Australian dollars , AU$ ) and cost-effectiveness compared . Secondary outcomes included quality of life , psychological symptoms and use of non-opioid drugs . FINDINGS A total of 119 subjects were r and omized and analysed . At 3 months , 33/58 ( 57 % ) r and omized to unobserved treatment , and 37/61 ( 61 % ) observed were retained ( log-rank chi2 = 0.04 , df = 1 , P = 0.84 ) . On an intention-to-treat analysis , reductions in days of heroin use in the preceding month , from baseline to 3 months , did not differ significantly ; 18.5 days ( 95 % CI : 21.8 - 15.3 ) and 22.0 days ( 95 % CI : 24.3 - 19.7 ) , respectively ( Mann-Whitney U = 807.5 , P = 0.13 ) . The mean cost for the unobserved group was AU$1,663 ( 95 % CI 1308 - 2017 ) per treatment episode , significantly less than the mean cost for the observed group at AU$2,138 ( 95 % CI 1713 - 2562 ) . CONCLUSIONS Retention and heroin use was not significantly different between observed and unobserved dosing groups . Attendance for observed dosing was not associated with worse retention . Treatment with close clinical monitoring , but no observation of dosing , was significantly cheaper and therefore significantly more cost-effective Objectives To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels ( DRLs ) as defined by the WHO , and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases , injuries and deaths . Design Decision modelling using Markov chains compared costs and effects over 5 years . Setting The analysis was from the perspective of the National Health Service ( NHS ) in Engl and and Wales . Participants The model considered the licensed population for nalmefene , specifically adults with both alcohol dependence and high/very high DRLs , who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment . Data sources We modelled treatment effect using data from three clinical trials for nalmefene ( ESENSE 1 ( NCT00811720 ) , ESENSE 2 ( NCT00812461 ) and SENSE ( NCT00811941 ) ) . Baseline characteristics of the model population , treatment re source utilisation and utilities were from these trials . We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies . Health-related costs were from UK sources . Main outcome measures We measured incremental cost per quality -adjusted life year ( QALY ) gained and number of alcohol-attributable harmful events avoided .  Results Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio ( ICER ) of £ 5204 per QALY gained , and was therefore cost-effective at the £ 20 000 per QALY gained decision threshold . Sensitivity analyses showed that the conclusion was robust . Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to psychosocial support alone over the course of 5 years . Conclusions Nalmefene can be seen as a cost-effective treatment for alcohol dependence , with substantial public health benefits . Trial registration numbers This cost-effectiveness analysis was developed based on data from three r and omised clinical trials : ESENSE 1 ( NCT00811720 ) , ESENSE 2 ( NCT00812461 ) and SENSE ( NCT00811941 ) BACKGROUND Economic evaluations in health care involve the identification , measurement , valuation , and then comparison of the costs ( inputs ) and outcomes of treatments or preventive activities . The aim was to analyze the cost-utility of six-month methadone maintenance treatment program in a Lithuanian primary health care setting . METHODS A prospect i ve study design was used . All the information was obtained through the vali date d question naires at the baseline and 3- and 6-month follow-ups . WHOQOL-BREF was used to assess the quality of life ; the costs were assessed using the DATCAP methodology from the perspective of a patient and outpatient clinic during follow-up period . RESULTS A total of 102 opioid-dependent patients were recruited in the study ; 512 follow-up patient-months were obtained . The methadone maintenance treatment has significantly improved physical , psychological , and environmental components of quality of life during follow-up . Total program costs were 61 288.87 EUR . Cost paid by a patient comprised about 31 % of total program costs . Cost per quality -adjusted life-month ( QALM ) for physical domain was 2227.55 EUR ; for psychological domain , 1879.50 EUR ; for social domain , 5467.64 EUR ; and for environmental domain , 4626.47 EUR . Costs per QALM and quality -adjusted life-year ( QALY ) for total quality of life in the maintenance program were 2864.00 EUR and 34 368.00 EUR , respectively . CONCLUSIONS Our results showed that 6-month methadone maintenance program was effective in the terms of quality -of-life improvement .  Methadone maintenance treatment program was less effective in terms of cost per QALY Models for the economic evaluation of health technologies provide valuable information to decision makers . The choice of model structure is rarely discussed in published studies and can affect the results produced . Many papers describe good modelling practice , but few describe how to choose from the many types of available models . This paper develops a new taxonomy of model structures . The horizontal axis of the taxonomy describes assumptions about the role of expected values , r and omness , the heterogeneity of entities , and the degree of non-Markovian structure . Commonly used aggregate models , including decision trees and Markov models require large population numbers , homogeneous sub-groups and linear interactions . Individual models are more flexible , but may require replications with different r and om numbers to estimate expected values . The vertical axis of the taxonomy describes potential interactions between the individual actors , as well as how the interactions occur through time . Models using interactions , such as  system dynamics  , some  Markov models  , and  discrete event simulation  are fairly uncommon in the health economics but are necessary for modelling infectious diseases and systems with constrained re sources . The paper provides guidance for choosing a model , based on key requirements , including output requirements , the population size , and system complexity Abstract Background and aim : Buprenorphine offers an alternative to methadone in the treatment of heroin dependence , and has the advantage of allowing alternate-day dosing . This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a r and omised trial . Study design and methods : The study was a r and omised , open-label , 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone . Those who were currently on a methadone program ( n = 57 ; continuing therapy subgroup ) were analysed separately from new treatment recipients ( n = 82 ; initial therapy subgroup ) . The study took a broad societal perspective and included health , crime and personal costs . Data on re source use and outcomes were a combination of clinical records and self report 
    Output:
    