BackgroundThis study aims to compare the potential short-term effects of non-pharmacological interventions (NPIs) on prehypertensive people, and provide evidence for intervention models with potential in future community-based management.MethodsIn this Bayesian network meta-analysis, Pubmed, Embase, and Web of science were screened up to 16 October 2021. Prehypertensive patients (systolic blood pressure, SBP 120–139 mmHg/diastolic blood pressure, DBP 80–89 mmHg) with a follow-up period longer than 4 weeks were targeted. Sixteen NPIs were identified during the scope review and categorized into five groups. Reduction in SBP and DBP was selected as outcome variables and the effect sizes were compared using consistency models among interventions and intervention groups. Grade approach was used to assess the certainty of evidence.ResultsThirty-nine studies with 8,279 participants were included. For SBP, strengthen exercises were the most advantageous intervention group when compared with usual care (mean difference = −6.02 mmHg, 95% CI −8.16 to −3.87), and combination exercise, isometric exercise, and aerobic exercise were the three most effective specific interventions. For DBP, relaxation was the most advantageous intervention group when compared with usual care (mean difference = −4.99 mmHg, 95% CI −7.03 to −2.96), and acupuncture, meditation, and combination exercise were the three most effective specific interventions. No inconsistency was found between indirect and direct evidence. However, heterogeneity was detected in some studies.ConclusionNPIs can bring short-term BP reduction benefits for prehypertensive patients, especially exercise and relaxation. NPIs could potentially be included in community-based disease management for prehypertensive population once long-term real-world effectiveness and cost-effectiveness are proven.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518, identifier: CRD42020151518.

Patients with prediabetes who are at a high risk of progressing to diabetes are recommended early-stage intervention, according to guidelines. Non-pharmacological interventions are effective and cost-effective for glycemic control compared with medicines. We aim to explore which non-pharmacological interventions have the greatest potential effectiveness, cost-effectiveness, and feasibility in community-based diabetes management in China. We will perform a systematic review and network meta-analysis to compare the effectiveness of included non-pharmacological interventions, then use Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) to model the yearly incidence of complications, costs, and health utility for the lifetime. Published studies (only randomized controlled trials (RCTs) and cluster RCTs with at least one study arm of any non-pharmacological intervention) will be retrieved and screened using several databases. Primary outcomes included blood glucose, glycated hemoglobin, incidence of type 2 diabetes mellitus, and achievement of normoglycemia. Health utilities and cost parameters are to be calculated using a societal perspective and integrated into the modified CHIME model to achieve quality-adjusted life-year (QALY) estimates and lifetime costs. QALYs and incremental cost-effectiveness ratio will then be used to determine effectiveness and cost-effectiveness, respectively. Our study findings can inform improved diabetes management in countries with no intervention programs for these patients.

Background: Vaccination can significantly reduce the health impact and economic burden of coronavirus disease 2019 (COVID-19), but vaccination levels for COVID-19 in most African countries lag far behind global averages. We assessed the cost-effectiveness of different COVID-19 vaccination strategies in Kenya and determined the optimal vaccination strategy. Methods: Using a dynamic transmission model, we divided the population into three groups: 0-18 years, 19-58 years and 58+ years. We assessed the effectiveness and cost-effectiveness of three vaccination strategies at different numbers of daily vaccinations based on previous studies and public databases. Nine scenarios were modeled and compared to no-continuation-vaccination to calculate the number of averted diseases, averted deaths, and net benefits of different vaccination strategies. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to assess the stability of our findings. Results: Compared to no-continuation-vaccination for various vaccination scenarios, all vaccination strategies were found to be effective and cost-saving. The incremental net benefit ranged from 0.235 billion USD to 2.305 billion USD, and prioritizing vaccination boosters for individuals aged 19-58 was identified as the most cost-effective option. On the other hand, prioritizing vaccination for the unvaccinated population aged 58 and above could potentially reduce COVID-19 related deaths by 1.59%-56.60%, which was the most effective approach in avoiding cause-specific deaths. However, all vaccination strategies were found to be ineffective in controlling the infection trend when compared to no intervention under different vaccination scenarios, with only 474,318-5,306,865 infections potentially being prevented. Conclusion: Timely and widespread vaccination against COVID-19 in Kenya is effective and cost-effective, a specific vaccination strategy should be selected based on decision-making needs. Priority vaccination for the elderly without vaccination may be more cost-effective compared with other vaccination strategies.

Background: The initial mass vaccination's effectiveness has diminished, necessitating accelerated immunization coverage scaling. China has shifted nucleic acid testing from large-scale to voluntary. This study assesses the effectiveness and cost-effectiveness of different booster vaccination strategies in China. Methods: A dynamic transmission model divided the population into three groups: 0-19, 20-59, and 60+ years. We evaluated the effectiveness and cost-effectiveness of three vaccination strategies based on previous studies and public databases. Three scenarios were modeled and compared to no-continuation-vaccination to calculate averted diseases, deaths, and net benefits. One-way sensitivity analysis and probabilistic sensitivity analysis assessed findings' stability. Results: COVID-19 vaccination had significant health benefits compared to no continuing vaccination. Strategy II (prioritizing vaccinated 20-59-year-olds, then vaccinated 60+ individuals, and finally 0-19-year-olds) was the most cost-effective. Strategy I (prioritizing unvaccinated 60+ individuals, then 20-59, and finally 0-19) prevented the most deaths. Strategy II was the most cost-effective, with a total cost of 93,995,223,462 USD and the highest net benefit of 3,054,475,908,551,960 USD. Strategy II resulted in the highest number of avoided cases across categories, including infected, asymptomatic, mild/moderate, severe, and critical cases. Each strategy's effects on preventing new cases and critical illness were comparable. Sensitivity analyses confirmed the results' reliability. Conclusion: Prioritizing vaccinated 20-59-year-olds, then vaccinated 60+ individuals, and finally 0-19-year-olds was the most effective prevention strategy. The vaccination strategy should be tailored to the pandemic situation and available medical resources for maximum health gains.

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