CDC SAYS EARLY TREATMENT OF ROCKY MOUNTAIN SPOTTED FEVER MAY SAVE MILLIONS, PREVENT PREMATURE DEATH AND DISABILITY

FROM:  U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION
Prevention and early treatment of RMSF in Arizona may save millions by preventing premature death and disability

Several Arizona American Indian communities severely impacted by outbreak, CDC/IHS study finds

The mounting costs of an epidemic of Rocky Mountain spotted fever (RMSF) among several American Indian tribes in Arizona suggests that prevention and control efforts would be cost effective.  A recent study released by experts at the Centers for Disease Control and Prevention (CDC) and the Indian Health Service (IHS), in partnership with Arizona tribes, describes an estimated $13.2 million in losses linked to the epidemic of RMSF between 2002 and 2011, on two Indian reservations. Cost estimates include medical costs, time off work, and loss of lifetime productivity due to early death. These values underestimate the actual cost of the epidemic because long-term losses from disability and expensive medical procedures are not included. Preventing tick bites is the most important step in preventing severe illness and death from RMSF. CDC, IHS, state, and tribal governments are working together to develop effective prevention programs to gain control of this devastating epidemic.

“Rocky Mountain Spotted Fever is completely preventable,” said Naomi Drexler, CDC epidemiologist and one of the study’s authors. “State, federal and tribal health authorities have been working together since the start of the epidemic to build effective community-based tick control programs, and these efforts have produced remarkable reductions in human cases. These programs are costly, but medical expenses and lives lost cost four times more than RMSF prevention efforts. Increasing access to these prevention efforts is critical to save lives and protect communities.”

Published in The American Journal of Tropical Medicine and Hygiene, the study reviewed 205 medical records from two American Indian communities at the center of the epidemic. Over 80 percent of RMSF cases required emergency room visits, 14 percent were admitted to the intensive care unit for severe illness, and 7 percent were fatal. The average cost per death from RMSF ($775,467) is more than five times that of pneumococcal disease ($140,862) in the United States. More than half of RMSF deaths were among children, raising the long-term social costs of the epidemic.

RMSF is a severe disease caused by the bacterium Rickettsia rickettsii and spread through the bite of an infected tick. RMSF begins with non-specific symptoms such as fever and headache, vomiting, diarrhea, and sometimes rash. Severely ill patients may require amputation of fingers, toes or limbs due to blood loss; heart and lung specialty care; and management in intensive care units. More than 20 percent of untreated cases are fatal; the average time from the beginning of symptoms to death is only eight days.

HHS SAYS PREVENTION PROGRAM REDUCES FALL AMONG ELDERLY

FROM:  U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
June 8, 2015
Comprehensive prevention program effectively reduces falls among older people
HHS-supported study tests falls intervention program

Families and physicians have a new tool in the fight against falls- a comprehensive prevention program developed by the U.S. Department of Health and Human Services that reduces both falls and resulting use of long-term care such as nursing homes.

The prevention program, which includes clinical in-home assessments of health, physical functioning, falls history, home environment, and medications to create customized recommendations, was developed by HHS based on the research evidence on risk factors and interventions. Using a randomized control trial, the program was tested among long-term care insurance policy holders age 75 and older to determine whether the intervention was effective and, if so, the impact on long-term care utilization.

The study found that the program led to significantly lower rates of falls over a one-year study period. Those who received the intervention had a 13 percent lower rate of falls, and an 11 percent reduction in risk of falling compared to the control group. Participants also had a significantly lower rate of injurious falls. Long-term care insurance claims were 33 percent lower over a three-year period. The intervention, which cost $500 per person to administer, saved $838 per person.

Falls- which happen to 1 in 3 people age 65 and over every year-- can cause pain, suffering, and death, and cost an estimated $35 billion in health care spending in 2014. They are a leading risk factor for needing long-term care at home or in a nursing facility. Given the impact of falls, findings from the HHS-funded study give hope for reducing the rate of falls among the growing population of older adults.

“While falls are preventable, we need to intervene at the right time in a way that is comprehensive and yet individually tailored,” said Richard Frank, Ph.D., the assistant secretary for planning and evaluation at HHS, whose office funded the study. “Preventing falls helps everyone: the older person, their family, and the health and long-term care systems. And this study shows that by investing in falls prevention, we can reduce long-term care use and spending.”

The risk factors for a fall include fear of falling, gait and balance problems, certain medications, clutter in the home, and some health conditions. Few interventions have taken a comprehensive approach to address all of the risk factors through one program.

Although this study focused on the rate of falls and long-term care utilization and costs, future research will examine the impact of the intervention on health care utilization and costs.

“We expect to see a similar or greater return on investment in terms of health care costs,” added Richard Frank.