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Fehily C, Ling R, Searles A, Bartlem K, Wiggers J, Hodder R, Wilson A, Colyvas K, Bowman J. An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial. BMC Health Serv Res 2020; 20:405. [PMID: 32393307 PMCID: PMC7212584 DOI: 10.1186/s12913-020-05204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, however, such care is infrequently provided in routine consultations. An alternative model of care is to appoint a clinician to the dedicated role of offering and providing preventive care in an additional consultation: the 'specialist clinician' model. Economic evaluations of models of care are needed to determine the cost of adhering to guidelines and policies, and to inform pragmatic service delivery decisions. This study is an economic evaluation of the specialist clinician model; designed to achieve policy concordant preventive care delivery. METHODS A retrospective analysis of the incremental costs, cost-effectiveness, and budget impact of a 'specialist preventive care clinician' (an occupational therapist) was conducted in a randomised controlled trial, where participants were randomised to receive usual care; or usual care plus the offer of an additional preventive care consultation with the specialist clinician. The study outcome was client acceptance of referrals to two free telephone-based chronic disease prevention services. This is a key care delivery outcome mandated by the local health district policy of the service. The base case analysis assumed the mental health service cost perspective. A budget impact analysis determined the annual budget required to implement the model of care for all clients of the community mental health service over 5 years. RESULTS There was a significantly greater increase from baseline to follow-up in the proportion of intervention participants accepting referrals to both telephone services, compared to usual care. The incremental cost-effectiveness ratio was $347 per additional acceptance of a referral (CI: $263-$494). The annual budget required to implement the model of care for all prospective clients was projected to be $711,446 over 5-years; resulting in 2616 accepted referrals. CONCLUSIONS The evaluation provides key information regarding the costs for the mental health service to adhere to policy targets, indicating the model of care involved a low per client cost whilst increasing key preventive care delivery outcomes. Additional modelling is required to further explore its economic benefits. TRIAL REGISTRATION ACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia.
| | - Rod Ling
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Rebecca Hodder
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Andrew Wilson
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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Ferri V, Quijano Y, Nuñez J, Caruso R, Duran H, Diaz E, Fabra I, Malave L, Isernia R, d'Ovidio A, Agresott R, Gomez P, Isojo R, Vicente E. Robotic-assisted right colectomy versus laparoscopic approach: case-matched study and cost-effectiveness analysis. J Robot Surg 2020; 15:115-123. [PMID: 32367439 DOI: 10.1007/s11701-020-01084-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to compare clinical and oncological outcomes of robot-assisted right colectomy with those of conventional laparoscopy-assisted right colectomy, reporting for the first time in literature, a cost-effectiveness analysis. METHODS This is a case-matched prospective non-randomized study conducted from October 2013 to October 2017 at Sanchinarro University Hospital, Madrid. Patients with right-sided colonic adenocarcinoma or adenoma, not suitable endoscopic resection were treated with robot-assisted right colectomy and a propensity score-matched (1:1) was used to balance preoperative characteristics of a laparoscopic control group. Perioperative, postoperative, long-term oncological results and costs were analysed, and quality-adjusted life years (QALY), and the cost-effectiveness ratio (ICER) were calculated. The primary end point was to compare the cost-effectiveness differences between both groups. A willingness-to-pay of 20,000 and 30,000 per QALY was used as a threshold to recognize which treatment was most cost effective. RESULTS Thirty-five robot-assisted right colectomies were included and a group of 35 laparoscopy-assisted right colectomy was selected. Compared with the laparoscopic group, the robotic group was associated with longer operation times (243 min vs. 179 min, p < 0.001). No significant difference was observed in terms of total costs between the robotic and laparoscopic groups (9455.14 vs 8227.50 respectively, p = 0.21). At a willingness-to-pay threshold of 20,000 and 30,000, there was a 78.78-95.04% probability that the robotic group was cost effective relative to laparoscopic group. CONCLUSION Robot-assisted right colectomy is a safe and feasible technique and is a cost-effective procedure.
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Affiliation(s)
- Valentina Ferri
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain.
| | - Yolanda Quijano
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Javier Nuñez
- IVEC (Instituto de Validación de la Eficiencia Clínica), Fundación de Investigación HM Hospitales, Madrid, Spain
| | - Riccardo Caruso
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Hipolito Duran
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Eduardo Diaz
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Isabel Fabra
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Luisi Malave
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Roberta Isernia
- Division of General Surgery, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Angelo d'Ovidio
- Division of General Surgery, Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy
| | - Ruben Agresott
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Patricio Gomez
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Rigoberto Isojo
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
| | - Emilio Vicente
- Division of General Surgery, HM-Sanchinarro University Hospital, San Pablo University, calle oña 10, Madrid, Spain
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Clarke L. An introduction to economic studies, health emergencies, and COVID-19. J Evid Based Med 2020; 13:161-167. [PMID: 32470229 PMCID: PMC7283784 DOI: 10.1111/jebm.12395] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/08/2020] [Indexed: 01/23/2023]
Abstract
The COVID-19 pandemic has created widespread harm and disruption. Countries have implemented unprecedented measures to protect the lives and livelihoods of their inhabitants. The scope and composition of these responses are shaped, in part, by research and analysis about the estimated economic impacts of the COVID-19 Pandemic and proposed responses to it. This analysis outlines basic features and principles involved in economic studies, specifically economic impact studies and economic evaluations, which have formed a significant part of the ever-increasing evidence base about COVID-19. This analysis introduces economic studies in this context, highlighting what they can do, their limitations, and key steps involved in conducting them. It highlights examples of economic analysis focused on COVID-19 and on health emergencies and disasters more broadly. Knowing how economic studies are conducted, and their limitations, will help introduce how their findings can be a useful, usable, and used part of efforts to tackle this global health crisis.
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Affiliation(s)
- Lorcan Clarke
- London School of Economics and Political ScienceLondonUnited Kingdom of Great Britain
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Lite S, Gordon WJ, Stern AD. Association of the Meaningful Use Electronic Health Record Incentive Program With Health Information Technology Venture Capital Funding. JAMA Netw Open 2020; 3:e201402. [PMID: 32207830 PMCID: PMC7093764 DOI: 10.1001/jamanetworkopen.2020.1402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
Importance Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated electronic health record (EHR) adoption since its passage, clinician satisfaction with EHRs remains low, and the association of HITECH with health care information technology (IT) entrepreneurship has remained largely unstudied. Objective To determine whether the passage of the HITECH Act was associated with an increase in key measures of health care IT entrepreneurship. Design, Setting, and Participants This economic evaluation of venture capital (VC) activity in the US from 2000 to 2019 examined funding trends in health care IT, EHR-related companies, and all VC investments before and after the passage of HITECH. A difference-in-differences analysis compared investments in health care IT companies with those of companies in 3 categories: general health care (non-IT), IT (non-health care), and all US VC transactions. Data were analyzed from September 2018 to August 2019. Exposures Venture capital funding received by US companies before and after the HITECH Act. Main Outcomes and Measures Venture capital investment in health care IT companies and the proportion of those investments going to seed-stage companies, a proxy for very early-stage entrepreneurship and innovation. Results The data included 70 982 investments, of which 9425 (13.3%) were seed stage, 10 706 (15.1%) were early stage, and 50 851 (71.6%) were growth stage. After passage of the HITECH Act, investment in both health care IT companies and EHR-related companies increased at a rate much faster (13.0% and 11.4%, respectively) than VC as a whole (6.9%). In addition, the proportion of investments going to seed-stage health care IT companies increased compared with both overall VC investments and non-IT health care investments. Health care IT companies saw increased probabilities of transactions being seed-stage of 5.1% (SE, 2.2%; 95% CI, 0.8% to 9.3%; P = .02) compared with the entire sample of VC transactions and 13.6% (SE, 1.9%; 95% CI, 9.9% to 17.2%; P < .001) compared with non-IT health care VC transactions. Health care IT had essentially 0 increased probability of a transaction being seed stage compared with IT companies outside health care (-0.8% probability; SE, 2.4%; 95% CI, -5.4% to 3.9%; P = .75). Conclusions and Relevance Although widespread clinician dissatisfaction with EHR systems remains a challenge, the HITECH Act's incentive program may have catalyzed early-stage entrepreneurship in health care IT, suggesting an important role for incentives in promoting innovation.
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Affiliation(s)
- Samuel Lite
- Harvard Business School, Boston, Massachusetts
| | - William Joseph Gordon
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Partners HealthCare, Boston, Massachusetts
| | - Ariel Dora Stern
- Harvard Business School, Boston, Massachusetts
- Harvard-MIT Center for Regulatory Science, Boston, Massachusetts
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105
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Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study. Tech Coloproctol 2020; 24:247-254. [PMID: 32020350 DOI: 10.1007/s10151-020-02151-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The differences between the costs of robotic rectal resection and of the laparoscopic approach are still not well known. The aim of this study was to evaluate the cost-effectiveness of robotic versus laparoscopic surgery. METHODS We conducted an observational, comparative, prospective, non-randomized study on patients having laparoscopic and robotic rectal resection between February 2014 and March 2018 at the Sanchinarro University Hospital, Madrid. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). The primary endpoint was to compare cost effectiveness in the robotic and laparoscopic surgery groups. A willingness-to-pay of 20,000€ and 30,000€ per QALY was used as a threshold to determine the most cost-effective treatment. RESULTS A total of 81 RRR and 104 LRR were included. The mean operative costs were higher for RRR (4307.09€ versus 3834.58€; p = 0.04), although mean overall costs were similar (7272.03€ for RRR and 6968.63€ for the LLR; p = 0.44). Mean QALYs at 1 year for the RRR group (0.8482) was higher than that associated with LRR (0.6532) (p = 0.018). At a willingness-to-pay threshold of 20,000€ and 30,000€ there was a 95.54% and 97.18% probability, respectively, that RRR was more cost-effective than LRR. CONCLUSIONS Our data regarding the cost-effectiveness of RRR versus LRR shows a benefit for RRR.
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Walsh CA, Rosenberg AR, Lau N, Syrjala KL. Key considerations for advancing the development and testing of mHealth interventions in adolescent and young adult oncology. Psychooncology 2020; 29:220-223. [PMID: 31475768 PMCID: PMC6980895 DOI: 10.1002/pon.5216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Casey A Walsh
- University of Washington School of Public Health, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Abby R Rosenberg
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Nancy Lau
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Mendivil J, Appierto M, Aceituno S, Comas M, Rué M. Economic evaluations of screening strategies for the early detection of colorectal cancer in the average-risk population: A systematic literature review. PLoS One 2019; 14:e0227251. [PMID: 31891647 PMCID: PMC6938313 DOI: 10.1371/journal.pone.0227251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background Colorectal cancer (CRC) screening has proven effective in reducing CRC mortality. This study aimed to systematically review, and evaluate the reporting quality, of the economic evidence regarding CRC screening in average-risk individuals. Methods Databases searched included Medline, EMBASE, National Health Service Economic Evaluation, Database of Abstracts of Reviews of Effects, Cost-Effectiveness Analysis registry, EconLit, and Health Technology Assessment database. Eligible studies were cost-effectiveness and cost-utility analyses comparing CRC screening strategies in average-risk individuals, published in English or Spanish, between January 2012 and November 2018. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results Of 1,993 publications initially retrieved, 477 were excluded by duplicate review, 1,449 by title/abstract review, and 34 by full-text review. Finally, 33 publications were included in the qualitative synthesis. Most studies were conducted in Europe (36,4%), followed by United States (24,2%) and Asia (24,2%). The main screening modalities considered were fecal immunochemical tests (70%), colonoscopy (67%), guaiac fecal occult blood test (42%) and flexible sigmoidoscopy (30%). In most studies, CRC screening was deemed cost-effective compared to no screening. Sensitivity analyses indicated that cost of CRC screening tests, adherence to screening, screening test sensitivity, and cost of CRC treatment had the greatest impact on cost-effectiveness results across studies. The majority of studies (73%) adequately reported at least 50% of the items included in the CHEERS checklist. Least well reported items included setting, study perspective, discount rate, model choice, and methods to identify effectiveness data or to estimate resource use and costs. Conclusions CRC screening is an efficient alternative to no screening. Nevertheless, it is not possible to conclude which strategy should be preferred for population-based screening programs. Although we observed an overall good adherence to CHEERS recommendations, there is still room for improvement in economic evaluations reporting in this field.
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Affiliation(s)
- Joan Mendivil
- Outcomes Research and Epidemiology, Shire International GmbH, a Takeda Company, Zug, Switzerland
- * E-mail:
| | | | - Susana Aceituno
- Health Economics department, Outcomes’ 10 SLU, Castellon, CS, Spain
| | - Mercè Comas
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute); Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Montserrat Rué
- Departament of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
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Moloney E, Craig D, Holdsworth N, Smithson J. Optimising clinical effectiveness and quality along the atrial fibrillation anticoagulation pathway: an economic analysis. BMC Health Serv Res 2019; 19:1007. [PMID: 31883510 PMCID: PMC6935474 DOI: 10.1186/s12913-019-4841-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background Atrial fibrillation (AF) represents the most common sustained cardiac arrhythmia. A service evaluation was carried out at an anticoagulation clinic in Newcastle upon-Tyne to explore the efficacy of introducing self-testing of anticoagulation status for AF patients on warfarin. The analysis presented aims to assess the potential cost savings and clinical outcomes associated with introducing self-testing at a clinic in the Northeast of England, and to determine the cost-effectiveness of a redesigned treatment pathway including genetic testing and self-testing components. Methods Questionnaires were administered to individuals participating in the service evaluation to understand the patient costs associated with clinical monitoring (139 patients), and quality-of-life before and after the introduction of self-testing (varying numbers). Additionally, data on time in therapeutic range (TTR) were captured at multiple time points to identify any change in outcome. Finally, an economic model was developed to assess the cost-effectiveness of introducing a redesigned treatment pathway, including genetic testing and self-testing, for AF patients. Results The average cost per patient of attending the anticoagulation clinic was £16.24 per visit (including carer costs). Costs were higher amongst patients tested at the hospital clinic than those tested at the community clinic. Improvements in quality-of-life across all psychological topics, and improved TTR, were seen following the introduction of self-testing. Results of the cost-effectiveness analysis showed that the redesigned treatment pathway was less costly and more effective than current practice. Conclusions Allowing AF patients on warfarin to self-test, rather than attend clinic to have their anticoagulation status assessed, has the potential to reduce patient costs. Additionally, self-testing may result in improved quality-of-life and TTR. Introducing genetic testing to guide patient treatment based on sensitivity to warfarin, and applying this in combination with self-testing, may also result in improved patient outcomes and reduced costs to the health service in the long-term.
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Affiliation(s)
- Eoin Moloney
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK.
| | - Dawn Craig
- Health Economics Group, Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Nikki Holdsworth
- Academic Health Science Network North East and North Cumbria, Newcastle, UK
| | - Joanne Smithson
- Academic Health Science Network North East and North Cumbria, Newcastle, UK
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Kent S, Becker F, Feenstra T, Tran-Duy A, Schlackow I, Tew M, Zhang P, Ye W, Lizheng S, Herman W, McEwan P, Schramm W, Gray A, Leal J, Lamotte M, Willis M, Palmer AJ, Clarke P. The Challenge of Transparency and Validation in Health Economic Decision Modelling: A View from Mount Hood. PHARMACOECONOMICS 2019; 37:1305-1312. [PMID: 31347104 PMCID: PMC6860461 DOI: 10.1007/s40273-019-00825-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Transparency in health economic decision modelling is important for engendering confidence in the models and in the reliability of model-based cost-effectiveness analyses. The Mount Hood Diabetes Challenge Network has taken a lead in promoting transparency through validation with biennial conferences in which diabetes modelling groups meet to compare simulated outcomes of pre-specified scenarios often based on the results of pivotal clinical trials. Model registration is a potential method for promoting transparency, while also reducing the duplication of effort. An important network initiative is the ongoing construction of a diabetes model registry (https://www.mthooddiabeteschallenge.com). Following the 2012 International Society for Pharmacoeconomics and Outcomes Research and the Society of Medical Decision Making (ISPOR-SMDM) guidelines, we recommend that modelling groups provide technical and non-technical documentation sufficient to enable model reproduction, but not necessarily provide the model code. We also request that modelling groups upload documentation on the methods and outcomes of validation efforts, and run reference case simulations so that model outcomes can be compared. In this paper, we discuss conflicting definitions of transparency in health economic modelling, and describe the ongoing development of a registry of economic models for diabetes through the Mount Hood Diabetes Challenge Network, its objectives and potential further developments, and highlight the challenges in its construction and maintenance. The support of key stakeholders such as decision-making bodies and journals is key to ensuring the success of this and other registries. In the absence of public funding, the development of a network of modellers is of huge value in enhancing transparency, whether through registries or other means.
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Affiliation(s)
- Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frauke Becker
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Talitha Feenstra
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services Research, Bilthoven, The Netherlands
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ping Zhang
- Division of Diabetes Translation, Centres for Disease Control and Prevention, Atlanta, USA
| | - Wen Ye
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Shi Lizheng
- Department of Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - William Herman
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Phil McEwan
- Centre for Health Economics, Swansea University, Swansea, UK
| | | | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Michael Willis
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Andrew J Palmer
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Menzies Institute for Medical Research, The University of Tasmania, Hobart, Australia
| | - Philip Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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McMeekin N, Geue C, Briggs A, Rombach I, Li HK, Bejon P, McNally M, Atkins BL, Ferguson J, Scarborough M. Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15314.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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Buitenwerf E, Berends AMA, van Asselt ADI, Korteweg T, Greuter MJW, Veeger NJM, Links TP, Dullaart RPF, Kerstens MN. Diagnostic Accuracy of Computed Tomography to Exclude Pheochromocytoma: A Systematic Review, Meta-analysis, and Cost Analysis. Mayo Clin Proc 2019; 94:2040-2052. [PMID: 31515105 DOI: 10.1016/j.mayocp.2019.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of unenhanced computed tomography (CT) attenuation values to exclude a pheochromocytoma in the diagnostic work-up of patients with an adrenal incidentaloma and to model the associated difference in diagnostic costs. METHODS The MEDLINE and Embase databases were searched from indexing to September 27, 2018, and studies reporting the proportion of pheochromocytomas on either side of the 10-Hounsfield unit (HU) threshold on unenhanced CT were included. The pooled proportion of pheochromocytomas with an attenuation value greater than 10 HU was determined, as were the modeled financial costs of the current and alternative diagnostic approaches. RESULTS Of 2957 studies identified, 31 were included (N=1167 pheochromocytomas). Overall risk of bias was low. Heterogeneity was not observed between studies (Q=11.5, P=.99, I2=0%). The pooled proportion of patients with attenuation values greater than 10 HU was 0.990 (95% CI, 0.984-0.995). The modeled financial costs using the new diagnostic approach were €55 (∼$63) lower per patient. CONCLUSION Pheochromocytomas can be reliably ruled out in the case of an adrenal lesion with an unenhanced CT attenuation value of 10 HU or less. Therefore, determination of metanephrine levels can be restricted to adrenal tumors with an unenhanced CT attenuation value greater than 10 HU. Implementing this novel diagnostic strategy is cost-saving.
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Affiliation(s)
- Edward Buitenwerf
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands.
| | - Annika M A Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Antoinette D I van Asselt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tijmen Korteweg
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nic J M Veeger
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, the Netherlands
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112
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Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest: A Markov decision model. Resuscitation 2019; 143:150-157. [PMID: 31473264 DOI: 10.1016/j.resuscitation.2019.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment. METHODS A decision tree and Markov model were constructed based on current literature. The model was conditional on age, Charlson Comorbidity Index (CCI) and sex. Three treatment strategies were considered: ECPR for patients with an Age-Combined Charlson Comorbidity Index (ACCI) below different thresholds (2-4), ECPR for everyone (EALL), and ECPR for no one (NE). Cost-effectiveness was assessed with costs per quality-of-life adjusted life years (QALY). MEASUREMENTS AND MAIN RESULTS Treating eligible patients with an ACCI below 2 points costs 8394 (95% CI: 4922-14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8825 (95% CI: 5192-15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5478-16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10,818 (95% CI: 6357-19,400) euro per extra QALY per IHCA patient. For WTP thresholds of 0-9500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9500 and 12,500, treating eligible patients with an ACCI below 4 has the highest probability of being the most cost-effective strategy. For WTP thresholds of 12,500 or higher, EALL was found to have the highest probability of being the most cost-effective strategy. CONCLUSIONS Given that conventional WTP thresholds in Europe and North-America lie between 50,000-100,000 euro or U.S. dollars, ECPR can be considered a cost-effective treatment after in-hospital cardiac arrest from a healthcare perspective. More research is necessary to validate the effectiveness of ECPR, with a focus on the long-term effects of complications of ECPR.
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113
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Guillaumier A, McCrabb S, Spratt NJ, Pollack M, Baker AL, Magin P, Turner A, Oldmeadow C, Collins C, Callister R, Levi C, Searles A, Deeming S, Wynne O, Denham AMJ, Clancy B, Bonevski B. An online intervention for improving stroke survivors' health-related quality of life: study protocol for a randomised controlled trial. Trials 2019; 20:491. [PMID: 31399140 PMCID: PMC6688335 DOI: 10.1186/s13063-019-3604-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/19/2019] [Indexed: 11/22/2022] Open
Abstract
Background Recurrent stroke is a major contributor to stroke-related disability and costs. Improving health-risk behaviours and mental health has the potential to significantly improve recovery, enhance health-related quality of life (HRQoL), independent living, and lower the risk of recurrent stroke. The primary aim will be to test the effectiveness of an online intervention to improve HRQoL among stroke survivors at 6 months’ follow-up. Programme effectiveness on four health behaviours, anxiety and depression, cost-effectiveness, and impact on other hospital admissions will also be assessed. Methods/design An open-label randomised controlled trial is planned. A total of 530 adults will be recruited across one national and one regional stroke registry and block randomised to the intervention or minimal care control group. The intervention group will receive access to the online programme Prevent 2nd Stroke (P2S); the minimal care control group will receive an email with Internet addresses of generic health sites designed for the general population. The primary outcome, HRQoL, will be measured using the EuroQol-5D. A full analysis plan will compare between groups from baseline to follow-up. Discussion A low-cost per user option to supplement current care, such as P2S, has the potential to increase HRQoL for stroke survivors, and reduce the risk of second stroke. Trial registration Australian and New Zealand Clinical Trials Registry, ID: ACTRN12617001205325p. Registered on 17 August 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3604-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashleigh Guillaumier
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Neil J Spratt
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia.,Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Michael Pollack
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Parker Magin
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Alyna Turner
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, PO Box 291, Geelong, VIC, Australia.,Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Clare Collins
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Robin Callister
- The University of Newcastle, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Chris Levi
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Andrew Searles
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Simon Deeming
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Alexandra M J Denham
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Brigid Clancy
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, 1 University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia.
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Pérez-Aranda A, D'Amico F, Feliu-Soler A, McCracken LM, Peñarrubia-María MT, Andrés-Rodríguez L, Angarita-Osorio N, Knapp M, García-Campayo J, Luciano JV. Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study). J Clin Med 2019; 8:jcm8071068. [PMID: 31330832 PMCID: PMC6678679 DOI: 10.3390/jcm8071068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022] Open
Abstract
Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost-utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention ("FibroQoL") and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost-utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.
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Affiliation(s)
- Adrián Pérez-Aranda
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Department of Clinical Psychology and Psychobiology (Section Personality, Assessment and Psychological Treatments), University of Barcelona, 08193 Barcelona, Spain
| | - Francesco D'Amico
- The London School of Economics and Political Science (LSE), London WC2A 2AE, UK
| | - Albert Feliu-Soler
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain.
| | - Lance M McCracken
- Department of Psychology, Uppsala University, SE-751 05 Uppsala, Sweden
| | - María T Peñarrubia-María
- Primary Health Centre Bartomeu Fabrés Anglada, SAP Delta Llobregat, Unitat Docent Costa de Ponent, Institut Català de la Salut, 08850 Gavà, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Fundació IDIAP Jordi Gol I Gurina, 08007 Barcelona, Spain
| | - Laura Andrés-Rodríguez
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Natalia Angarita-Osorio
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Martin Knapp
- The London School of Economics and Political Science (LSE), London WC2A 2AE, UK
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Javier García-Campayo
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Department of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), 50009 Zaragoza, Spain
| | - Juan V Luciano
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain.
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McMeekin N, Geue C, Briggs A, Rombach I, Li HK, Bejon P, McNally M, Atkins BL, Ferguson J, Scarborough M. Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. Wellcome Open Res 2019. [PMID: 31930174 DOI: 10.12688/wellcomeopenres.15314.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial 'Oral Versus Intravenous Antibiotics' (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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Affiliation(s)
- Nicola McMeekin
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Claudia Geue
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Andrew Briggs
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Ines Rombach
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Ho Kwong Li
- Division of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Philip Bejon
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Martin McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, OX3 7HE, UK
| | - Bridget L Atkins
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Jamie Ferguson
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Matthew Scarborough
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
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116
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McMeekin N, Geue C, Briggs A, Rombach I, Li HK, Bejon P, McNally M, Atkins BL, Ferguson J, Scarborough M. Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. Wellcome Open Res 2019; 4:108. [PMID: 31930174 PMCID: PMC6944252 DOI: 10.12688/wellcomeopenres.15314.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections. Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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Affiliation(s)
- Nicola McMeekin
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Claudia Geue
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Andrew Briggs
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Ines Rombach
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Ho Kwong Li
- Division of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Philip Bejon
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Martin McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, OX3 7HE, UK
| | - Bridget L Atkins
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Jamie Ferguson
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Matthew Scarborough
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
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117
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McMeekin N, Geue C, Briggs A, Rombach I, Li HK, Bejon P, McNally M, Atkins BL, Ferguson J, Scarborough M. Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. Wellcome Open Res 2019. [PMID: 31930174 DOI: 10.12688/wellcomeopenres.15314.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial 'Oral Versus Intravenous Antibiotics' (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.
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Affiliation(s)
- Nicola McMeekin
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Claudia Geue
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Andrew Briggs
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Ines Rombach
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Ho Kwong Li
- Division of Infectious Diseases, Imperial College London, London, W12 0NN, UK.,Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Philip Bejon
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,Wellcome Trust Research Programme, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Martin McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, OX3 7HE, UK
| | - Bridget L Atkins
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Jamie Ferguson
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
| | - Matthew Scarborough
- Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, OX3 7HE, UK
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118
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Castillo-Jimenez DA, García-Perdomo HA. Re: Niranjan J. Sathianathen, Badrinath R. Konety, Fernando Alarid-Escudero, Nathan Lawrentschuk, Damien M. Bolton, Karen M. Kuntz. Cost-effectiveness Analysis of Active Surveillance Strategies for Men with Low-risk Prostate Cancer. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2018.10.055. Eur Urol 2019; 76:e9. [DOI: 10.1016/j.eururo.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
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119
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Kählke F, Berger T, Schulz A, Baumeister H, Berking M, Cuijpers P, Bruffaerts R, Auerbach RP, Kessler RC, Ebert DD. Efficacy and cost-effectiveness of an unguided, internet-based self-help intervention for social anxiety disorder in university students: protocol of a randomized controlled trial. BMC Psychiatry 2019; 19:197. [PMID: 31238907 PMCID: PMC6593551 DOI: 10.1186/s12888-019-2125-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 04/22/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is highly prevalent among university students, but the majority of affected students remain untreated. Internet- and mobile-based self-help interventions (IMIs) may be a promising strategy to address this unmet need. This study aims to investigate the efficacy and cost-effectiveness of an unguided internet-based treatment for SAD among university students. The intervention is optimized for the treatment of university students and includes one module targeting fear of positive evaluations that is a neglected aspect of SAD treatment. METHODS The study is a two arm randomized controlled trial in which 200 university students with a primary diagnosis of SAD will be assigned randomly to either a wait-list control group (WLC) or the intervention group (IG). The intervention consists of 9 sessions of an internet-based cognitive-behavioral treatment, which also includes a module on fear of positive evaluation (FPE). Guidance is delivered only on the basis of standardized automatic messages, consisting of positive reinforcements for session completion, reminders, and motivational messages in response to non-adherence. All participants will additionally have full access to treatment as usual. Diagnostic status will be assessed through Structured Clinical Interviews for DSM Disorders (SCID). Assessments will be completed at baseline, 10 weeks and 6-month follow-up. The primary outcome will be SAD symptoms at post-treatment, assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). Secondary outcomes will include diagnostic status, depression, quality of life and fear of positive evaluation. Cost-effectiveness and cost-utility analyses will be evaluated from a societal and health provider perspective. DISCUSSION Results of this study will contribute to growing evidence for the efficacy and cost-effectiveness of unguided IMIs for the treatment of SAD in university students. Consequently, this trial may provide valuable information for policy makers and clinicians regarding the allocation of limited treatment resources to such interventions. TRIAL REGISTRATION DRKS00011424 (German Clinical Trials Register (DRKS)) Registered 14/12/2016.
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Affiliation(s)
- Fanny Kählke
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Nägelsbachstrasse 25a, 91052, Erlangen, Germany.
| | - Thomas Berger
- 0000 0001 0726 5157grid.5734.5Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ava Schulz
- Department of Experimental Psychopathology and Psychotherapy, University of Zürich, Psychiatric University Hospital, Zürich, Switzerland
| | - Harald Baumeister
- 0000 0004 1936 9748grid.6582.9Department of Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Matthias Berking
- 0000 0001 2107 3311grid.5330.5Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Nägelsbachstrasse 25a, 91052 Erlangen, Germany
| | - Pim Cuijpers
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Vrije University Amsterdam, Amsterdam, The Netherlands
| | - Ronny Bruffaerts
- 0000 0001 0668 7884grid.5596.fResearch Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Randy P. Auerbach
- 0000000419368729grid.21729.3fDepartment of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY USA ,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY USA
| | - Ronald C. Kessler
- 000000041936754Xgrid.38142.3cDepartment for Health Care Policy, Harvard Medical School, Boston, MA USA
| | - David Daniel Ebert
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Vrije University Amsterdam, Amsterdam, The Netherlands
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Arundel C, James S, Northgraves M, Booth A. Study reporting guidelines: How valid are they? Contemp Clin Trials Commun 2019; 14:100343. [PMID: 30923775 PMCID: PMC6421355 DOI: 10.1016/j.conctc.2019.100343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 10/28/2022] Open
Abstract
Reporting guidelines help improve the reporting of specific study designs, and clear guidance on the best approaches for developing guidelines is available. The methodological strength, or validation of guidelines is however unclear. This article explores what validation of reporting guidelines might involve, and whether this has been conducted for key reporting guidelines.
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Affiliation(s)
- Catherine Arundel
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Mutyambizi-Mafunda V, Myers B, Sorsdahl K, Lund C, Naledi T, Cleary S. Integrating a brief mental health intervention into primary care services for patients with HIV and diabetes in South Africa: study protocol for a trial-based economic evaluation. BMJ Open 2019; 9:e026973. [PMID: 31092660 PMCID: PMC6530312 DOI: 10.1136/bmjopen-2018-026973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Depression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness of such interventions in low-income and middle-income countries. This paper describes the proposed economic evaluation of a health systems intervention testing the effectiveness, cost-effectiveness and cost-utility of two task-sharing approaches to integrating services for common mental disorders with HIV and diabetes primary care services. METHODS AND ANALYSIS This evaluation will be conducted as part of a three-armed cluster randomised controlled trial of clinical effectiveness. Trial clinical outcome measures will include primary outcomes for risk of depression and alcohol use, and secondary outcomes for risk of chronic disease (HIV and diabetes) treatment failure. The cost-effectiveness analysis will evaluate cost per unit change in Alcohol Use Disorder Identification Test and Centre for Epidemiological Studies scale on Depression scores as well as cost per unit change in HIV RNA viral load and haemoglobin A1c, producing results of provider and patient cost per patient year for each study arm and chronic disease. The cost utility analyses will provide results of cost per quality-adjusted life year gained. Additional analyses relevant for implementation including budget impact analyses will be conducted to inform the development of a business case for scaling up the country's investment in mental health services. ETHICS AND DISSEMINATION The Western Cape Department of Health (WCDoH) (WC2016_RP6_9), the South African Medical Research Council (EC 004-2/2015), the University of Cape Town (089/2015) and Oxford University (OxTREC 2-17) provided ethical approval for this study. Results dissemination will include policy briefs, social media, peer-reviewed papers, a policy dialogue workshop and press briefings. TRIAL REGISTRATION NUMBER PACTR201610001825405.
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Affiliation(s)
- Vimbayi Mutyambizi-Mafunda
- Health Economics Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, Western Cape, South Africa
| | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerburg, Western Cape, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research, King's College London, London, UK
| | - Tracey Naledi
- Desmond Tutu HIV Research Centre, University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
- Western Cape Department of Health, Cape Town, Western Cape, South Africa
| | - Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Western Cape, South Africa
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Abdul Rafar NR, Hong YH, Wu DBC, Othman MF, Neoh CF. Cost-Effectiveness of Adjuvant Trastuzumab Therapy for Early Breast Cancer in Asia: A Systematic Review. Value Health Reg Issues 2019; 18:151-158. [PMID: 31082795 DOI: 10.1016/j.vhri.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/29/2019] [Accepted: 02/24/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To systematically review and assess the quality of the economic evidence of adjuvant trastuzumab usage in early breast cancer in Asian countries. METHODS Literature search was performed using 6 electronic databases (PubMed, Scopus, Ovid MEDLINE, EconLit, National Health Service Economic Evaluation Database, and ISI Web of Knowledge). The final search was performed in October 2018. All potential economic studies were then checked for eligibility. The reporting and methodological qualities of each study were independently assessed by 2 authors of this review, using the Consolidated Health Economic Evaluation Reporting Standards, Drummond, and Philips checklists. To compare the different currencies used in these studies, all costs were converted into US dollars (2016). RESULTS A total of 6 studies were included; most of them were performed from the healthcare provider perspective. The incremental cost-effectiveness ratio for evaluation performed for a lifetime horizon were reported at $8573 and $20 816 per quality-adjusted life-year in 2 studies. The model outcome was generally sensitive to the changes in trastuzumab drug acquisition cost and discount rate, as well as its clinical effectiveness. For the quality assessment, all studies fulfilled more than 50% of the requirements in the Consolidated Health Economic Evaluation Reporting Standards, Drummond, and Philips checklists. CONCLUSIONS Adjuvant trastuzumab therapy is considered a cost-effective option for early breast cancer in Asian countries including China, Iran, Japan, Singapore, and Taiwan. All studies were generally well conducted. Economic evaluations from the societal perspective, with inclusion of indirect and informal care costs, are warranted to facilitate informed decision making among policy makers.
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Affiliation(s)
| | - Yet Hoi Hong
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Bin-Chia Wu
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes, Health and Well-Being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Muhamad Faiz Othman
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia; Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia.
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Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography. J Thorac Imaging 2019; 34:160-169. [DOI: 10.1097/rti.0000000000000379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mujica-Mota R, Varley-Campbell J, Tikhonova I, Cooper C, Griffin E, Haasova M, Peters J, Lucherini S, Talens-Bou J, Long L, Sherriff D, Napier M, Ramage J, Hoyle M. Everolimus, lutetium-177 DOTATATE and sunitinib for advanced, unresectable or metastatic neuroendocrine tumours with disease progression: a systematic review and cost-effectiveness analysis. Health Technol Assess 2019; 22:1-326. [PMID: 30209002 DOI: 10.3310/hta22490] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neuroendocrine tumours (NETs) are a group of heterogeneous cancers that develop in cells in the diffuse neuroendocrine system. OBJECTIVES To estimate the clinical effectiveness of three interventions [everolimus (Afinitor®; Novartis International AG, Basel, Switzerland), lutetium-177 DOTATATE (177Lu-DOTATATE) (Lutathera®; Imaging Equipment Ltd, Radstock, UK) and sunitinib (Sutent®; Pfizer Inc., New York, NY, USA)] for treating unresectable or metastatic NETs with disease progression and establish the cost-effectiveness of these interventions. DATA SOURCES The following databases were searched from inception to May 2016: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE Daily, Epub Ahead of Print, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. REVIEW METHODS We systematically reviewed the clinical effectiveness and cost-effectiveness literature on everolimus, 177Lu-DOTATATE and sunitinib for treating advanced, unresectable or metastatic progressive NETs. The following NET locations were considered separately: pancreas, gastrointestinal (GI) tract and lung, and GI tract (midgut only). We wrote a survival partition cohort-based economic evaluation in Microsoft Excel® 2013 (Microsoft Corporation, Redmond, WA, USA) from the UK NHS and Personal Social Services perspective. This comprised three health states: (1) progression-free survival (PFS), (2) progressed disease and (3) death. RESULTS Three randomised controlled trials (RCTs), RADIANT-3 [RAD001 in Advanced Neuroendocrine Tumors, Third Trial; pancreatic NETs (pNETs): everolimus vs. best supportive care (BSC)], A6181111 (pNETs: sunitinib vs. BSC) and RADIANT-4 (RAD001 in Advanced Neuroendocrine Tumors, Fourth Trial; GI and lung NETs: everolimus vs. BSC), met the inclusion criteria for the clinical effectiveness systematic review. The risk of bias was low. Although the NETTER-1 (Neuroendocrine Tumors Therapy) RCT, of 177Lu-DOTATATE plus 30 mg of octreotide (Sandostatin®, Novartis) compared with 60 mg of octreotide, was excluded from the review, we nonetheless present the results of this trial, as it informs our estimate of the cost-effectiveness of 177Lu-DOTATATE. The pNETs trials consistently found that the interventions improved PFS and overall survival (OS) compared with BSC. Our indirect comparison found no significant difference in PFS between everolimus and sunitinib. Estimates of OS gain were confounded because of high rates of treatment switching. After adjustment, our indirect comparison suggested a lower, but non-significant, hazard of death for sunitinib compared with everolimus. In GI and lung NETs, everolimus significantly improved PFS compared with BSC and showed a non-significant trend towards improved OS compared with BSC. Adverse events were more commonly reported following treatment with targeted interventions than after treatment with BSC. In the base case for pNETs, assuming list prices, we estimated incremental cost-effectiveness ratios (ICERs) for everolimus compared with BSC of £45,493 per quality-adjusted life-year (QALY) and for sunitinib compared with BSC of £20,717 per QALY. These ICERs increased substantially without the adjustment for treatment switching. For GI and lung NETs, we estimated an ICER for everolimus compared with BSC of £44,557 per QALY. For GI (midgut) NETs, the ICERs were £199,233 per QALY for everolimus compared with BSC and £62,158 per QALY for a scenario analysis comparing 177Lu-DOTATATE with BSC. We judge that no treatment meets the National Institute for Health and Care Excellence's (NICE) end-of-life criteria, although we cannot rule out that sunitinib in the A6181111 trial does. LIMITATIONS A RCT with included comparators was not identified for 177Lu-DOTATATE. The indirect treatment comparison that our economic analysis was based on was of a simple Bucher type, unadjusted for any differences in the baseline characteristics across the two trials. CONCLUSIONS Given NICE's current stated range of £20,000-30,000 per QALY for the cost-effectiveness threshold, based on list prices, only sunitinib might be considered good value for money in England and Wales. FUTURE WORK Further analysis of individual patient data from RADIANT-3 would allow assessment of the robustness of our findings. The data were not made available to us by the company sponsoring the trial. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041303. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ruben Mujica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Irina Tikhonova
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Ed Griffin
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Marcela Haasova
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Jaime Peters
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Stefano Lucherini
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Juan Talens-Bou
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - Linda Long
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | - David Sherriff
- Plymouth Oncology Centre, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Mark Napier
- Exeter Oncology Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - John Ramage
- Neuroendocrine Tumour Service, King's College Hospital NHS Foundation Trust, London, UK
| | - Martin Hoyle
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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Flight L, Arshad F, Barnsley R, Patel K, Julious S, Brennan A, Todd S. A Review of Clinical Trials With an Adaptive Design and Health Economic Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:391-398. [PMID: 30975389 DOI: 10.1016/j.jval.2018.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/28/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An adaptive design uses data collected as a clinical trial progresses to inform modifications to the trial. Hence, adaptive designs and health economics aim to facilitate efficient and accurate decision making. Nevertheless, it is unclear whether the methods are considered together in the design, analysis, and reporting of trials. This review aims to establish how health economic outcomes are used in the design, analysis, and reporting of adaptive designs. METHODS Registered and published trials up to August 2016 with an adaptive design and health economic analysis were identified. The use of health economics in the design, analysis, and reporting was assessed. Summary statistics are presented and recommendations formed based on the research team's experiences and a practical interpretation of the results. RESULTS Thirty-seven trials with an adaptive design and health economic analysis were identified. It was not clear whether the health economic analysis accounted for the adaptive design in 17/37 trials where this was thought necessary, nor whether health economic outcomes were used at the interim analysis for 18/19 of trials with results. The reporting of health economic results was suboptimal for the (17/19) trials with published results. CONCLUSIONS Appropriate consideration is rarely given to the health economic analysis of adaptive designs. Opportunities to use health economic outcomes in the design and analysis of adaptive trials are being missed. Further work is needed to establish whether adaptive designs and health economic analyses can be used together to increase the efficiency of health technology assessments without compromising accuracy.
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Affiliation(s)
- Laura Flight
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Fahid Arshad
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Rachel Barnsley
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Kian Patel
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Steven Julious
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Susan Todd
- Department of Mathematics and Statistics, University of Reading, Reading, England, UK
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Gallagher TK, Kelly ME, Hoti E. Meta-analysis of the cost-effectiveness of early versus delayed cholecystectomy for acute cholecystitis. BJS Open 2019; 3:146-152. [PMID: 30957060 PMCID: PMC6433303 DOI: 10.1002/bjs5.50120] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/15/2018] [Indexed: 01/03/2023] Open
Abstract
Background Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. Methods Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta‐analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score. Results Six studies containing cost analyses were included in the meta‐analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was −2·18 (95 per cent c.i. −3·86 to −0·51; P = 0·011; I2 = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41–72), indicating overall poor‐to‐fair quality. Conclusion Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.
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Affiliation(s)
- T K Gallagher
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4
| | - M E Kelly
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4
| | - E Hoti
- Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4
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Handels R, Wimo A. Challenges and recommendations for the health-economic evaluation of primary prevention programmes for dementia. Aging Ment Health 2019; 23:53-59. [PMID: 29039976 DOI: 10.1080/13607863.2017.1390730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aimed to review health-economic evaluations of (hypothetical) intervention programmes for the primary prevention of dementia, and highlight challenges and provide recommendations for future research to estimate its cost-effectiveness. METHODS We searched the databases PubMed, MODEM, CEA and NHS for publications on the cost-consequence, -effectiveness, -utility or -benefit analysis of (hypothetical) interventions to reduce the risk of developing dementia for persons without dementia, and described the study characteristics. RESULTS Three publications described the evaluation of a hypothetical risk reduction due to physical activity or a multidomain intervention programme. Two studies reported a reduction of care costs. One study yielded two scenarios of increased care costs and one scenario of reduced care costs. Only one study reported the impact in QALY terms, and found a QALY gain. CONCLUSION A few studies have evaluated a hypothetical multidomain prevention intervention, and reported that primary dementia prevention is potentially cost-saving or cost-effective. Various challenges remain to evaluate the health-economic impact of prevention interventions, including extrapolation of short-term trial effects, care costs in the dementia-free and life years gained, and accurate representation of usual care. We recommend extensive sensitivity analyses to examine the impact of assumptions regarding these aspects on the outcomes of cost-effectiveness studies.
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Affiliation(s)
- Ron Handels
- a Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, School for Mental Health and Neurosciences , Maastricht University , Maastricht , The Netherlands.,b Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics , Karolinska Institute , Stockholm , Sweden
| | - Anders Wimo
- b Department of Neurobiology, Care Science and Society, Division of Neurogeriatrics , Karolinska Institute , Stockholm , Sweden.,c Centre for Research & Development, Uppsala University / County Council of Gävleborg , Gävle , Sweden
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Špacírová Z, Epstein D, García-Mochón L, Aparicio VA, Borges-Cosic M, López Del Amo MP, Martín-Martín JJ. Cost-effectiveness of a primary care-based exercise intervention in perimenopausal women. The FLAMENCO Project. GACETA SANITARIA 2018; 33:529-535. [PMID: 30340794 DOI: 10.1016/j.gaceta.2018.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adequate physical activity levels and a healthy lifestyle may prevent all kinds of non-communicable diseases, promote well-being and reduce health-care costs among perimenopausal women. This study assessed an exercise programme for perimenopausal women. METHOD A total of 150 women (aged 45-64 years) not engaged in regular physical activity were randomly assigned to either a 16 week exercise intervention or to the control group. The study was conducted from the perspective of the National Health System. Health outcomes were quality-adjusted life years (QALYs), measured by the EuroQol-5D-5L questionnaire. The total direct costs of the programme were the costs of visits to primary care, specialty care, emergency, medicines, instructor cost and infrastructure cost. The results were expressed as the incremental cost-effectiveness ratio. Sensitivity analysis was undertaken to test the robustness of the analysis. RESULTS Mean QALYs over 16 weeks were.228 in the control group and.230 in the intervention group (mean difference: .002; 95% confidence interval [95%CI]: -0.005 to 0.009). Improvements from baseline were greater in the intervention group in all dimensions of the EuroQol-5D-5L but not statistically significant. The total costs at the end of the intervention were 160.38 € in the control group and 167.80 € in the intervention group (mean difference: 7.42 €; 95%CI: -47 to 62). The exercise programme had an incremental cost-effectiveness ratio of 4,686 €/QALY. CONCLUSIONS The programme could be considered cost-effective, although the overall difference in health benefits and costs was very modest. Longer term follow-up is needed.
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Affiliation(s)
- Zuzana Špacírová
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain.
| | - David Epstein
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain
| | | | - Virginia A Aparicio
- Department of Physiology, Faculty of Pharmacy, Faculty of Sport Sciences, and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain; VU University and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Milkana Borges-Cosic
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - M Puerto López Del Amo
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain
| | - José J Martín-Martín
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain
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Liu J, Gormley N, Dasenbrock HH, Aglio LS, Smith TR, Gormley WB, Robertson FC. Cost-Benefit Analysis of Transitional Care in Neurosurgery. Neurosurgery 2018; 85:672-679. [DOI: 10.1093/neuros/nyy424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/09/2018] [Indexed: 11/12/2022] Open
Abstract
AbstractBACKGROUNDTransitional care programs (TCPs) coordinate care to improve safety and efficiency surrounding hospital discharge. While TCPs have the potential to reduce hospital length of stay and readmissions, their financial implications are less well understood.OBJECTIVETo perform a cost-benefit analysis of a previously published neurosurgical TCP implemented at an urban academic hospital from 2013 to 2015.METHODSPatients received intensive preoperative education and framing of expectations for hospitalization, in-hospital discharge planning and medication reconciliation with a nurse educator, and a follow-up phone call postdischarge. The cost-benefit analysis involved program costs (nurse educator salary) and total direct hospital costs within the 30-d perioperative window including readmission costs.RESULTSThe average cost of the TCP was $435 per patient. The TCP was associated with an average total cost reduction of 17.2% (95% confidence interval [CI]: 7.3%-26.7%, P = .001). This decrease was driven by a 14.3% reduction in the average initial admission cost (95% CI: 6.2%-23.7%, P = .001), largely attributable to the 16.3% decrease in length of stay (95% CI: 9.93%-23.49%, P < .001). Thirty-day readmissions were significantly decreased in the TCP group, with a 5.5% readmission rate for controls and 2.4% for TCP enrollees (P = .04). The average cost of readmission was decreased by 71.3% (95% CI: 58.7%-74.7%, P < .01).CONCLUSIONThis neurosurgical TCP was associated with decreased costs of initial admissions, 30-d readmissions, and total costs of hospitalization alongside previously published decreased length of stay and reduced 30-d readmission rates. These results underscore the clinical and financial feasibility and impact of transitional care in a surgical setting.
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Affiliation(s)
- Jingyi Liu
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Natalia Gormley
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Hormuzdiyar H Dasenbrock
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Linda S Aglio
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain, Brigham and Women's Hospital, Boston, Massachusetts
| | - Timothy R Smith
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - William B Gormley
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Faith C Robertson
- Harvard Medical School, Boston, Massachusetts
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
OBJECTIVES Anxiety and/or depression during pregnancy or year after childbirth is the most common complication of childbearing. Economic evaluations of interventions for the prevention or treatment of perinatal anxiety and/or depression (PAD) were systematically reviewed with the aim of guiding researchers and commissioners of perinatal mental health services towards potentially cost-effective strategies. METHODS Electronic searches were conducted on the MEDLINE, PsycINFO and NHS Economic Evaluation and Health Technology Assessment databases in September 2017 to identify relevant economic evaluations published since January 2000. Two stages of screening were used with prespecified inclusion/exclusion criteria. A data extraction form was designed prior to the literature search to capture key data. A published checklist was used to assess the quality of publications identified. RESULTS Of the 168 non-duplicate citations identified, 8 studies met the inclusion criteria for the review; all but one focussing solely on postnatal depression in mothers. Interventions included prevention (3/8), treatment (3/8) or identification plus treatment (2/8). Two interventions were likely to be cost-effective, both incorporated identification plus treatment. Where the cost per quality-adjusted life year (QALY) gained was reported, interventions ranged from being dominant (cheaper and more effective than usual care) to costing £39 875/QALY. CONCLUSIONS Uncertainty and heterogeneity across studies in terms of setting and design make it difficult to make direct comparisons or draw strong conclusions. However, the two interventions incorporating identification plus treatment of perinatal depression were both likely to be cost-effective. Many gaps were identified in the economic evidence, such as the cost-effectiveness of interventions for perinatal anxiety, antenatal depression or interventions for fathers. PROSPERO REGISTRATION NUMBER CRD42016051133.
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Affiliation(s)
- Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Public Health, University of Manchester, Manchester, UK
| | - Gemma E Shields
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Public Health, University of Manchester, Manchester, UK
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Epstein D, Onida S, Bootun R, Ortega-Ortega M, Davies AH. Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:911-920. [PMID: 30098668 DOI: 10.1016/j.jval.2018.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS], endovenous laser ablation [EVLA], and radiofrequency ablation [RFA]) and emerging technologies (mechanochemical ablation [MOCA] and cyanoacrylate glue occlusion [CAE]) for treatment of varicose veins over 5 years. METHODS A Markov decision model was constructed. Effectiveness was measured by re-intervention on the truncal vein, re-treatment of residual varicosities, and quality-adjusted life-years (QALYs) over 5 years. Model inputs were estimated from systematic review, the UK National Health Service unit costs, and manufacturers' list prices. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS CONS has the lowest overall cost and quality of life per person over 5 years; HL/S, EVLA, RFA, and MOCA have on average similar costs and effectiveness; and CAE has the highest overall cost but is no more effective than other therapies. The incremental cost per QALY of RFA versus CONS was £5,148/QALY. Time to return to work or normal activities was significantly longer after HL/S than after other procedures. CONCLUSIONS At a threshold of £20,000/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.
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Affiliation(s)
- David Epstein
- Department of Applied Economics, School of Economics and Business Studies, University of Granada, Granada, Spain
| | - Sarah Onida
- Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Charing Cross Hospital, London, UK
| | - Roshan Bootun
- Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Charing Cross Hospital, London, UK
| | - Marta Ortega-Ortega
- Department of Applied Economics, Public Economics and Political Economy, School of Economics and Business, Complutense University of Madrid, Madrid, Spain.
| | - Alun H Davies
- Academic Section of Vascular Surgery, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Charing Cross Hospital, London, UK
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Aceituno S, Gozalbo I, Appierto M, Lizán T L. Cost-effectiveness of lenalidomide in combination with dexamethasone compared to bortezomib in combination with dexamethasone for the second-line treatment of multiple myeloma in Chile. Medwave 2018; 18:e7220. [DOI: 10.5867/medwave.2018.03.7220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/13/2018] [Indexed: 11/27/2022] Open
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Thavorn K, Kugathasan H, Tan DHS, Moqueet N, Baral SD, Skidmore B, MacFadden D, Simkin A, Mishra S. Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis. Syst Rev 2018; 7:47. [PMID: 29544530 PMCID: PMC5855998 DOI: 10.1186/s13643-018-0710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with antiretrovirals is an efficacious and effective intervention to decrease the risk of HIV (human immunodeficiency virus) acquisition. Yet drug and delivery costs prohibit access in many jurisdictions. In the absence of guidelines for the synthesis of economic evaluations, we developed a protocol for a systematic review of economic evaluation studies for PrEP by drawing on best practices in systematic reviews and the conduct and reporting of economic evaluations. We aim to estimate the incremental cost per health outcome of PrEP compared with placebo, no PrEP, or other HIV prevention strategies; assess the methodological variability in, and quality of, economic evaluations of PrEP; estimate the incremental cost per health outcome of different PrEP implementation strategies; and quantify the potential sources of heterogeneity in outcomes. METHODS We will systematically search electronic databases (MEDLINE, Embase) and the gray literature. We will include economic evaluation studies that assess both costs and health outcomes of PrEP in HIV-uninfected individuals, without restricting language or year of publication. Two reviewers will independently screen studies using predefined inclusion criteria, extract data, and assess methodological quality using the Philips checklist, Second Panel on the Cost-effectiveness of Health and Medicines, and the International Society for Pharmacoeconomics and Outcomes Research recommendations. Outcomes of interest include incremental costs and outcomes in natural units or utilities, cost-effectiveness ratios, and net monetary benefit. We will perform descriptive and quantitative syntheses using sensitivity analyses of outcomes by population subgroups, HIV epidemic settings, study designs, baseline intervention contexts, key parameter inputs and assumptions, type of outcomes, economic perspectives, and willingness to pay values. DISCUSSION Findings will guide future economic evaluation of PrEP strategies in terms of methodological and knowledge gaps, and will inform decisions on the efficient integration of PrEP into public health programs across epidemiologic and health system contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038440 .
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Affiliation(s)
- Kednapa Thavorn
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, ICES Ottawa, Ottawa, Ontario, Canada
| | - Howsikan Kugathasan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Darrell H S Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Nasheed Moqueet
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Stefan D Baral
- Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, 21205, USA
| | - Becky Skidmore
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Derek MacFadden
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, 02115, USA
| | - Anna Simkin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Sharmistha Mishra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada. .,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy and Management, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Medical Sciences, University of Toronto, Toronto, Canada.
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Auguste P, Tsertsvadze A, Pink J, Court R, Seedat F, Gurung T, Freeman K, Taylor-Phillips S, Walker C, Madan J, Kandala NB, Clarke A, Sutcliffe P. Accurate diagnosis of latent tuberculosis in children, people who are immunocompromised or at risk from immunosuppression and recent arrivals from countries with a high incidence of tuberculosis: systematic review and economic evaluation. Health Technol Assess 2018; 20:1-678. [PMID: 27220068 DOI: 10.3310/hta20380] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB) [(Zopf 1883) Lehmann and Neumann 1896], is a major cause of morbidity and mortality. Nearly one-third of the world's population is infected with MTB; TB has an annual incidence of 9 million new cases and each year causes 2 million deaths worldwide. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of screening tests [interferon-gamma release assays (IGRAs) and tuberculin skin tests (TSTs)] in latent tuberculosis infection (LTBI) diagnosis to support National Institute for Health and Care Excellence (NICE) guideline development for three population groups: children, immunocompromised people and those who have recently arrived in the UK from high-incidence countries. All of these groups are at higher risk of progression from LTBI to active TB. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library and Current Controlled Trials were searched from December 2009 up to December 2014. REVIEW METHODS English-language studies evaluating the comparative effectiveness of commercially available tests used for identifying LTBI in children, immunocompromised people and recent arrivals to the UK were eligible. Interventions were IGRAs [QuantiFERON(®)-TB Gold (QFT-G), QuantiFERON(®)-TB Gold-In-Tube (QFT-GIT) (Cellestis/Qiagen, Carnegie, VA, Australia) and T-SPOT.TB (Oxford Immunotec, Abingdon, UK)]. The comparator was TST 5 mm or 10 mm alone or with an IGRA. Two independent reviewers screened all identified records and undertook a quality assessment and data synthesis. A de novo model, structured in two stages, was developed to compare the cost-effectiveness of diagnostic strategies. RESULTS In total, 6687 records were screened, of which 53 unique studies were included (a further 37 studies were identified from a previous NICE guideline). The majority of the included studies compared the strength of association for the QFT-GIT/G IGRA with the TST (5 mm or 10 mm) in relation to the incidence of active TB or previous TB exposure. Ten studies reported evidence on decision-analytic models to determine the cost-effectiveness of IGRAs compared with the TST for LTBI diagnosis. In children, TST (≥ 5 mm) negative followed by QFT-GIT was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of £18,900 per quality-adjusted life-year (QALY) gained. In immunocompromised people, QFT-GIT negative followed by the TST (≥ 5 mm) was the most cost-effective strategy, with an ICER of approximately £18,700 per QALY gained. In those recently arrived from high TB incidence countries, the TST (≥ 5 mm) alone was less costly and more effective than TST (≥ 5 mm) positive followed by QFT-GIT or T-SPOT.TB or QFT-GIT alone. LIMITATIONS The limitations and scarcity of the evidence, variation in the exposure-based definitions of LTBI and heterogeneity in IGRA performance relative to TST limit the applicability of the review findings. CONCLUSIONS Given the current evidence, TST (≥ 5 mm) negative followed by QFT-GIT for children, QFT-GIT negative followed by TST (≥ 5 mm) for the immunocompromised population and TST (≥ 5 mm) for recent arrivals were the most cost-effective strategies for diagnosing LTBI that progresses to active TB. These results should be interpreted with caution given the limitations identified. The evidence available is limited and more high-quality research in this area is needed including studies on the inconsistent performance of tests in high-compared with low-incidence TB settings; the prospective assessment of progression to active TB for those at high risk; the relative benefits of two-compared with one-step testing with different tests; and improved classification of people at high and low risk for LTBI. STUDY REGISTRATION This study is registered as PROSPERO CRD42014009033. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Peter Auguste
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alexander Tsertsvadze
- Evidence in Communicable Disease Epidemiology and Control, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joshua Pink
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Farah Seedat
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tara Gurung
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Walker
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ngianga-Bakwin Kandala
- Department of Mathematics and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - Aileen Clarke
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Scheffers-van Schayck T, Otten R, Engels R, Kleinjan M. Evaluation and Implementation of a Proactive Telephone Smoking Cessation Counseling for Parents: A Study Protocol of an Effectiveness Implementation Hybrid Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E97. [PMID: 30720774 PMCID: PMC5800196 DOI: 10.3390/ijerph15010097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023]
Abstract
Detrimental health consequences of smoking for both parents and children stress the importance for parents to quit. A Dutch efficacy trial supported the efficacy of proactive telephone counseling on parents. Still, how this program would function in "real world" conditions and how parents could be optimally reached is unclear. Therefore, this study will use an innovative method to examine the recruitment success of two implementation approaches (i.e., via a healthcare approach and a mass media approach) to test the (cost)effectiveness of the program. A two-arm randomized controlled trial and an implementation study (i.e., process evaluation) are conducted. Parents (N = 158) will be randomly assigned to the intervention (i.e., telephone counseling) or control conditions (i.e., self-help brochure). Primary outcome measure is 7-day point prevalence abstinence at three months post-intervention. Qualitative and quantitative research methods are used for the process evaluation. We expect that parents in the intervention condition have higher cessation rates than parents in the control condition. We also expect that the recruitment of parents via (youth) health care services is a more promising implementation approach compared to mass media. Results will have implications for the effectiveness of a proactive telephone counseling and provide directions for its successful implementation.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands.
- Department of Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
| | - Roy Otten
- Department of Research and Development, Pluryn, P.O. Box 53, 6500 AB Nijmegen, The Netherlands.
- ASU REACH Institute, Department of Psychology, Arizona State University, P.O. Box 876005, Tempe, AZ 85287-6005, USA.
| | - Rutger Engels
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands.
- Department of Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands.
- Department of Cultural Diversity & Youth, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, The Netherlands.
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Economic evaluations of internet- and mobile-based interventions for the treatment and prevention of depression: A systematic review. J Affect Disord 2018; 225:733-755. [PMID: 28922737 DOI: 10.1016/j.jad.2017.07.018] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 07/04/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Internet- and mobile-based interventions (IMIs) targeting depression have been shown to be clinically effective and are considered a cost-effective complement to established interventions. The aim of this review was to provide an overview of the evidence for the cost-effectiveness of IMIs for the treatment and prevention of depression. METHODS A systematic database search was conducted (Medline, PsychInfo, CENTRAL, PSYNDEX, OHE HEED). Relevant articles were selected according to defined eligibility criteria. IMIs were classified as cost-effective if they were below a willingness-to-pay threshold (WTP) of €22,845 (£20,000) - €34,267 (£30,000) per additional quality-adjusted life year (QALY) according to the National Institute for Health and Clinical Excellence (NICE) standard. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standard guidelines and the Cochrane Risk of Bias Tool. RESULTS Of 1538 studies, seven economic evaluations of IMIs for the treatment of major depression, four for the treatment of subthreshold/minor depression and one for the prevention of depression. In six studies, IMIs were classified as likely to be cost-effective with an incremental cost-utility ratio between €3088 and €22,609. All of these IMIs were guided. Overall quality of most economic evaluations was evaluated as good. All studies showed some risk of bias. LIMITATIONS The studies used different methodologies and showed some risk of bias. These aspects as well as the classification of cost-effectiveness according to the WTP proposed by NICE should be considered when interpreting the results. CONCLUSIONS Results indicate that guided IMIs for the treatment of (subthreshold) depression have the potential to be a cost-effective complement to established interventions, but more methodologically sound studies are needed.
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Rudgard WE, Evans CA, Sweeney S, Wingfield T, Lönnroth K, Barreira D, Boccia D. Comparison of two cash transfer strategies to prevent catastrophic costs for poor tuberculosis-affected households in low- and middle-income countries: An economic modelling study. PLoS Med 2017; 14:e1002418. [PMID: 29112693 PMCID: PMC5675360 DOI: 10.1371/journal.pmed.1002418] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 09/29/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Illness-related costs for patients with tuberculosis (TB) ≥20% of pre-illness annual household income predict adverse treatment outcomes and have been termed "catastrophic." Social protection initiatives, including cash transfers, are endorsed to help prevent catastrophic costs. With this aim, cash transfers may either be provided to defray TB-related costs of households with a confirmed TB diagnosis (termed a "TB-specific" approach); or to increase income of households with high TB risk to strengthen their economic resilience (termed a "TB-sensitive" approach). The impact of cash transfers provided with each of these approaches might vary. We undertook an economic modelling study from the patient perspective to compare the potential of these 2 cash transfer approaches to prevent catastrophic costs. METHODS AND FINDINGS Model inputs for 7 low- and middle-income countries (Brazil, Colombia, Ecuador, Ghana, Mexico, Tanzania, and Yemen) were retrieved by literature review and included countries' mean patient TB-related costs, mean household income, mean cash transfers, and estimated TB-specific and TB-sensitive target populations. Analyses were completed for drug-susceptible (DS) TB-related costs in all 7 out of 7 countries, and additionally for drug-resistant (DR) TB-related costs in 1 of the 7 countries with available data. All cost data were reported in 2013 international dollars ($). The target population for TB-specific cash transfers was poor households with a confirmed TB diagnosis, and for TB-sensitive cash transfers was poor households already targeted by countries' established poverty-reduction cash transfer programme. Cash transfers offered in countries, unrelated to TB, ranged from $217 to $1,091/year/household. Before cash transfers, DS TB-related costs were catastrophic in 6 out of 7 countries. If cash transfers were provided with a TB-specific approach, alone they would be insufficient to prevent DS TB catastrophic costs in 4 out of 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $3.8 million (95% CI: $3.8 million-$3.8 million) and $75 million (95% CI: $50 million-$100 million) per country. If instead cash transfers were provided with a TB-sensitive approach, alone they would be insufficient to prevent DS TB-related catastrophic costs in any of the 6 countries, and when increased enough to prevent DS TB catastrophic costs would require a budget between $298 million (95% CI: $219 million-$378 million) and $165,367 million (95% CI: $134,085 million-$196,425 million) per country. DR TB-related costs were catastrophic before and after TB-specific or TB-sensitive cash transfers in 1 out of 1 countries. Sensitivity analyses showed our findings to be robust to imputation of missing TB-related cost components, and use of 10% or 30% instead of 20% as the threshold for measuring catastrophic costs. Key limitations were using national average data and not considering other health and social benefits of cash transfers. CONCLUSIONS A TB-sensitive cash transfer approach to increase all poor households' income may have broad benefits by reducing poverty, but is unlikely to be as effective or affordable for preventing TB catastrophic costs as a TB-specific cash transfer approach to defray TB-related costs only in poor households with a confirmed TB diagnosis. Preventing DR TB-related catastrophic costs will require considerable additional investment whether a TB-sensitive or a TB-specific cash transfer approach is used.
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Affiliation(s)
- William E. Rudgard
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- * E-mail:
| | - Carlton A. Evans
- Innovation For Health And Development (IFHAD), Section of Infectious Diseases & Immunity, Imperial College London and Wellcome Trust Imperial College Centre for Global Health Research, London, United Kingdom
- Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA, Lima, Perú
- Innovation For Health And Development (IFHAD), Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Tom Wingfield
- Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust Imperial College Centre for Global Health Research, London, United Kingdom
- Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Draurio Barreira
- National TB Control Program (NTP), Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília DF, Brazil
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
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Urine circulating-tumor DNA (ctDNA) detection of acquired EGFR T790M mutation in non-small-cell lung cancer: An outcomes and total cost-of-care analysis. Lung Cancer 2017; 110:19-25. [PMID: 28676213 DOI: 10.1016/j.lungcan.2017.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Third-generation tyrosine kinase inhibitors (TKIs) have proven effective in patients with the acquired EGFR T790M resistance mutation who progress on prior EGFR TKI therapy. Median progression-free survival (PFS) on a 3rd-gen TKI was 9-10 months for T790M+ patients compared to 2.8 months for T790M- patients. PFS is similar regardless of the specimen used to assess T790M, such as tissue, plasma, or urine ctDNA. This study aimed to assess the total cost of care of a urine-testing strategy (UTS) versus a tissue-testing strategy (TTS) for T790M detection, in patients with EGFR-mutation positive lung adenocarcinoma and progression on prior TKI therapy. MATERIALS AND METHODS Long-term outcomes and economic implications were assessed from a US payer perspective. Endpoints were PFS, overall survival (OS), medical resource use and related costs. DATA SOURCES We included published randomized drug trials and Medicare fee schedules. A state-transition analysis and Markov model tracked patients from stable disease to progression and death. Univariate and multivariate sensitivity analyses were performed to assess the robustness of findings and identify factors that most influenced outcomes and costs. RESULTS UTS increased the rate of detection of patients with T790M mutation eligible for treatment with 3rd generation TKI by 7% compared with TTS; urine ctDNA testing detected T790M mutation in some patients for whom biopsy could not be performed or when tissue testing yielded indeterminate results. Due to enhanced targeting of TKI therapy, UTS increased PFS and OS by 0.44 and 0.35 months, respectively. UTS yields a savings of $1243-$1680 per patient due to avoidance of biopsy, potential biopsy-associated complications, and tissue-based molecular testing in approximately 55.6% of patients. Probability of T790M detection by tissue and cost of biopsy procedure were the most influential factors. CONCLUSION UTS prolonged PFS/OS due to increased detection of T790M mutation and decreased biopsies and complication-related costs.
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Wikman-Jorgensen PE, Llenas-García J, Pérez-Porcuna TM, Hobbins M, Ehmer J, Mussa MA, Ascaso C. Microscopic observation drug-susceptibility assay vs. Xpert ® MTB/RIF for the diagnosis of tuberculosis in a rural African setting: a cost-utility analysis. Trop Med Int Health 2017; 22:734-743. [PMID: 28380276 DOI: 10.1111/tmi.12879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the cost-utility of microscopic observation drug-susceptibility assay (MODS) and Xpert® MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique. METHODS Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert® MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add-on test after a negative SM. Costs were calculated in 2013 USD, effects in disability-adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique. RESULTS MODS as an add-on test to negative SM produced an incremental cost-effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert® MTB/RIF as an add-on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert® MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert® MTB/RIF ICER in the one-way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert® MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not. CONCLUSION Our cost-utility analysis favours the implementation of Xpert® MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting.
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Affiliation(s)
- Philip E Wikman-Jorgensen
- Department of Public Health, University of Barcelona, Barcelona, Spain.,SolidarMed Mozambique, Ancuabe, Mozambique
| | - Jara Llenas-García
- SolidarMed Mozambique, Ancuabe, Mozambique.,Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | - Tomàs M Pérez-Porcuna
- Department of Public Health, University of Barcelona, Barcelona, Spain.,Research Unit, Paediatrics Department, CAP Valldoreix, Mutua Terrassa Foundation, Mutua Terrassa University Hospital, Terrassa, Catalunya, Spain
| | | | | | - Manuel A Mussa
- Provincial Health Directorate, Operational Research Nucleus of Pemba, Pemba, Mozambique
| | - Carlos Ascaso
- Department of Public Health, University of Barcelona, Barcelona, Spain
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140
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Easton T, Milte R, Crotty M, Ratcliffe J. Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure. BMC Health Serv Res 2017; 17:226. [PMID: 28327120 PMCID: PMC5361718 DOI: 10.1186/s12913-017-2165-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/15/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure. METHODS A systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective. RESULTS Fourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia. CONCLUSIONS Robust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977 .
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Rachel Milte
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
- Institute for Choice, Business School, University of South Australia, Adelaide, SA Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001 Australia
| | - Julie Ratcliffe
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia
- Institute for Choice, Business School, University of South Australia, Adelaide, SA Australia
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141
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Rawson TM, Moore LSP, Hernandez B, Charani E, Castro-Sanchez E, Herrero P, Hayhoe B, Hope W, Georgiou P, Holmes AH. A systematic review of clinical decision support systems for antimicrobial management: are we failing to investigate these interventions appropriately? Clin Microbiol Infect 2017; 23:524-532. [PMID: 28268133 DOI: 10.1016/j.cmi.2017.02.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Clinical decision support systems (CDSS) for antimicrobial management can support clinicians to optimize antimicrobial therapy. We reviewed all original literature (qualitative and quantitative) to understand the current scope of CDSS for antimicrobial management and analyse existing methods used to evaluate and report such systems. METHOD PRISMA guidelines were followed. Medline, EMBASE, HMIC Health and Management and Global Health databases were searched from 1 January 1980 to 31 October 2015. All primary research studies describing CDSS for antimicrobial management in adults in primary or secondary care were included. For qualitative studies, thematic synthesis was performed. Quality was assessed using Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) criteria. CDSS reporting was assessed against a reporting framework for behaviour change intervention implementation. RESULTS Fifty-eight original articles were included describing 38 independent CDSS. The majority of systems target antimicrobial prescribing (29/38;76%), are platforms integrated with electronic medical records (28/38;74%), and have a rules-based infrastructure providing decision support (29/38;76%). On evaluation against the intervention reporting framework, CDSS studies fail to report consideration of the non-expert, end-user workflow. They have narrow focus, such as antimicrobial selection, and use proxy outcome measures. Engagement with CDSS by clinicians was poor. CONCLUSION Greater consideration of the factors that drive non-expert decision making must be considered when designing CDSS interventions. Future work must aim to expand CDSS beyond simply selecting appropriate antimicrobials with clear and systematic reporting frameworks for CDSS interventions developed to address current gaps identified in the reporting of evidence.
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Affiliation(s)
- T M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK.
| | - L S P Moore
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK
| | - B Hernandez
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - E Charani
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK
| | - E Castro-Sanchez
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK
| | - P Herrero
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - B Hayhoe
- School of Public Health, Imperial College, London, UK
| | - W Hope
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - P Georgiou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - A H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College, London, UK
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van der Pol S, Degener F, Postma MJ, Vemer P. An Economic Evaluation of Sacubitril/Valsartan for Heart Failure Patients in the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:388-396. [PMID: 28292483 DOI: 10.1016/j.jval.2016.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/20/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND In September 2014, the PARADIGM-HF trial showed the heart failure drug combination sacubitril/valsartan to be superior to enalapril for patients with a reduced ejection fraction. OBJECTIVES To determine the incremental cost-effectiveness of sacubitril/valsartan compared with enalapril in the Netherlands using the clinical data from the PARADIGM-HF trial. METHODS To compare sacubitril/valsartan and enalapril in a cost-effectiveness study, a Markov model was developed using the effectiveness data from the PARADIGM-HF trial. A health care payer's perspective was applied in the economic evaluation. The developed model was used to evaluate the cost-effectiveness for sacubitril/valsartan at different per diem prices. RESULTS The base-case analysis showed that sacubitril/valsartan can be cost-effective at maximum daily costs of €5.50 and €14.14 considering willingness-to-pay thresholds of €20,000 and €50,000 per quality-adjusted life-year (QALY), respectively. Sensitivity analysis demonstrated the robustness of the model, identifying only the price of sacubitril/valsartan and the mortality within the sacubitril/valsartan group as significant drivers of the cost-effectiveness ratio. Sacubitril/valsartan was cost-effective at a willingness-to-pay threshold of €20,000 per QALY (€50,000 per QALY) in more than 80% of the replications with certainty at the price point of €3 (€10). CONCLUSIONS Sacubitril/valsartan can be considered a cost-effective treatment at a daily price of €5.25. Unless priced lower than enalapril (<€0.045 per day), sacubitril/valsartan is very unlikely to be cost-saving/dominant.
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Affiliation(s)
- Simon van der Pol
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Fabian Degener
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands; Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Pepijn Vemer
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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Easton T, Milte R, Crotty M, Ratcliffe J. Advancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2016; 14:12. [PMID: 27999476 PMCID: PMC5153687 DOI: 10.1186/s12962-016-0061-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022] Open
Abstract
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents’ quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, Flinders University, Adelaide, Australia ; NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia ; Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Rachel Milte
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia ; Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia ; Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, Adelaide, Australia ; NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia
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Ferrari GRA, Becker ES, Smit F, Rinck M, Spijker J. Investigating the (cost-) effectiveness of attention bias modification (ABM) for outpatients with major depressive disorder (MDD): a randomized controlled trial protocol. BMC Psychiatry 2016; 16:370. [PMID: 27809880 PMCID: PMC5094081 DOI: 10.1186/s12888-016-1085-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the range of available, evidence-based treatment options for Major Depressive Disorder (MDD), the rather low response and remission rates suggest that treatment is not optimal, yet. Computerized attention bias modification (ABM) trainings may have the potential to be provided as cost-effective intervention as adjunct to usual care (UC), by speeding up recovery and bringing more patients into remission. Research suggests, that a selective attention for negative information contributes to development and maintenance of depression and that reducing this negative bias might be of therapeutic value. Previous ABM studies in depression, however, have been limited by small sample sizes, lack of long-term follow-up measures or focus on sub-clinical samples. This study aims at evaluating the long-term (cost-) effectiveness of internet-based ABM, as add-on treatment to UC in adult outpatients with MDD, in a specialized mental health care setting. METHODS/DESIGN This study presents a double-blind randomized controlled trial in two parallel groups with follow-ups at 1, 6, and 12 months, combined with an economic evaluation. One hundred twenty six patients, diagnosed with MDD, who are registered for specialized outpatient services at a mental health care organization in the Netherlands, are randomized into either a positive training (towards positive and away from negative stimuli) or a sham training, as control condition (continuous attentional bias assessment). Patients complete eight training sessions (seven at home) during a period of two weeks (four weekly sessions). Primary outcome measures are change in attentional bias (pre- to post-test), mood response to stress (at post-test) and long-term effects on depressive symptoms (up to 1-year follow-up). Secondary outcome measures include rumination, resilience, positive and negative affect, and transfer to other cognitive measures (i.e., attentional bias for verbal stimuli, cognitive control, positive mental imagery), as well as quality of life and costs. DISCUSSION This is the first study investigating the long-term effects of ABM in adult outpatients with MDD, alongside an economic evaluation. Next to exploring the mechanism underlying ABM effects, this study provides first insight into the effects of combining ABM and UC and the potential implementation of ABM in clinical practice. TRIAL REGISTRATION Trialregister.nl, NTR5285 . Registered 20 July 2015.
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Affiliation(s)
- Gina R. A. Ferrari
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands ,Pro Persona, Center for Mental Health Care, Nijmegen, The Netherlands
| | - Eni S. Becker
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands ,Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands ,Department of Epidemiology and Biostatistics, EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Jan Spijker
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands ,Pro Persona, Center for Mental Health Care, Nijmegen, The Netherlands
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Braam K, van Dijk-Lokkart E, van Dongen J, van Litsenburg R, Takken T, Huisman J, Merks J, Bosmans J, Hakkenbrak N, Bierings M, van den Heuvel-Eibrink M, Veening M, van Dulmen-den Broeder E, Kaspers G. Cost-effectiveness of a combined physical exercise and psychosocial training intervention for children with cancer: Results from the quality of life in motion study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- K.I. Braam
- Department of Paediatric Oncology/Haematology; VU University Medical Center; Amsterdam The Netherlands
| | - E.M. van Dijk-Lokkart
- Department of Medical Psychology; VU University Medical Center; Amsterdam The Netherlands
| | - J.M. van Dongen
- Department of Health Sciences and the EMGO Institute for Health and Care Research; Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam The Netherlands
| | - R.R.L. van Litsenburg
- Department of Paediatric Oncology/Haematology; VU University Medical Center; Amsterdam The Netherlands
| | - T. Takken
- Child Development & Exercise Center; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - J. Huisman
- Department of Medical Psychology and Social Work; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - J.H.M. Merks
- Department of Paediatric Oncology; Emma Children's Hospital/Academic Medical Centre; Amsterdam The Netherlands
| | - J.E. Bosmans
- Department of Health Sciences and the EMGO Institute for Health and Care Research; Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam The Netherlands
| | - N.A.G. Hakkenbrak
- Department of Paediatric Oncology/Haematology; VU University Medical Center; Amsterdam The Netherlands
| | - M.B. Bierings
- Department of Haematology and Stem Cell Transplantation; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - M.M. van den Heuvel-Eibrink
- Department of Paediatric Oncology/Haematology; Erasmus Medical Center; Sophia Children's Hospital; Rotterdam The Netherlands
- Princess Maxima Center for Pediatric Oncology; Utrecht The Netherlands
| | - M.A. Veening
- Department of Paediatric Oncology/Haematology; VU University Medical Center; Amsterdam The Netherlands
| | - E. van Dulmen-den Broeder
- Department of Paediatric Oncology/Haematology; VU University Medical Center; Amsterdam The Netherlands
| | - G.J.L. Kaspers
- Department of Paediatric Oncology/Haematology; VU University Medical Center; Amsterdam The Netherlands
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Ma H, Jian W, Xu T, He Y, Rizzo JA, Fang H. Quality of pharmacoeconomic research in China: A systematic review. Medicine (Baltimore) 2016; 95:e5114. [PMID: 27741131 PMCID: PMC5072958 DOI: 10.1097/md.0000000000005114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The number of pharmacoeconomic publications in the literature from China has risen rapidly, but the quality of pharmacoeconomic publications from China has not been analyzed. OBJECTIVES This study aims to identify all recent pharmacoeconomic publications from China, to critically appraise the reporting quality, and to summarize the results. METHODS Four databases (PubMed, Web of Science, Medline, and EmBase) were searched for original articles published up to December 31, 2014. The Consolidated Health Economic Evaluation Reporting Standards statement including 24 items was used to assess the quality of reporting of these articles. RESULTS Of 1046 articles identified, 32 studies fulfilled the inclusion criteria. They were published in 23 different journals. Quality of reporting varied between studies, with an average score of 18.7 (SD = 4.33) out of 24 (range 9-23.5). There was an increasing trend of pharmacoeconomic publications and reporting quality over years from 2003 to 2014. According to the Consolidated Health Economic Evaluation Reporting Standards, the reporting quality for the items including "title," "comparators of method," and "measurement of effectiveness" are quite low, with less than 50% of studies fully satisfying these reporting standards. In contrast, reporting was good for the items including "introduction," "study perspective," "choice of health outcomes," "study parameters," "characterizing heterogeneity," and "discussion," with more than 75% of the articles satisfying these reporting criteria. The remaining items fell in between these 2 extremes, with 50% to 75% of studies satisfying these criteria. CONCLUSION Our study suggests the need for improvement in a number of reporting criteria. But the criteria for which reporting quality was low seem to be limitations that would be straightforward to correct in future studies.
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Affiliation(s)
- Huifen Ma
- China Center for Health Development Studies, Peking University
| | - Weiyan Jian
- Department of Health Policy and Administration, Peking University, Haidian District, Beijing, China
| | - Tingting Xu
- China Center for Health Development Studies, Peking University
| | - Yasheng He
- China Center for Health Development Studies, Peking University
| | - John A. Rizzo
- Departments of Economics and Department of Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY
| | - Hai Fang
- China Center for Health Development Studies, Peking University
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Yun BJ, Myriam Hunink MG, Prabhakar AM, Heng M, Liu SW, Qudsi R, Raja AS. Diagnostic Imaging Strategies for Occult Hip Fractures: A Decision and Cost-Effectiveness Analysis. Acad Emerg Med 2016; 23:1161-1169. [PMID: 27286291 DOI: 10.1111/acem.13026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/02/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hip fractures cause significant morbidity and mortality. Determining the optimal diagnostic strategy for the subset of patients with potential occult hip fracture remains challenging. We determined the most cost-effective strategy for the diagnosis of occult hip fractures from the choices of performing only computed tomography (CT), performing only magnetic resonance imaging (MRI), performing CT and if negative performing MRI (MRI-selective strategy) or discharging the patient without advanced imaging. METHODS We developed a decision-analytic model to compare outcomes and costs of different diagnostic strategies for the diagnosis of an occult hip fracture from a societal perspective. Model inputs were derived from charge data, Medicare reimbursements, and the literature. Strategies with an incremental cost-effectiveness ratio (ICER) below $100,000 per quality-adjusted life-year (QALY) gained were considered cost-effective. We tested the robustness of our results using probabilistic sensitivity analysis. RESULTS Compared to a CT strategy, MRI provides an additional 0.05 QALY at an incremental cost of $1,227 and ICER of $25,438/QALY. For facilities without MRI capability, if the cost of transfer is below $1,228, transferring the patient to a MRI-capable facility is the most cost-effective strategy. Above this cost, employing a CT and if negative transfer to a MRI-capable facility strategy was more cost-effective. When the cost of a transfer reached more than $4,039, it became more cost-effective to only obtain a CT. CONCLUSION MRI is a cost-effective strategy for the diagnosis of an occult hip fracture. For facilities without MRI capability, the most cost-effective strategy depends on the cost of the interfacility transfer.
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Affiliation(s)
- Brian J. Yun
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | - M. G. Myriam Hunink
- Departments of Radiology and Epidemiology Erasmus University Medical Center Rotterdam Netherlands
- Centre for Health Decision Science Harvard T.H. Chan School of Public Health Boston MA
| | - Anand M. Prabhakar
- Division of Cardiovascular Imaging Department of Radiology Boston MA
- Division of Emergency Imaging Department of Radiology Boston MA
- Harvard Medical School Boston MA
| | - Marilyn Heng
- Department of Orthopaedic Surgery Boston MA
- Harvard Orthopaedic Trauma Initiative Boston MA
- Harvard Medical School Boston MA
| | - Shan W. Liu
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
- Harvard Medical School Boston MA
| | - Rameez Qudsi
- Department of Orthopaedic Surgery Boston MA
- Harvard Medical School Boston MA
| | - Ali S. Raja
- Department of Emergency Medicine Massachusetts General Hospital Boston MA
- Department of Radiology Brigham and Women's Hospital Boston MA
- Harvard Medical School Boston MA
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A systematic review of economic models used to assess the cost-effectiveness of strategies for identifying latent tuberculosis in high-risk groups. Tuberculosis (Edinb) 2016; 99:81-91. [DOI: 10.1016/j.tube.2016.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/30/2016] [Accepted: 04/12/2016] [Indexed: 11/20/2022]
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Review of Research Reporting Guidelines for Radiology Researchers. Acad Radiol 2016; 23:537-58. [PMID: 26928069 DOI: 10.1016/j.acra.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 12/11/2022]
Abstract
Prior articles have reviewed reporting guidelines and study evaluation tools for clinical research. However, only some of the many available accepted reporting guidelines at the Enhancing the QUAlity and Transparency Of health Research Network have been discussed in previous reports. In this paper, we review the key Enhancing the QUAlity and Transparency Of health Research reporting guidelines that have not been previously discussed. The study types include diagnostic and prognostic studies, reliability and agreement studies, observational studies, analytical and descriptive, experimental studies, quality improvement studies, qualitative research, health informatics, systematic reviews and meta-analyses, economic evaluations, and mixed methods studies. There are also sections on study protocols, and statistical analyses and methods. In each section, there is a brief overview of the study type, and then the reporting guideline(s) that are most applicable to radiology researchers including radiologists involved in health services research are discussed.
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