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van Oostendorp JY, Dekker L, van Dieren S, Bemelman WA, Han-Geurts IJM. Antibiotic Treatment foLlowing surgical drAinage of perianal abScess (ATLAS): protocol for a multicentre, double-blind, placebo-controlled, randomised trial. BMJ Open 2022; 12:e067970. [PMID: 36351727 PMCID: PMC9644350 DOI: 10.1136/bmjopen-2022-067970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Perianal fistula is a burdening disease with an annual incidence of 6-12/100 000 in Western countries. More than 90% of crypto-glandular fistulas originate from perianal abscess. Despite adequate drainage, up to 83% recur or result in an anal fistula, the majority developing within 12 months. There is some evidence that gut-derived bacteria play a role in the development of perianal fistula. Up till now, it is not common practice to routinely administer prophylactic antibiotics to prevent anal fistula development. There is a need for a study to establish whether adding antibiotic treatment to surgical drainage of perianal abscess results in a reduction in perianal fistulas. METHODS AND ANALYSIS This multicentre, double-blind, randomised, placebo-controlled trial investigates whether addition of antibiotics (ciprofloxacin and metronidazole) to surgical drainage of a perianal abscess is beneficial compared with surgical drainage alone. The primary outcome is the development of a perianal fistula within 1 year. Secondary outcomes include quality of life, treatment costs, need for repeated drainage, patient-reported outcomes and other clinical outcomes. Participants are recruited in one academic and seven peripheral Dutch clinics. To demonstrate a reduction of perianal fistula from 30% to 15% when treated with adjuvant antibiotics with a two-sided alpha of 0.05, a power of 80% and taking a 10% loss to follow-up percentage into account, the total sample size will be 298 participants. Data will be analysed according to the intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers (nr. 2021_010). Written consent is obtained from each participant prior to randomisation into the study. The results of this trial will be submitted for publication in international peer-reviewed journals, presented at conferences and spread to coloproctological associations. TRIAL REGISTRATION NUMBERS 2020-004449-35; NCT05385887.
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Affiliation(s)
- Justin Y van Oostendorp
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands
| | - Lisette Dekker
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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Solis EC, Carlier IVE, van der Wee NJA, van Hemert AM. The clinical and cost-effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners/caregivers: study protocol of a multicenter pragmatic randomized controlled trial. Trials 2021; 22:731. [PMID: 34688307 PMCID: PMC8542316 DOI: 10.1186/s13063-021-05666-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the "Patient and Partner Education Program for All Chronic Illnesses" (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers. METHODS Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed methods research approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All therapist. Primary and secondary outcome measurements are at 0, 3, 6, and 12 months. DISCUSSION This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers. TRIAL REGISTRATION Netherlands Trial Register Identifier NTR5973 . Registered on 20 July 2016.
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Affiliation(s)
- Ericka C. Solis
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ingrid V. E. Carlier
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nic J. A. van der Wee
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Dekker L, Han-Geurts IJM, van Dieren S, Bemelman WA. HollAND trial: comparison of rubber band ligation and haemorrhoidectomy in patients with symptomatic haemorrhoids grade III: study protocol for a multicentre, randomised controlled trial and cost–utility analysis. BMJ Open 2021. [PMCID: PMC8039253 DOI: 10.1136/bmjopen-2020-046836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Haemorrhoidal disease is one of the most common anorectal disorders, which affects nearly half of the general population. Treatment of grade III haemorrhoids consists initially of conservative measures, followed by rubber band ligation and haemorrhoidectomy when unsuccessful. Given the current guidelines and numerous modalities the obvious question which needs to be answered is which treatment is the best for grade III haemorrhoids. There is a need for evaluating treatment from the patient’s point of view and transparency in surgical and non-surgical treatment outcome. Methods and analysis This multicentre, randomised controlled, non-inferiority trial with cost–utility analysis compares haemorrhoidectomy with rubber band ligation. Patients aged 18 years and older with symptomatic haemorrhoids grade III are recruited. Primary outcome measure is quality of life at 24 months measured with the EQ-5D-5L and in-hospital (in)direct costs and out-of-hospital postoperative costs. A key secondary outcome is recurrence at 1-year postprocedure. Secondary outcomes are complaint reduction with proctology-specific patient-reported outcome measurements (Haemorrhoid Severity Score, ProctoPROM, PROM-HISS, vaizey score), resumption of work, pain and complication rates. Data are collected at seven different time points. Standard postprocedural care is followed. A sample size has been calculated using a one sided alpha of 0.025 and a power of 80% with an SD of 0.15 and a non-inferiority limit of 0.05. With stratification by centre and to adjust for 10% lost to follow-up the total sample size will be 360 patients in total (180 per group). Data will be analysed according to the intention-to-treat and the per-protocol principle. Ethics and dissemination The protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centres, location AMC. Findings will be disseminated in peer-reviewed journals and presented at conferences, whether they are positive, negative or inconclusive. Trial registration numbers NCT04621695, NTR8020
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Affiliation(s)
- Lisette Dekker
- Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands
- Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Susan van Dieren
- Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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Cherutich P, Farquhar C, Wamuti B, Otieno FA, Ng'ang'a A, Mutiti PM, Macharia P, Sambai B, Bukusi D, Levin C. HIV partner services in Kenya: a cost and budget impact analysis study. BMC Health Serv Res 2018; 18:721. [PMID: 30223833 PMCID: PMC6142360 DOI: 10.1186/s12913-018-3530-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The elicitation of contact information, notification and testing of sex partners of HIV infected patients (aPS), is an effective HIV testing strategy in low-income settings but may not necessarily be affordable. We applied WHO guidelines and the International Society for Pharmaco-economics and Outcomes Research (ISPOR) guidelines to conduct cost and budget impact analyses, respectively, of aPS compared to current practice of HIV testing services (HTS) in Kisumu County, Kenya. METHODS Using study data and time motion studies, we constructed an Excel-based tool to estimate costs and the budget impact of aPS. Cost data were collected from selected facilities in Kisumu County. We report the annual total and unit costs of HTS, incremental total and unit costs for aPS, and the budget impact of scaling up aPS over a 5-year horizon. We also considered a task-shifted scenario that used community health workers (CHWs) rather than facility based health workers and conducted sensitivity analyses assuming different rates of scale up of aPS. RESULTS The average unit costs for HIV testing among HIV-infected index clients was US$ 25.36 per client and US$ 17.86 per client using nurses and CHWs, respectively. The average incremental costs for providing enhanced aPS in Kisumu County were US$ 1,092,161 and US$ 753,547 per year, using nurses and CHWs, respectively. The average incremental cost of scaling up aPS over a five period was 45% higher when using nurses compared to using CHWs (US$ 5,460,837 and US$ 3,767,738 respectively). Over the five years, the upper-bound budget impact of nurse-model was US$ 1,767,863, 63% and 35% of which were accounted for by aPS costs and ART costs, respectively. The CHW model incurred an upper-bound incremental cost of US$ 1,258,854, which was 71.2% lower than the nurse-based model. The budget impact was sensitive to the level of aPS coverage and ranged from US$ 28,547 for 30% coverage using CHWs in 2014 to US$ 1,267,603 for 80% coverage using nurses in 2018. CONCLUSION Scaling aPS using nurses has minimal budget impact but not cost-saving over a five-year period. Targeting aPS to newly-diagnosed index cases and task-shifting to community health workers is recommended.
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Affiliation(s)
- Peter Cherutich
- Ministry of Health, Afya House, Cathedral Road, P.O Box 30016-00100, Nairobi, Kenya.
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Beatrice Wamuti
- Department of Research and Training, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix A Otieno
- Department of Research and Training, Kenyatta National Hospital, Nairobi, Kenya
| | - Ann Ng'ang'a
- Ministry of Health, Afya House, Cathedral Road, P.O Box 30016-00100, Nairobi, Kenya
| | - Peter Maingi Mutiti
- Department of Research and Training, Kenyatta National Hospital, Nairobi, Kenya
| | - Paul Macharia
- Ministry of Health, Afya House, Cathedral Road, P.O Box 30016-00100, Nairobi, Kenya
| | - Betsy Sambai
- Department of Research and Training, Kenyatta National Hospital, Nairobi, Kenya
| | - David Bukusi
- Department of Research and Training, Kenyatta National Hospital, Nairobi, Kenya
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, WA, USA
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Khan HR, Kralj-Hans I, Haldar S, Bahrami T, Clague J, De Souza A, Francis D, Hussain W, Jarman J, Jones DG, Mediratta N, Mohiaddin R, Salukhe T, Jones S, Lord J, Murphy C, Kelly J, Markides V, Gupta D, Wong T. Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF): study protocol for a randomised controlled trial. Trials 2018; 19:117. [PMID: 29458408 PMCID: PMC5819216 DOI: 10.1186/s13063-018-2487-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 01/22/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation. The main purpose of this trial is to compare the effectiveness and safety of these two interventions. METHODS/DESIGN Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF) is a prospective, multi-centre, randomised controlled trial within three NHS tertiary cardiovascular centres specialising in treatment of atrial fibrillation. Eligible adults (n = 120) with symptomatic, long-standing, persistent atrial fibrillation will be randomly allocated to either catheter ablation or thoracoscopic ablation in a 1:1 ratio. Pre-determined lesion sets will be delivered in each treatment arm with confirmation of appropriate conduction block. All patients will have an implantable loop recorder (ILR) inserted subcutaneously immediately following ablation to enable continuous heart rhythm monitoring for at least 12 months. The devices will be programmed to detect episodes of atrial fibrillation and atrial tachycardia ≥ 30 s in duration. The patients will be followed for 12 months, completing appropriate clinical assessments and questionnaires every 3 months. The ILR data will be wirelessly transmitted daily and evaluated every month for the duration of the follow-up. The primary endpoint in the study is freedom from atrial fibrillation and atrial tachycardia at the end of the follow-up period. DISCUSSION The CASA-AF Trial is a National Institute for Health Research-funded study that will provide first-class evidence on the comparative efficacy, safety and cost-effectiveness of thoracoscopic surgical ablation and conventional percutaneous catheter ablation for long-standing persistent atrial fibrillation. In addition, the results of the trial will provide information on the effects on patients' quality of life. TRIAL REGISTRATION ISRCTN Registry, ISRCTN18250790 . Registered on 24 April 2015.
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Affiliation(s)
- Habib Rehman Khan
- Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Institute of Cardiovascular Medicine and Science, London, UK
| | | | - Shouvik Haldar
- Royal Brompton and Harefield NHS Trust, London, UK
- Institute of Cardiovascular Medicine and Science, London, UK
| | | | | | | | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - David Gareth Jones
- Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | - Simon Jones
- New York University School of Medicine, New York, NY USA
| | - Joanne Lord
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Caroline Murphy
- King’s Clinical Trials Unit, Institute of Psychiatry, King’s College London, London, UK
| | - Joanna Kelly
- King’s Clinical Trials Unit, Institute of Psychiatry, King’s College London, London, UK
| | | | - Dhiraj Gupta
- National Heart and Lung Institute, Imperial College London, London, UK
- Institute of Cardiovascular Medicine and Science, London, UK
- Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Tom Wong
- Royal Brompton and Harefield NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Institute of Cardiovascular Medicine and Science, London, UK
- Royal Brompton Hospital, Sydney Street, London, UK
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Fragoulakis V, Mitropoulou C, Katelidou D, van Schaik RH, Maniadakis N, Patrinos GP. Performance Ratio Based Resource Allocation Decision-Making in Genomic Medicine. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2017; 21:67-73. [PMID: 28118098 DOI: 10.1089/omi.2016.0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In modern healthcare systems, the available resources may influence the morbidity, mortality, and-consequently-the level of healthcare provided in every country. This is of particular interest in developing countries where the resources are limited and must be spent wisely to address social justice and the right for equal access in healthcare services by all the citizens in economically viable terms. In this light, the current allocation is, in practice, inefficient and rests mostly on each country's individual political and historical context and, thus, does not always incorporate decision-making enabled by economic models. In this study, we present a new economic model, specifically for resource allocation for genomic medicine, based on performance ratio, with potential applications in diverse healthcare sectors, which are particularly appealing for developing countries and low-resource environments. The model proposes a new method for resource allocation taking into account (1) the size of innovation of a new technology, (2) the relative effectiveness in comparison with social preferences, and (3) the cost of the technology, which permits the measurement of effectiveness to be determined differently in the context of a specific disease and then to be expressed in a relative form using a common performance ratio. The present work expands on previous work for innovation in economic models pertaining to genomic medicine and supports translational science.
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Affiliation(s)
- Vasilios Fragoulakis
- 1 Department of Pharmacy, University of Patras School of Health Sciences , Patras, Greece .,2 Department of Health Services Management, National School of Public Health , Athens, Greece
| | - Christina Mitropoulou
- 3 Erasmus MC , Department of Clinical Chemistry, Rotterdam, the Netherlands .,4 The Golden Helix Foundation , London, United Kingdom
| | | | - Ron H van Schaik
- 3 Erasmus MC , Department of Clinical Chemistry, Rotterdam, the Netherlands
| | - Nikolaos Maniadakis
- 2 Department of Health Services Management, National School of Public Health , Athens, Greece
| | - George P Patrinos
- 1 Department of Pharmacy, University of Patras School of Health Sciences , Patras, Greece
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Merlo G, Page K, Ratcliffe J, Halton K, Graves N. Bridging the gap: exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:303-309. [PMID: 25288052 DOI: 10.1007/s40258-014-0132-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.
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Affiliation(s)
- Gregory Merlo
- Centre of Research Excellence in Reducing Healthcare Associated Infections (CRE-RHAI), Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia,
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