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Fu R, Ng V, Liu M, Wells D, Yurga E, Nauenberg E. Considering patient perspectives in economic evaluations of health interventions. Front Public Health 2023; 11:1212583. [PMID: 37876714 PMCID: PMC10593459 DOI: 10.3389/fpubh.2023.1212583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Current guidelines for evaluating the cost-effectiveness of health interventions commonly recommend the use of a payer and/or a societal perspective. This raises the concern that the resulting reimbursement decision may overlook the full spectrum of impacts and equity considerations. In this paper, we argue that a potential solution is to supplement a societal- or payer-perspective economic evaluation with an additional evaluation accounting for exclusively the patient perspective. We present five categories of health interventions for which a patient-perspective analysis may be informative including those (1) that cross the definitional boundary between drugs and non-drug technologies; (2) affect patient adherence to protocol; (3) represent revolutionary treatments for genetic disorders; (4) with an incremental cost-effectiveness ratio involving slightly less effective, but substantially less costly, than the current standard; and (5) have been previously approved for funding but now being targeted for potential delisting or disinvestment. Real-world examples are discussed in detail. Lived experience individuals were invited to provide vignettes. Discussions are provided regarding how to incorporate patient inputs to improve patient-centered decision-making.
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Affiliation(s)
- Rui Fu
- Department of Otolaryngology—Head & Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vivian Ng
- Roche Diagnostics, Laval, QC, Canada
| | - Michael Liu
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - David Wells
- The Canadian Agency for Drugs and Technologies in Health (CADTH), Nanaimo, BC, Canada
| | - Emre Yurga
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Nauenberg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Ontario Ministry of Health, Toronto, ON, Canada
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Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I, Gerlach H, Hartmann K, Kahle B, Kluess H, Mendoza E, Mühlberger D, Mumme A, Nüllen H, Rass K, Reich-Schupke S, Stenger D, Stücker M, Schmedt CG, Schwarz T, Tesmann J, Teßarek J, Werth S, Valesky E. S2k guidelines: diagnosis and treatment of varicose veins. DER HAUTARZT; ZEITSCHRIFT FUR DERMATOLOGIE, VENEROLOGIE, UND VERWANDTE GEBIETE 2022; 73:1-44. [PMID: 35438355 PMCID: PMC9358954 DOI: 10.1007/s00105-022-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Pannier
- Praxis für Dermatologie und Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany.
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Mogaldea A, Goecke T, Theodoridis K, Haverich A, Cebotari S, Hilfiker A. Tissue Engineering of Vein Valves Based on Decellularized Natural Matrices. Cells Tissues Organs 2017; 204:199-209. [DOI: 10.1159/000477776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 01/12/2023] Open
Abstract
Valvular repair or transplantation, designed to restore the venous valve function of the legs, has been proposed as treatment in chronic venous insufficiency. Available grafts or surgeries have provided limited durability so far. Generating venous valve substitutes by means of tissue engineering could be a solution. We generated decellularized jugular ovine vein conduits containing valves (oVVC) after reseeding with ovine endothelial cells differentiated from peripheral blood-derived endothelial cells (oPBEC), cultivated in vitro corresponding to the circulatory situation in the lower leg at rest and under exertion. oVVC were decellularized by detergent treatment. GFP-labeled oPBEC were seeded onto the luminal side of the decellularized oVVC and cultivated under static-rotational conditions for 6 h (group I) and 12 h (group II), respectively. Reseeded matrices of group I were exposed to continuous low flow conditions (“leg at rest”). The tissues of group II were exposed to a gradually increasing flow (“leg under effort”). After 5 days, the grafts of group I revealed a uniform luminal endothelial cell coverage of the examined areas of the venous walls and adjacent venous valve leaflets. In group II, the cell coverage on luminal areas of the venous wall parts was found to be nearly complete. The endothelial cell coverage of adjacent venous valve leaflets was revealed to be less dense and confluent. Endothelial cells cultured on acellular vein tissues of both groups were distinctly orientated uniformly in the flow direction, clearly creating a stable and flow-orientated layer. Thus, an endothelium could successfully be reestablished on the luminal surface of a decellularized venous valve by seeding peripheral blood endothelial cells and culturing under different conditions.
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Stücker M, Debus ES, Hoffmann J, Jünger M, Kröger K, Mumme A, Ramelet AA, Rabe E. Konsensuspapier zur symptomorientierten Therapie der chronischen Venenerkrankungen. J Dtsch Dermatol Ges 2016; 14:575-84. [DOI: 10.1111/ddg.13006_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Markus Stücker
- Klinik für Dermatologie und Allergologie und Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken; Ruhr-Universität Bochum
| | - Eike Sebastian Debus
- Klinik und Poliklinik für Gefäßmedizin des Universitätsklinikums Hamburg-Eppendorf
| | - Johannes Hoffmann
- Klinik für Gefäßchirurgie und Phlebologie am Contilia Herz- und Gefäßzentrum Elisabeth Krankenhaus Essen und Sektion Gefäßchirurgie am Universitätsklinikum Essen
| | - Michael Jünger
- Klinik und Poliklinik für Hautkrankheiten; Universitätsmedizin Greifswald
| | - Knut Kröger
- Fachbereich Angiologie der Klinik für Gefäßmedizin; HELIOS Klinikum Krefeld
| | - Achim Mumme
- Klinik für Gefäßchirurgie und Venenzentrum der dermatologischen und gefäßchirurgischen Kliniken; Ruhr-Universität Bochum
| | | | - Eberhard Rabe
- Dermatologische Angiologie - Phlebologie; Universitätsklinikum Bonn
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Stücker M, Debus ES, Hoffmann J, Jünger M, Kröger K, Mumme A, Ramelet A, Rabe E. Consensus statement on the symptom‐based treatment of chronic venous diseases. J Dtsch Dermatol Ges 2016; 14:575-83. [DOI: 10.1111/ddg.13006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Markus Stücker
- Department of Dermatology and Allergology and Center for Venous Disorders of the Departments of Dermatology and Vascular Surgery Ruhr University Bochum Bochum Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine University Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Johannes Hoffmann
- Department of Vascular Surgery and Phlebology at the Contilia Cardiovascular Center, Elisabeth Hospital Essen, and Division of Vascular Surgery University Hospital Essen Essen Germany
| | - Michael Jünger
- Department of Dermatology University Medicine Greifswald Greifswald Germany
| | - Knut Kröger
- Division of Angiology, Department of Vascular Medicine HELIOS Medical Center Krefeld Krefeld Germany
| | - Achim Mumme
- Department of Vascular Surgery and Center for Venous Disorders of the Departments of Dermatology and Vascular Surgery Ruhr University Bochum Bochum Germany
| | | | - Eberhard Rabe
- Department of Dermatology and Allergology, Bonn, Germany University of Bonn Bonn Germany
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Rabe E, Guex JJ, Morrison N, Ramelet AA, Schuller-Petrovic S, Scuderi A, Staelens I, Pannier F. Treatment of chronic venous disease with flavonoids: recommendations for treatment and further studies. Phlebology 2013; 28:308-19. [PMID: 23395842 DOI: 10.1177/0268355512471929] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A variety of studies have suggested that flavonoids are effective for the treatment of CVD. However, many questions remain about their mechanism of action and when, how, and for what signs and symptoms they should be used. METHOD A panel of experts in CVD met in Budapest, Hungary in December 2011 to discuss the current state of knowledge of CVD and the role of flavonoids in its treatment. The discussion was based on a literature search in the current databases. The goals of this paper are recommendations for further studies on the use of flavonoids in the treatment of CVD. RESULTS There is good evidence to recommend the use of flavonoids in the treatment of CVD. However, because of the poor quality of some older clinical trials, inadequate reporting, and insufficient information, much work is still needed to firmly establish their clinical efficacy and to determine when and how they should be employed. In particular, long-term randomized, placebo-controlled, double-blind studies are needed to establish the efficacy and safety of flavonoids. Additional studies are also needed to establish their mechanism of action, pharmacokinetics, toxicity, and cost-effectiveness. CONCLUSIONS Aside from good evidence for the use of flavonoids in CVD further studies are indicated to establish long term treatment in this indication.
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Affiliation(s)
- E Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany.
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Chi YW, Schul M, Gibson K, Rosenblatt M, Kabnick L, Jaff M. Chronic venous disorder registry: A new perspective. Phlebology 2013; 29:415-27. [DOI: 10.1177/0268355513484143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic venous disorder is one of the most prevalent medical conditions in the US that carries significant economic and health burden. The knowledge into venous pathophysiology, how it develops, and the true quality of life benefits of various treatment options are largely unknown. A truly meaningful clinical data capture system specifically for venous disorder may provide answers to the paucity of data. We describe a modern system to capture research and best practice data using the state of art information technology.
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Affiliation(s)
- Yung-Wei Chi
- Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Marlin Schul
- Lafayette Regional Vein & Laser Center, Lafayette, IN, USA
| | | | | | - Lowell Kabnick
- Department of Surgery, New York University Vein Center, New York, NY, USA
| | - Michael Jaff
- Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Shadid N, Ceulen R, Nelemans P, Dirksen C, Veraart J, Schurink GW, van Neer P, vd Kley J, de Haan E, Sommer A. Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein. Br J Surg 2012; 99:1062-70. [PMID: 22627969 DOI: 10.1002/bjs.8781] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND New minimally invasive treatment modalities, such as ultrasound-guided foam sclerotherapy (UGFS), are becoming more popular. In a multicentre randomized controlled non-inferiority trial, the effectiveness and costs of UGFS and surgery for treatment of the incompetent great saphenous vein (GSV) were compared. METHODS Patients with primary great saphenous varicose veins were assigned randomly to either UGFS or surgical stripping with high ligation. Recurrence, defined as reflux combined with venous symptoms, was determined on colour duplex scans at baseline, 3 months, 1 year and 2 years after initial treatment. Secondary outcomes were presence of recurrent reflux (irrespective of symptoms), reduction of symptoms, health-related quality of life (EQ-5D(™)), adverse events and direct hospital costs. RESULTS Two hundred and thirty patients were treated by UGFS and 200 underwent GSV stripping. The 2-year probability of recurrence was similar in the UGFS and surgery groups: 11·3 per cent (24 of 213) and 9·0 per cent (16 of 177) respectively (P = 0·407). At 2 years, reflux irrespective of venous symptoms was significantly more frequent in the UGFS group (35·0 per cent) than in the surgery group (21·0 per cent) (P = 0·003). Mean(s.d.) hospital costs per patient over 2 years were €774(344) per patient for UGFS and €1824(141) for stripping. CONCLUSION At 2-year follow-up, UGFS was not inferior to surgery when reflux associated with venous symptoms was the clinical outcome of interest. UGFS has the potential to be a cost-effective approach to a common health problem. Registration numbers: NCT01103258 (http://www.clinicaltrials.gov) and NTR654 (http://www.trialregister.nl).
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Affiliation(s)
- N Shadid
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Pichetti S, Sorasith C, Sermet C. Analysis of the impact of removing mucolytics and expectorants from the list of reimbursable drugs on prescription rates: A time-series analysis for France 1998–2010. Health Policy 2011; 102:159-69. [DOI: 10.1016/j.healthpol.2011.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 05/23/2011] [Accepted: 07/01/2011] [Indexed: 01/18/2023]
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Rabe E, Pannier F. Societal costs of chronic venous disease in CEAP C4, C5, C6 disease. Phlebology 2010; 25 Suppl 1:64-7. [DOI: 10.1258/phleb.2010.010s09] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- E Rabe
- Department of Dermatology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - F Pannier
- Department of Dermatology, University of Maastricht Medical Centre, MUMC+, Maastricht, Netherlands
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