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Persad-Paisley E, Laguna A, Paracha S, Maxwell A. Abstract No. 102 Using Representation Quotients to Examine Trends in Representation of Racial/Ethnic and Gender Groups Applying and Matriculating into Interventional Radiology Residency Programs Between 2017 and 2021. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Iheanacho F, Rex N, Collins S, Baird G, Maxwell A. Abstract No. 60 Treatment margins and local tumor progression following thermal ablation of small renal masses. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Maxwell A, Mendoza H, Sellitti M, Camacho J, Deipolyi A, Ziv E, Sofocleous C, Yarmohammadi H, Maybody M, Humm J, Schwartz J, Juluru K, Dunphy M, Boas F. Abstract No. 26 Optimizing Y-90 particle density improves outcomes after radioembolization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Maxwell A, Sofocleous C, Solomon S, Kemeny N, Camacho J, Deipolyi A, Yarmohammadi H, Ziv E, Petre E, Boas F. Abstract No. 19 Optimal timing of cytotoxic chemotherapy when combined with thermal ablation of liver metastases. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Yarmohammadi H, Elsakka A, Nurili F, Maxwell A, Ridouani F, Ziv E, O’Reilly E, Cheleuitte-Nieves C, Schook L, Solomon S, Boas F. Abstract No. 86 Treatment of pancreatic cancer by intra-arterial injection of an emulsion of lipiodol and bumetanide (an anti-glycolytic drug) in a transgenic mutated pig model (Oncopig). J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Seow TXF, Benoit E, Dempsey C, Jennings M, Maxwell A, McDonough M, Gillan CM. A dimensional investigation of error-related negativity (ERN) and self-reported psychiatric symptoms. Int J Psychophysiol 2020; 158:340-348. [PMID: 33080287 PMCID: PMC7612131 DOI: 10.1016/j.ijpsycho.2020.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 08/05/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Alterations in error processing are implicated in a range of DSM-defined psychiatric disorders. For instance, obsessive-compulsive disorder (OCD) and generalised anxiety disorder show enhanced electrophysiological responses to errors-i.e. error-related negativity (ERN)-while others like schizophrenia have an attenuated ERN. However, as diagnostic categories in psychiatry are heterogeneous and also highly intercorrelated, the precise mapping of ERN enhancements/impairments is unclear. To address this, we recorded electroencephalograms (EEG) from 196 participants who performed the Flanker task and collected scores on 9 questionnaires assessing psychiatric symptoms to test if a dimensional framework could reveal specific transdiagnostic clinical manifestations of error processing dysfunctions. Contrary to our hypothesis, we found non-significant associations between ERN amplitude and symptom severity of OCD, trait anxiety, depression, social anxiety, impulsivity, eating disorders, alcohol addiction, schizotypy and apathy. A transdiagnostic approach did nothing to improve signal; there were non-significant associations between all three transdiagnostic dimensions (anxious-depression, compulsive behaviour and intrusive thought, and social withdrawal) and ERN magnitude. In these same individuals, we replicated a previously published transdiagnostic association between goal-directed learning and compulsive behaviour and intrusive thought. Possible explanations discussed are (i) that associations between the ERN and psychopathology might be smaller than previously assumed, (ii) that these associations might depend on a greater level of symptom severity than other transdiagnostic cognitive biomarkers, or (iii) that task parameters, such as the ratio of compatible to incompatible trials, might be crucial for ensuring the sensitivity of the ERN to clinical phenomena.
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Affiliation(s)
- T X F Seow
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - E Benoit
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - C Dempsey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - M Jennings
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - A Maxwell
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - M McDonough
- St. Patrick's University Hospital, Dublin, Ireland
| | - C M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Patel K, Maxwell A, Bailey C. 3:54 PM Abstract No. 361 Safety and efficacy of central venous line placement via internal jugular vein in patients with total artificial hearts. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Maxwell A, Holman T, Novak T. Idiopathic Pulmonary Arterial Hypertension Unmasked by Pregnancy. Acute Med 2020; 19:240-243. [PMID: 33215178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 31-year old woman presented to the acute medical unit 9 days post-partum with shortness of breath and peripheral oedema. Initially suspected to have either a pulmonary embolism or post-partum cardiomyopathy, she proceeded to have imaging including a CT Pulmonary angiogram and echocardiogram, which were suggestive of pulmonary hypertension and severe right heart failure. Her history and other investigations did not reveal any obvious cause for this. She was transferred to a specialist centre where she was diagnosed with Idiopathic Pulmonary Arterial Hypertension (IPAH), previously known as primary pulmonary hypertension. Shortness of breath during pregnancy and in the postpartum period is a relatively common acute medical presentation. Whilst IPAH is a rare diagnosis, it carries a high mortality rate, particularly in pregnancy, and requires prompt specialist investigation, diagnosis and management.
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Affiliation(s)
- A Maxwell
- MBBS, MRCP Core Medical Trainee, Great Western Hospital, Swindon
| | - T Holman
- MBBS, MSc. Clinical Fellow in Acute Medicine, Great Western Hospital, Swindon
| | - T Novak
- MD, MRCP Acute Medical Consultant, Great Western Hospital, Swindon
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Richardson J, Iezzi A, Maxwell A. Sharing and the Provision of "Cost-Ineffective" Life-Extending Services to Less Severely Ill Patients. Value Health 2018; 21:951-957. [PMID: 30098673 DOI: 10.1016/j.jval.2017.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/07/2017] [Accepted: 12/05/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cost-utility analysis prioritizes services using cost, life-years, and the health state utility of the life-years. Nevertheless, a significant body of evidence suggests that the public would prefer more variables to be considered in decision making and at least some sharing of the budget with services for severe conditions that are not cost-effective because of their high cost. OBJECTIVES To examine whether this preference for sharing persists for less severe conditions when both cost effectiveness and illness severity would indicate that resources should be allocated to other services. METHODS Survey respondents were asked to divide a budget between two patients facing life-threatening illnesses. The severity of the illnesses differed and the price of treatment was varied. RESULTS Sharing occurred in all scenarios including scenarios in which the illness was less severe and services were not cost-effective. Results are consistent with behavior commonly observed in other contexts. CONCLUSIONS Results suggest that sharing per se is important and that the public would support some funding of cost-ineffective services for less severe health problems.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
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Richardson J, Iezzi A, Maxwell A, Chen G. Does the use of the proportional shortfall help align the prioritisation of health services with public preferences? Eur J Health Econ 2018; 19:797-806. [PMID: 28801762 DOI: 10.1007/s10198-017-0923-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
It has been proposed that equity may be included in the economic evaluation of health services using the 'proportional shortfall' (PS)-the proportion of a person's QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people's preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. Survey respondents were asked to allocate 100 votes between 13 scenarios and a standard scenario. Variation in the allocation of votes was explained by health gain and different combinations of the equity variables. Differences in votes for the comparisons were significantly related to differences in PS but the relationship was weaker than between votes and the age related variables. Cases were identified where PS suggested a priority ordering of services which was strongly rejected by respondents. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| | - Gang Chen
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
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Richardson J, Iezzi A, Maxwell A. Uncertainty and the Undervaluation of Services for Severe Health States in Cost-Utility Analyses. Value Health 2018; 21:850-857. [PMID: 30005758 DOI: 10.1016/j.jval.2017.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 10/20/2017] [Accepted: 10/29/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To test the hypothesis that the "severity effect"-the preference for more than utility-maximizing expenditure on severe health states-may be the result of, or exacerbated by, the uncertainty associated with the chance of contracting the illness that causes the severe health state. METHODS Survey respondents were asked to imagine that they will contract one of two illnesses and asked to allocate a budget between two insurance policies, each of which provides services for the treatment of one of the illnesses. A person's final health state varied with the amount of insurance purchased for the illness that occurred and therefore with the level of treatment. The relative cost of the two policies was altered and the selected levels of insurance compared with the levels that would be provided by a health authority that sought to maximize total utility or quality-adjusted life-years from its own budget. RESULTS Respondents selected more than utility-maximizing insurance for protection against severe health states. A number of psychological factors that affect measurement under uncertainty do not affect utility as currently measured. This difference may explain the present results and also explain the "severity paradox" that personal preferences as presently measured imply less expenditure on severe health states than do "social preferences" for the treatment of strangers. CONCLUSIONS Uncertainty alters preferences. Incorporating these preferences in decision making would result in greater spending on severe health states.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
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Farrell LJ, Lo R, Wanford JJ, Jenkins A, Maxwell A, Piddock LJV. Revitalizing the drug pipeline: AntibioticDB, an open access database to aid antibacterial research and development. J Antimicrob Chemother 2018; 73:2284-2297. [DOI: 10.1093/jac/dky208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L J Farrell
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - R Lo
- School of Biological Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Biological Chemistry, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
| | - J J Wanford
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - A Jenkins
- British Society for Antimicrobial Chemotherapy, Griffin House, 53 Regent Place, Birmingham B1 3NJ, UK
| | - A Maxwell
- Department of Biological Chemistry, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
| | - L J V Piddock
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Abstract
Background Patients with a permanent impairment may be unable to reach full health. Consequently health services which cure illnesses which are unrelated to the impairment may increase health less than services for patients with no impairment. While it has been argued that this should not lead to discrimination against impaired patients there is little evidence to determine whether this equity-efficiency trade-off is consistent with social values. Objectives To measure the effect of permanent impairment upon the social valuation of services for unrelated illnesses. Methods Social valuations of services for illnesses associated with mobility, depression or pain were assessed and compared for patients with and without a permanent impairment using the Relative Social Willingness to Pay (RS-WTP) instrument. The maximum valuation of services for impaired patients was also compared with the maximum utility which could be gained when utility was measured using three multi attribute utility instruments. Results Curing the illness of impaired patients was valued 8–11 percent less than the cure of patients with no impairment. Discrimination decreased as the severity of the illness increased. Valuation of health states using the utility instruments implied significantly greater discrimination than the social valuations using the RS-WTP instrument. Conclusions Health services are valued less highly when a patient’s health potential is impaired. However discrimination is significantly less than would occur if the value of the services were limited to the value of the health state causing the impairment. The argument for disregarding a patient’s limited health potential when resources are allocated therefore receives some support from social valuations but the case for completely equal treatment depends upon additional ethical arguments.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic, Australia
- * E-mail:
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic, Australia
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Richardson J, Iezzi A, Maxwell A. How important is severity for the evaluation of health services: new evidence using the relative social willingness to pay instrument. Eur J Health Econ 2017; 18:671-683. [PMID: 27456337 DOI: 10.1007/s10198-016-0817-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/05/2016] [Indexed: 06/06/2023]
Abstract
The 'severity hypothesis' is that a health service which increases a patient's utility by a fixed amount will be valued more highly when the initial health state is more severe. Supporting studies have employed a limited range of analytical techniques and the objective of the present paper is to test the hypothesis using a new methodology, the Relative Social Willingness to Pay. Three subsidiary hypotheses are: (1) that the importance of the 'severity effect' varies with the type of medical problem; (2) that the relationship between value and utility varies with the severity of the initial health state; and (3) that there is a threshold beyond which severity effects are insignificant. For each of seven different health problems respondents to a web-based survey were asked to allocate a budget to five services which would, cumulatively, move a person from near death to full health. The time trade-off utilities of health states before and after the service were estimated. The social valuation of the service measured by the budget allocation was regressed upon the corresponding increase in utility and severity as measured by the pre-service health state utility. Results confirm the severity hypothesis and support the subsidiary hypotheses. However, the effects identified are quantitatively significant only for the most severe health states. This implies a relatively limited redistribution of resources from those with less severe to those with more severe health problems.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Level 2, 15 Innovation Walk, Clayton, VIC, 3800, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Level 2, 15 Innovation Walk, Clayton, VIC, 3800, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Level 2, 15 Innovation Walk, Clayton, VIC, 3800, Australia
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Richardson J, Iezzi A, Chen G, Maxwell A. Communal Sharing and the Provision of Low-Volume High-Cost Health Services: Results of a Survey. Pharmacoecon Open 2017; 1:13-23. [PMID: 29442298 PMCID: PMC5689032 DOI: 10.1007/s41669-016-0002-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This paper suggests and tests a reason why the public might support the funding of services for rare diseases (SRDs) when the services are effective but not cost effective, i.e. when more health could be produced by allocating funds to other services. It is postulated that the fairness of funding a service is influenced by a comparison of the average patient benefit with the average cost to those who share the cost. METHODS Survey respondents were asked to allocate a budget between cost-effective services that had a small effect upon a large number of relatively well patients and SRDs that benefited a small number of severely ill patients but were not cost effective because of their high cost. RESULTS Part of the budget was always allocated to the SRDs. The budget share rose with the number sharing the cost. DISCUSSION Sharing per se appears to characterise preferences. This has been obscured in studies that focus upon cost per patient rather than cost per person sharing the cost.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| | - Gang Chen
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
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Kaambwa B, Chen G, Ratcliffe J, Iezzi A, Maxwell A, Richardson J. Mapping Between the Sydney Asthma Quality of Life Questionnaire (AQLQ-S) and Five Multi-Attribute Utility Instruments (MAUIs). Pharmacoeconomics 2017; 35:111-124. [PMID: 27557995 DOI: 10.1007/s40273-016-0446-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Economic evaluation of health services commonly requires information regarding health-state utilities. Sometimes this information is not available but non-utility measures of quality of life may have been collected from which the required utilities can be estimated. This paper examines the possibility of mapping a non-utility-based outcome, the Sydney Asthma Quality of Life Questionnaire (AQLQ-S), onto five multi-attribute utility instruments: Assessment of Quality of Life 8 Dimensions (AQoL-8D), EuroQoL 5 Dimensions 5-Level (EQ-5D-5L), Health Utilities Index Mark 3 (HUI3), 15 Dimensions (15D), and the Short-Form 6 Dimensions (SF-6D). METHODS Data for 856 individuals with asthma were obtained from a large Multi-Instrument Comparison (MIC) survey. Four statistical techniques were employed to estimate utilities from the AQLQ-S. The predictive accuracy of 180 regression models was assessed using six criteria: mean absolute error (MAE), root mean squared error (RMSE), correlation, distribution of predicted utilities, distribution of residuals, and proportion of predictions with absolute errors <0.0.5. Validation of initial 'primary' models was carried out on a random sample of the MIC data. RESULTS Best results were obtained with non-linear models that included a quadratic term for the AQLQ-S score along with demographic variables. The four statistical techniques predicted models that performed differently when assessed by the six criteria; however, the best results, for both the estimation and validation samples, were obtained using a generalised linear model (GLM estimator). CONCLUSIONS It is possible to predict valid utilities from the AQLQ-S using regression methods. We recommend GLM models for this exercise.
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Affiliation(s)
- Billingsley Kaambwa
- Flinders Health Economics Group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, Adelaide, SA, 5041, Australia.
| | - Gang Chen
- Centre for Health Economics, Building 75, 15 Innovation Walk, Monash University, Clayton, VIC, 3800, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, Adelaide, SA, 5041, Australia
| | - Angelo Iezzi
- Centre for Health Economics, Building 75, 15 Innovation Walk, Monash University, Clayton, VIC, 3800, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Building 75, 15 Innovation Walk, Monash University, Clayton, VIC, 3800, Australia
| | - Jeff Richardson
- Centre for Health Economics, Building 75, 15 Innovation Walk, Monash University, Clayton, VIC, 3800, Australia
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Richardson J, McKie J, Iezzi A, Maxwell A. Age Weights for Health Services Derived from the Relative Social Willingness-to-Pay Instrument. Med Decis Making 2016; 37:239-251. [PMID: 27140188 DOI: 10.1177/0272989x16645576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effect of a patient's age on the social valuation of health services remains controversial, with empirical results varying in magnitude and implying a different age-value profile. This article employs a new methodology to re-examine these questions. Data were obtained from 2 independent Web-based surveys that administered the Relative Social Willingness to Pay instrument. In the first survey, the age of the patient receiving a life-saving service was varied. Patients were left with either poor mental or physical health. In the second survey, patient age was varied for a service that fully cured the patient's poor mental or physical health. In total, therefore, 4 sets of age weights were obtained: weights for life-extending services with poor physical or mental health outcomes and weights for quality-of-life improvement for patients in poor mental or physical health. Results were consistent. Increasing age was associated in each case with a monotonic decrease in the social valuation of the services. The decrease in value was quantitatively small until age 60 years. By age 80 years, the social value of services had declined by about 50%. The decline commenced at an earlier age in the context of physical health, although the magnitude of the decrement by age 80 years was unrelated to the type of service. With 1 exception, there was little difference in the valuation of services by the age of the survey respondent. Respondents aged >60 years placed a lower, not higher, value on quality-of-life improvement for elderly individuals than other respondents. There was no difference in the valuation of life-extending services.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VI, Australia (JR, JM, AI, AM)
| | - John McKie
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VI, Australia (JR, JM, AI, AM)
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VI, Australia (JR, JM, AI, AM)
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Clayton, VI, Australia (JR, JM, AI, AM)
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Kanaan M, Mdege ND, Keding A, Parker RA, Mills N, Shah A, Strachan F, Keerie C, Weir CJ, Forbes A, Hemming K, Lawton SA, Healey E, Lewis M, Nicholls E, Jinks C, Tan V, Finney A, Mallen CD, Lenguerrand E, MacLennan G, Norrie J, Bhattacharya S, Draycott T, Hooper R, Teerenstra S, de Hoop E, Eldridge S, Girling A, Taljaard M, Di Tanna GL, Gasparrini A, Casula A, Caskey F, Lenguerrand E, Methven S, MacNeill S, May M, Selby N, Danon L, Christensen H, Finn A, May M, Takanashi F, Keding A, Crouch S, Kanaan M, Kristunas CA, Smith KL, Gray LJ, Matthews JN, Salman RAS, Parker RA, Maxwell A, Dennis M, Rudd A, Weir CJ, Thompson JA, Fielding KL, Davey C, Aiken AM, Hargreaves JR, Hayes RJ, Lyons VH, Li L, Hughes J, Rowhani-Rahbar A, Hemming K, Taljaard M, Forbes A. Proceedings of the First International Conference on Stepped Wedge Trial Design. Trials 2016; 17 Suppl 1:311. [PMID: 27454562 PMCID: PMC4959349 DOI: 10.1186/s13063-016-1436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
I1 Introduction Mona Kanaan, Noreen Dadirai Mdege, Ada Keding O1 The HiSTORIC trial: a hybrid before-and-after and stepped wedge design RA Parker, N Mills, A Shah, F Strachan, C Keerie, CJ Weir O2 Stepped wedge trials with non-uniform correlation structure Andrew Forbes, Karla Hemming O3 Challenges and solutions for the operationalisation of the ENHANCE study: a pilot stepped wedge trial within a general practice setting Sarah A Lawton, Emma Healey, Martyn Lewis, Elaine Nicholls, Clare Jinks, Valerie Tan, Andrew Finney, Christian D Mallen, on behalf of the ENHANCE Study Team O4 Early lessons from the implementation of a stepped wedge trial design investigating the effectiveness of a training intervention in busy health care settings: the Thistle study Erik Lenguerrand, Graeme MacLennan, John Norrie, Siladitya Bhattacharya, Tim Draycott, on behalf of the Thistle group O5 Sample size calculation for longitudinal cluster randomised trials: a unified framework for closed cohort and repeated cross-section designs Richard Hooper, Steven Teerenstra, Esther de Hoop, Sandra Eldridge O6 Restricted randomisation schemes for stepped-wedge studies with a cluster-level covariate Alan Girling, Monica Taljaard O7 A flexible modelling of the time trend for the analysis of stepped wedge trials: results of a simulation study Gian Luca Di Tanna, Antonio Gasparrini P1 Tackling acute kidney injury – a UK stepped wedge clinical trial of hospital-level quality improvement interventions Anna Casula, Fergus Caskey, Erik Lenguerrand, Shona Methven, Stephanie MacNeill, Margaret May, Nicholas Selby P2 Sample size considerations for quantifying secondary bacterial transmission in a stepped wedge trial of influenza vaccine Leon Danon, Hannah Christensen, Adam Finn, Margaret May P3 Sample size calculation for time-to-event data in stepped wedge cluster randomised trials Fumihito Takanashi, Ada Keding, Simon Crouch, Mona Kanaan P4 Sample size calculations for stepped-wedge cluster randomised trials with unequal cluster sizes Caroline A. Kristunas, Karen L. Smith, Laura J. Gray P5 The design of stepped wedge trials with unequal cluster sizes John N.S. Matthews P6 Promoting Recruitment using Information Management Efficiently (PRIME): a stepped wedge SWAT (study-within-a-trial) R Al-Shahi Salman, RA Parker, A Maxwell, M Dennis, A Rudd, CJ Weir P7 Implications of misspecified mixed effect models in stepped wedge trial analysis: how wrong can it be? Jennifer A Thompson, Katherine L Fielding, Calum Davey, Alexander M Aiken, James R Hargreaves, Richard J Hayes S1 Stepped Wedge Designs with Multiple Interventions Vivian H Lyons, Lingyu Li, James Hughes, Ali Rowhani-Rahbar S2 Analysis of the cross-sectional stepped wedge cluster randomised trial Karla Hemming, Monica Taljaard, Andrew Forbes
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Richardson J, Iezzi A, Khan MA, Chen G, Maxwell A. Measuring the Sensitivity and Construct Validity of 6 Utility Instruments in 7 Disease Areas. Med Decis Making 2015; 36:147-59. [DOI: 10.1177/0272989x15613522] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 09/20/2015] [Indexed: 01/13/2023]
Abstract
Background. Health services that affect quality of life (QoL) are increasingly evaluated using cost utility analyses (CUA). These commonly employ one of a small number of multiattribute utility instruments (MAUI) to assess the effects of the health service on utility. However, the MAUI differ significantly, and the choice of instrument may alter the outcome of an evaluation. Aims. The present article has 2 objectives: 1) to compare the results of 3 measures of the sensitivity of 6 MAUI and the results of 6 tests of construct validity in 7 disease areas and 2) to rank the MAUI by each of the test results in each disease area and by an overall composite index constructed from the tests. Methods. Patients and the general public were administered a battery of instruments, which included the 6 MAUI, disease-specific QoL instruments (DSI), and 6 other comparator instruments. In each disease area, instrument sensitivity was measured 3 ways: by the unadjusted mean difference in utility between public and patient groups, by the value of the effect size, and by the correlation between MAUI and DSI scores. Content and convergent validity were tested by comparison of MAUI utilities and scores from the 6 comparator instruments. These included 2 measures of health state preferences, measures of subjective well-being and capabilities, and generic measures of physical and mental QoL derived from the SF-36. Results. The apparent sensitivity of instruments varied significantly with the measurement method and by disease area. Validation test results varied with the comparator instruments. Notwithstanding this variability, the 15D, AQoL-8D, and the SF-6D generally achieved better test results than the QWB and EQ-5D-5L.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Australia (JR, AI, MAK, AM)
- Flinders Health Economics Group, Flinders University, Australia (GC)
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Australia (JR, AI, MAK, AM)
- Flinders Health Economics Group, Flinders University, Australia (GC)
| | - Munir A. Khan
- Centre for Health Economics, Monash Business School, Monash University, Australia (JR, AI, MAK, AM)
- Flinders Health Economics Group, Flinders University, Australia (GC)
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Australia (JR, AI, MAK, AM)
- Flinders Health Economics Group, Flinders University, Australia (GC)
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Australia (JR, AI, MAK, AM)
- Flinders Health Economics Group, Flinders University, Australia (GC)
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Smith H, Szczepura K, Mercer C, Maxwell A, Hogg P. Does elevating image receptor increase breast receptor footprint and improve pressure balance? Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2015.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schall KA, Holoyda KA, Grant CN, Levin DE, Torres ER, Maxwell A, Pollack HA, Moats RA, Frey MR, Darehzereshki A, Al Alam D, Lien C, Grikscheit TC. Adult zebrafish intestine resection: a novel model of short bowel syndrome, adaptation, and intestinal stem cell regeneration. Am J Physiol Gastrointest Liver Physiol 2015; 309:G135-45. [PMID: 26089336 PMCID: PMC4525108 DOI: 10.1152/ajpgi.00311.2014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 05/28/2015] [Indexed: 01/31/2023]
Abstract
Loss of significant intestinal length from congenital anomaly or disease may lead to short bowel syndrome (SBS); intestinal failure may be partially offset by a gain in epithelial surface area, termed adaptation. Current in vivo models of SBS are costly and technically challenging. Operative times and survival rates have slowed extension to transgenic models. We created a new reproducible in vivo model of SBS in zebrafish, a tractable vertebrate model, to facilitate investigation of the mechanisms of intestinal adaptation. Proximal intestinal diversion at segment 1 (S1, equivalent to jejunum) was performed in adult male zebrafish. SBS fish emptied distal intestinal contents via stoma as in the human disease. After 2 wk, S1 was dilated compared with controls and villus ridges had increased complexity, contributing to greater villus epithelial perimeter. The number of intervillus pockets, the intestinal stem cell zone of the zebrafish increased and contained a higher number of bromodeoxyuridine (BrdU)-labeled cells after 2 wk of SBS. Egf receptor and a subset of its ligands, also drivers of adaptation, were upregulated in SBS fish. Igf has been reported as a driver of intestinal adaptation in other animal models, and SBS fish exposed to a pharmacological inhibitor of the Igf receptor failed to demonstrate signs of intestinal adaptation, such as increased inner epithelial perimeter and BrdU incorporation. We describe a technically feasible model of human SBS in the zebrafish, a faster and less expensive tool to investigate intestinal stem cell plasticity as well as the mechanisms that drive intestinal adaptation.
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Affiliation(s)
- K. A. Schall
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - K. A. Holoyda
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - C. N. Grant
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - D. E. Levin
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - E. R. Torres
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - A. Maxwell
- 2Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - H. A. Pollack
- 3Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - R. A. Moats
- 3Department of Radiology, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - M. R. Frey
- 2Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California; ,4Department of Pediatrics and Department of Biochemistry and Molecular Biology, Keck School of Medicine at University of Southern California, Los Angeles, California; and
| | - A. Darehzereshki
- 2Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - D. Al Alam
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
| | - C. Lien
- 2Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California; ,5Department of Cardiothoracic Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - T. C. Grikscheit
- 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California; ,2Developmental Biology and Regenerative Medicine Program, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California;
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Stuart AV, Clement Y, Sealy P, Löbenberg R, Montane-Jaime L, Maharaj RG, Maxwell A. Comparing the Dissolution Profiles of Seven Metformin Formulations in Simulated Intestinal Fluid. DISSOLUT TECHNOL 2015. [DOI: 10.14227/dt220115p17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bundred S, Maxwell A, Morris J, Harake J, Whiteside S, Zhou J, Bundred N. PB.9. Randomised controlled trial of stereotactic 11G vacuum-assisted core biopsy for diagnosis and management of malignant microcalcification. Breast Cancer Res 2014. [PMCID: PMC4243960 DOI: 10.1186/bcr3741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Wilson M, Maxwell A, Gadde S, Hurley E, Bydder M, Harkness E, Ewins M, Astley S, Lim Y. PB.5. Accuracy of axillary nodal staging on MRI of the breasts: correlation with ultrasound of the axilla and histopathology findings. Breast Cancer Res 2014. [PMCID: PMC4243099 DOI: 10.1186/bcr3739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sivagnanam L, Hufton A, Berks M, Harkness E, Lim Y, Maxwell A, Wilson M, Bydder M, Gadde S, Evans DG, Howell A, Stavrinos P, Astley S. PB.23. Breast density in previous screening mammograms of women with and without breast cancer. Breast Cancer Res 2014. [PMCID: PMC4244072 DOI: 10.1186/bcr3717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Otsuka M, Harkness E, Chen X, Moschidis E, Bydder M, Gadde S, Lim Y, Maxwell A, Evans DG, Howell A, Stavrinos P, Wilson M, Astley S. Local breast density at lesion sites in diagnostic and previous screening mammograms. Breast Cancer Res 2014. [PMCID: PMC4243105 DOI: 10.1186/bcr3699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Meyer J, Maxwell A, Harkness E, Astley S, Mercer C, Wilson M, Bydder M, Lim Y, Morris J. PB.22. Does mammographic compression force at breast screening influence the likelihood of subsequent screening attendance? Breast Cancer Res 2014. [PMCID: PMC4243119 DOI: 10.1186/bcr3710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Daniels J, Harkness E, Lim Y, Maxwell A, Morris J, Stavrinos P, Wilson M, Bydder M, Evans DG, Howell A. PB.24. How does volumetric breast density change with time? Breast Cancer Res 2014. [PMCID: PMC4243094 DOI: 10.1186/bcr3729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Richardson J, Khan MA, Iezzi A, Maxwell A. Comparing and Explaining Differences in the Magnitude, Content, and Sensitivity of Utilities Predicted by the EQ-5D, SF-6D, HUI 3, 15D, QWB, and AQoL-8D Multiattribute Utility Instruments. Med Decis Making 2014; 35:276-91. [DOI: 10.1177/0272989x14543107] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Cost utility analysis permits the comparison of disparate health services by measuring outcomes in comparable units, namely, quality-adjusted life-years, which equal life-years times the utility of the health state. However, comparability is compromised when different utility instruments predict different utilities for the same health state. The present paper measures the extent of, and reason for, differences between the utilities predicted by the EQ-5D-5L, SF-6D, HUI 3, 15D, QWB, and AQoL-8D. Methods. Data were obtained from patients in seven disease areas and members of the healthy public in six countries. Differences between public and patient utilities were estimated using each of the instruments. To explain discrepancies between the estimates, the measurement scales and content of the instruments were compared. The sensitivity of instruments to independently measured health dimensions was measured in pairwise comparisons of all combinations of the instruments. Results. The difference between public and patient utilities varied with the choice of instrument by more than 50% for every disease group and in four of the seven groups by more than 100%. Discrepancies were associated with differences in both the instrument content and their measurement scales. Pairwise comparisons of instruments found that variation in the sensitivity to physical and psychosocial dimensions of health closely reflected the items in the instrument's descriptive systems. Discussion. Results indicate that instruments measure related but different constructs. They imply that commonly used instruments systematically discriminate against some classes of services, most notably mental health services. Differences in the instrument scales imply the need for transformations between the instruments to increase the comparability of measurement.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
| | - Munir A. Khan
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
| | - Angelo Iezzi
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
| | - Aimee Maxwell
- Centre for Health Economics, Monash University, Melbourne, Australia (JR, MAK, AI, AM)
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Richardson J, Iezzi A, Khan MA, Maxwell A. Validity and reliability of the Assessment of Quality of Life (AQoL)-8D multi-attribute utility instrument. Patient 2014; 7:85-96. [PMID: 24271592 PMCID: PMC3929769 DOI: 10.1007/s40271-013-0036-x] [Citation(s) in RCA: 329] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective The purpose of this paper was to report tests of the validity and reliability of a new instrument, the Assessment of Quality of Life (AQoL)-8D, which was constructed to improve the evaluation of health services that have an impact upon the psychosocial aspects of the quality of life. Methods Australian and US data from a large multi-instrument comparison survey were used to conduct tests of convergent, predictive and content validity using as comparators five other multi-attribute utility (MAU) instruments—the EQ-5D, SF-6D, Health Utilities Index (HUI) 3, 15D and the Quality of Well-Being (QWB)—as well as four non-utility instruments—the SF-36 and three measures of subjective well-being (SWB). A separate three part Australian survey was used to assess test–retest reliability. Results Results indicate that AQoL-8D correlates more highly with both the SWB instruments and the psychosocial dimensions of the SF-36, and that it is similar to the other MAU instruments in terms of its convergent and predictive validity. The second Australian survey demonstrated high test–retest reliability. Conclusions The results indicate that the AQoL-8D is a reliable and valid instrument which offers an alternative to the MAU instruments presently used in economic evaluation studies, and one which is particularly suitable when psychosocial elements of health are of importance.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash University, Clayton, Melbourne, VIC, 3800, Australia,
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Evans G, Stavrinos P, Dawe S, Harvie M, Wilson M, Maxwell A, Brentnall A, Cuzick J, Astley S, Howell A. 8LBA Assessing individual breast cancer risk within the UK National Health Service Breast Screening Programme: First prospective results from PROCAS. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khan-Perez J, Mercer C, Bydder M, Sergeant J, Morris J, Maxwell A, Rylance C, Astley S. PB.10: Breast compression, compressed breast thickness and volumetric breast density. Breast Cancer Res 2013. [PMCID: PMC3980792 DOI: 10.1186/bcr3511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Beattie L, Bydder M, Sergeant JC, Maxwell A, Barr N, Beetles U, Boggis CRM, Bundred S, Gadde S, Hurley E, Jain A, Lord E, Reece V, Wilson M, Stavrinos P, Evans DG, Howell A, Astley SM. PB.18: Factors affecting breast density assessment. Breast Cancer Res 2013. [PMCID: PMC3981048 DOI: 10.1186/bcr3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Johnson PF, Sergeant JC, Bydder M, Maxwell A, Whiteside S, Stavrinos P, Wilson M, Evans DG, Howell A, Astley SM. PB.25: Relationship between volumetric breast density, age and hormonal factors. Breast Cancer Res 2013. [PMCID: PMC3980887 DOI: 10.1186/bcr3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Samuels L, Astley SM, Maxwell A, Sergeant JC, Morris J, Wilson M, Stavrinos P, Evans DG, Howell A, Bydder M. PB.21: Relationship between volumetric breast density and socioeconomic status. Breast Cancer Res 2013; 15. [PMCID: PMC3981625 DOI: 10.1186/bcr3521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - A Maxwell
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, UK
| | | | - J Morris
- University Hospital of South Manchester, UK
| | - M Wilson
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, UK
| | - P Stavrinos
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, UK
| | - DG Evans
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, UK
| | - A Howell
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, UK
| | - M Bydder
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, UK
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Richardson J, Sinha K, Iezzi A, Maxwell A. Maximising health versus sharing: measuring preferences for the allocation of the health budget. Soc Sci Med 2012; 75:1351-61. [PMID: 22795915 DOI: 10.1016/j.socscimed.2012.05.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 05/14/2012] [Accepted: 05/29/2012] [Indexed: 11/25/2022]
Abstract
Empirical evidence indicates that people consider sharing health resources to be important even in the absence of the attributes usually associated with equity (age, social class, ethnicity, disease severity or geographic location). If government is to take account of these preferences then survey methods are needed which allow their measurement. The present paper presents a new technique for measuring these preferences and reports the results of a representative survey of 626 Australians which employed the technique. The online and postal survey did not include any of the attributes usually associated with equity but was designed to quantify the respective importance of sharing life years (outcome egalitarianism), resource sharing per se and the changing importance of total health as other attributes varied. Results indicate respondents were primarily concerned with outcome egalitarianism, and that cost per life year had a relatively small effect upon their allocative decisions.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Faculty of Business and Economics, Monash University, Clayton, Vic 3800, Australia.
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Kargel JS, Alho P, Buytaert W, Célleri R, Cogley JG, Dussaillant A, Guido Z, Haeberli W, Harrison S, Leonard G, Maxwell A, Meier C, Poveda G, Reid B, Reynolds J, Rodríguez CAP, Romero H, Schneider J. Glaciers in Patagonia: Controversy and prospects. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/2012eo220011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Robertson C, Arcot Ragupathy SK, Boachie C, Dixon JM, Fraser C, Hernández R, Heys S, Jack W, Kerr GR, Lawrence G, MacLennan G, Maxwell A, McGregor J, Mowatt G, Pinder S, Ternent L, Thomas RE, Vale L, Wilson R, Zhu S, Gilbert FJ. The clinical effectiveness and cost-effectiveness of different surveillance mammography regimens after the treatment for primary breast cancer: systematic reviews registry database analyses and economic evaluation. Health Technol Assess 2012; 15:v-vi, 1-322. [PMID: 21951942 DOI: 10.3310/hta15340] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Following primary breast cancer treatment, the early detection of ipsilateral breast tumour recurrence (IBTR) or ipsilateral secondary cancer in the treated breast and detection of new primary cancers in the contralateral breast is beneficial for survival. Surveillance mammography is used to detect these cancers, but the optimal frequency of surveillance and the length of follow-up are unclear. OBJECTIVES To identify feasible management strategies for surveillance and follow-up of women after treatment for primary breast cancer in a UK setting, and to determine the effectiveness and cost-effectiveness of differing regimens. METHODS A survey of UK breast surgeons and radiologists to identify current surveillance mammography regimens and inform feasible alternatives; two discrete systematic reviews of evidence published from 1990 to mid 2009 to determine (i) the clinical effectiveness and cost-effectiveness of differing surveillance mammography regimens for patient health outcomes and (ii) the test performance of surveillance mammography in the detection of IBTR and metachronous contralateral breast cancer (MCBC); statistical analysis of individual patient data (West Midlands Cancer Intelligence Unit Breast Cancer Registry and Edinburgh data sets); and economic modelling using the systematic reviews results, existing data sets, and focused searches for specific data analysis to determine the effectiveness and cost-utility of differing surveillance regimens. RESULTS The majority of survey respondents initiate surveillance mammography 12 months after breast-conserving surgery (BCS) (87%) or mastectomy (79%). Annual surveillance mammography was most commonly reported for women after BCS or after mastectomy (72% and 53%, respectively). Most (74%) discharge women from surveillance mammography, most frequently 10 years after surgery. The majority (82%) discharge from clinical follow-up, most frequently at 5 years. Combining initiation, frequency and duration of surveillance mammography resulted in 54 differing surveillance regimens for women after BCS and 56 for women following mastectomy. The eight studies included in the clinical effectiveness systematic review suggest surveillance mammography offers a survival benefit compared with a surveillance regimen that does not include surveillance mammography. Nine studies were included in the test performance systematic review. For routine IBTR detection, surveillance mammography sensitivity ranged from 64% to 67% and specificity ranged from 85% to 97%. For magnetic resonance imaging (MRI), sensitivity ranged from 86% to 100% and specificity was 93%. For non-routine IBTR detection, sensitivity and specificity for surveillance mammography ranged from 50% to 83% and from 57% to 75%, respectively, and for MRI from 93% to 100% and from 88% to 96%, respectively. For routine MCBC detection, one study reported sensitivity of 67% and specificity of 50% for both surveillance mammography and MRI, although this was a highly select population. Data set analysis showed that IBTR has an adverse effect on survival. Furthermore, women experiencing a second tumour measuring >20 mm in diameter were at a significantly greater risk of death than those with no recurrence or those whose tumour was <10 mm in diameter. In the base-case analysis, the strategy with the highest net benefit, and most likely to be considered cost-effective, was surveillance mammography alone, provided every 12 months at a societal willingness to pay for a quality-adjusted life-year of either £20,000 or £30,000. The incremental cost-effectiveness ratio for surveillance mammography alone every 12 months compared with no surveillance was £4727. LIMITATIONS Few studies met the review inclusion criteria and none of the studies was a randomised controlled trial. The limited and variable nature of the data available precluded any quantitative analysis. There was no useable evidence contained in the Breast Cancer Registry database to assess the effectiveness of surveillance mammography directly. The results of the economic model should be considered exploratory and interpreted with caution given the paucity of data available to inform the economic model. CONCLUSIONS Surveillance is likely to improve survival and patients should gain maximum benefit through optimal use of resources, with those women with a greater likelihood of developing IBTR or MCBC being offered more comprehensive and more frequent surveillance. Further evidence is required to make a robust and informed judgement on the effectiveness of surveillance mammography and follow-up. The utility of national data sets could be improved and there is a need for high-quality, direct head-to-head studies comparing the diagnostic accuracy of tests used in the surveillance population. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Alt S, Mitchenall LA, Maxwell A, Heide L. Inhibition of DNA gyrase and DNA topoisomerase IV of Staphylococcus aureus and Escherichia coli by aminocoumarin antibiotics. J Antimicrob Chemother 2011; 66:2061-9. [DOI: 10.1093/jac/dkr247] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ku H, Maxwell A, Wong P, Huang J, Fung H. Relationship between electrical and mechanical loss tangents of hollow glass powder reinforced epoxy composites: A pilot study. J Appl Polym Sci 2010. [DOI: 10.1002/app.33009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ojugbana CC, Maxwell A, Christopher O, Olebunne K. Investigation on speed related road crashes on highways of developing countries. The Nigerian Case study. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maxwell A, Anisha E, Ojugbana C, Unoka C. Addressing illegal road blockage by law enforcement agents and its attendant road deaths. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Olebunne K, David O, Maxwell A, Ojugbana C. Enhancing emergency response services in a developing country through community efforts. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Evans A, Clements K, Maxwell A, Bishop H, Hanby A, Lawrence G, Pinder SE. Lesion size is a major determinant of the mammographic features of ductal carcinoma in situ: findings from the Sloane project. Clin Radiol 2010; 65:181-4. [PMID: 20152272 DOI: 10.1016/j.crad.2009.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 04/28/2009] [Accepted: 05/08/2009] [Indexed: 11/19/2022]
Abstract
AIM To assess the radiological features of calcific ductal carcinoma in situ (DCIS) in a large, multicentre dataset according to grade and size, and to investigate the possibility that DCIS has different mammographic features when small. MATERIALS AND METHODS The dataset consisted of all Sloane Project DCIS cases where calcification was present mammographically and histological grade and size were available. The radiology data form classifies calcific DCIS as casting/linear, granular/irregular, or punctate. The pathology dataset includes cytonuclear grade and microscopic tumour size. Correlations were sought between the radiological findings and DCIS grade and size. The significance of differences was assessed using the chi-square test and chi-square test for trend. RESULTS One thousand, seven hundred and eighty-three cases were included in the study. Of these, 1128, 485, and 170 had high, intermediate, and low-grade DCIS, respectively. Casting calcification was more frequently seen the higher the grade of DCIS, occurring in 58% of high grade, 38% of intermediate grade, and 26% of low-grade cases, respectively (p<0.001). Casting calcification was also increasingly common with increasing lesion size, irrespective of the histological grade (p<0.001). Thus casting calcifications in small (<10mm) high-grade DCIS lesions were seen with a similar frequency (50%) to those in moderate-sized (21-30 mm) intermediate-grade lesions (48%), and to those in large (>30 mm) low-grade lesions (46%). CONCLUSION Lesion size has a strong influence on the radiological features of calcific DCIS; small, high-grade lesions often show no casting calcifications, whereas casting calcifications are seen in nearly half of large, low-grade lesions. As small clusters of punctate or granular calcifications may represent high-grade DCIS, an aggressive clinical approach to the diagnosis of such lesions is recommended as the adequate treatment of high-grade DCIS will prevent the occurrence of potentially life-threatening high-grade invasive disease.
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Affiliation(s)
- A Evans
- Ninewells Hospital and Medical School, Dundee, Scotland, UK.
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Manyalich M, Ricart A, Martínez I, Balleste C, Paredes D, Vilardell J, Avsec D, Dias L, Fehrman-Eckholm I, Hiesse C, Kyriakides G, Line PD, Maxwell A, Nanni Costa A, Paez G, Turcu R, Walaszewski J. EULID project: European living donation and public health. Transplant Proc 2010; 41:2021-4. [PMID: 19715823 DOI: 10.1016/j.transproceed.2009.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The choice of transplantation from a living donor offers advantages over a deceased donor. However, it also carries disadvantages related to donor risks in terms of health and safety. Furthermore, there are several controversial ethical aspects to be taken into account. Several national and international institutions and the scientific community have stated standards that have great influence on professional codes and legislations. Living organ donation and transplantation are to some extent regulated by parliamentary acts in most European countries. It is necessary to take a step forward to develop a legal framework to regulate all of these processes to guarantee the quality and to prevent illegal and nonethical practices. It is also necessary to develop and implement living donor protection practices not only in terms of physical health, but also to minimize potential impacts on the psychological, social, and economic spheres. Finally, an additional effort should be made to create a database model with recommendations for registration practices as part of the standardized follow-up care for the living donor. The European Living Donation (EULID) project's (http://www.eulivingdonor.eu/) main objective was to contribute to a European consensus to set standards and recommendations about legal, ethical, and living donor protection practices to guarantee the health and safety of living donors.
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Affiliation(s)
- M Manyalich
- Hospital Clínic of Barcelona, Barcelona, Spain.
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Robertson C, Thomas R, Heys S, Maxwell A, Gilbert F. A survey of UK breast surgeons and radiologists to determine current and aspired mammography surveillance practice after treatment for primary breast cancer. Breast Cancer Res 2009. [PMCID: PMC4284845 DOI: 10.1186/bcr2384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Maxwell A, Ward HA, Nairn RC. Freezing in an Isopentane-Liquid Nitrogen Mixture and Storage in 2-Octanol: Technical Improvements for Immunofluorescence. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/10520296609116329] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Borthwick E, Harris S, Welch C, Maxwell A, McAuley DF, Glover P, Harrison D, Rowan K. Early acute kidney injury in Northern Ireland ICUs. Crit Care 2009. [PMCID: PMC4084149 DOI: 10.1186/cc7427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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