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Conombo B, Guertin JR, Hoch JS, Grimshaw J, Bérubé M, Malo C, Berthelot S, Lauzier F, Stelfox HT, Turgeon AF, Archambault P, Belcaid A, Moore L. Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study. BMC Health Serv Res 2024; 24:479. [PMID: 38632593 PMCID: PMC11025277 DOI: 10.1186/s12913-024-10969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Audit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness. METHODS We conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided. RESULTS Results suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered. CONCLUSION A&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers' willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, CA, USA
| | - Jeremy Grimshaw
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Christian Malo
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
- Centre de Recherche Intégrée Pour Un Système Apprenant en Santé Et Services Sociaux, Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
| | - François Lauzier
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec City, Québec, Canada
| | - Amina Belcaid
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada.
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Marks Y, Hoch JS, Heath A, Pechlivanoglou P. Barriers and Facilitators of Using R for Decision Analytic Modeling in Health Technology Assessment: Focus Group Results. Pharmacoeconomics 2024:10.1007/s40273-024-01374-y. [PMID: 38607519 DOI: 10.1007/s40273-024-01374-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Decision models for health technology assessment (HTA) are largely submitted to HTA agencies using commercial software, which has known limitations. The use of the open-source programming language R has been suggested because of its efficiency, transparency, reproducibility, and ability to consider complex analyses. However, its use in HTA remains limited. This qualitative study aimed to explore the main reasons for this slow uptake of R in HTA and identify tangible facilitators. METHODS We undertook two semi-structured focus group discussions with 24 key stakeholders from government agencies, consultancy, pharmaceutical companies, and academia. Two 1.5-hour discussions reflected on barriers identified in a previous study and highlighted additional barriers. Discussions were recorded and semi-transcribed, and data were organized and summarized into key themes. RESULTS Human resources constraints were identified as a key barrier, including a lack of training, prioritization and collaboration, and resistance to change. Another key barrier was the lack of acceptance, or clear guidance, around submissions in R by HTA agencies. Participants also highlighted a lack of communication around accepted packages and decision model structures, and between HTA agencies on standard decision modeling structures. CONCLUSIONS There is a need for standardization, which can facilitate decision model sharing, coding homogeneity, and improved country adaptations. The creation of training materials and tailored workshops was identified as a key short-term facilitator. Increased communication and engagement of stakeholders could also facilitate the use of R by identifying needs and opportunities, encouraging HTA agencies to address structural barriers, and increasing incentives to use R.
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Affiliation(s)
- Yanara Marks
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
| | | | - Anna Heath
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Statistical Science, University College London, London, UK
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- IHPME, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Hoch JS, Kohatsu ND, Fleuret J, Backman DR. Cost-Effectiveness Analysis of a Community-Based Telewellness Weight Loss Program. AJPM Focus 2024; 3:100182. [PMID: 38304023 PMCID: PMC10832372 DOI: 10.1016/j.focus.2024.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction The purpose of this study was to perform a cost-effectiveness analysis of the Koa Family Program, a community-based telewellness weight reduction intervention for overweight and obese women aged 21-45 years with low income. The Koa Family Program resulted in an approximately 8-pound weight loss as demonstrated in an RCT published previously. Methods Estimates for the cost-effectiveness were derived from the prospective 25-week RCT including 70 women (25 kg/m2≤BMI<40 kg/m2). The analysis was from a program-funder perspective. Base case costs, as well as low and high scenario costs, were estimated from the services provided to intervention participants. The incremental costs were compared with the incremental effectiveness, with weight loss being the outcome of interest. Costs were in 2021 U.S. dollars. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and the incremental net benefit. The statistical uncertainty was characterized using an incremental net benefit by willingness-to-pay plot and a cost-effectiveness acceptability curve. Results The base case average cost per participant was $564.39. The low and high scenario average costs per participant were $407.34 and $726.22, respectively. Over the 25-week study timeframe, participants lost an average 7.7 pounds, yielding a base case incremental cost-effectiveness ratio of approximately $73 per extra pound lost. The probability that the Koa Family Program is cost-effective is 90%, assuming a willingness-to-pay of $115 for a 1-pound reduction, and is 95%, assuming a willingness-to-pay of $140. Conclusions The Koa Family Program provides good value with cost-effectiveness in line with other weight-loss interventions. This is a striking finding given that the Koa Family Program serves a more vulnerable population than is typically engaged in weight loss research studies.
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Affiliation(s)
- Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Neal D. Kohatsu
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Julia Fleuret
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Desiree R. Backman
- Center for Healthcare Policy and Research, University of California, Davis, California
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Chen S, Bang H, Hoch JS. A Tutorial on Net Benefit Regression for Real-World Cost-Effectiveness Analysis Using Censored Data from Randomized or Observational Studies. Med Decis Making 2024; 44:239-251. [PMID: 38347698 PMCID: PMC10987289 DOI: 10.1177/0272989x241230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/10/2024] [Indexed: 04/04/2024]
Abstract
HIGHLIGHTS We illustrate the steps involved in carrying out cost-effectiveness analysis using net benefit regressions with possibly censored demo data by providing step-by-step guidance and code applied to a data set.We demonstrate the importance of these new methods by illustrating how naïve methods for handling censoring can lead to biased cost-effectiveness results.
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Affiliation(s)
- Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Sacramento, CA, USA
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
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Movsisyan Vernon AS, Hoch JS, Fejerman L, Keegan TH. Cancer incidence among Armenians in California. Cancer Med 2024; 13:e7100. [PMID: 38491836 PMCID: PMC10943375 DOI: 10.1002/cam4.7100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/17/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION California is home to the largest population of Armenians in the United States. The historical categorization of Armenians as 'White' or 'Some Other Race' in population databases has likely masked cancer incidence patterns in this population. This is the first study considering cancer incidence among Armenians in California. METHODS We used the Armenian Surname List and birthplace information in the California Cancer Registry to identify Armenians with cancer diagnosed during 1988-2019. We calculated proportional incidence ratios (PIR) among Armenians compared with non-Hispanic Whites (NHWs). As an exploratory analysis, we calculated incidence rate ratios (IRR) during 2006-2015 using Armenian population denominators from the American Community Survey (ACS). We selected PIR as our primary method given uncertainty regarding the use of ACS population estimates for rate calculations. RESULTS There were 27,212 cancer diagnoses among Armenians in California, 13,754 among males and 13,458 among females. Armenian males had notably higher proportions of stomach (PIR = 2.39), thyroid (PIR = 1.45), and tobacco-related cancers including bladder (PIR = 1.53), colorectal (PIR = 1.29), and lung (PIR = 1.16) cancers. Higher proportional incidence of cancers including stomach (PIR = 3.24), thyroid (PIR = 1.47), and colorectal (PIR = 1.29) were observed among Armenian females. Exploratory IRR analyses showed higher stomach (IRR = 1.78), bladder (IRR = 1.13), and colorectal (IRR = 1.12) cancers among Armenian males and higher stomach (IRR = 2.54) cancer among Armenian females. CONCLUSION We observed higher stomach, colorectal and thyroid cancer incidence among males and females, and tobacco-related cancers among males. Further research is needed to refine Armenian population estimates and understand and address risk factors associated with specific cancers among Armenians in California.
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Affiliation(s)
- Ani S. Movsisyan Vernon
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- UC Davis Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Jeffrey S. Hoch
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- Center for Healthcare Policy and ResearchUniversity of CaliforniaDavisCaliforniaUSA
| | - Laura Fejerman
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- UC Davis Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Theresa H. Keegan
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- UC Davis Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
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Islam MH, Shrestha RK, Hoch JS, Farnham PG. Estimating the Cost-Effectiveness of HIV Self-Testing in the United States Using Net Benefit Regression. J Acquir Immune Defic Syndr 2024; 95:138-143. [PMID: 37831617 DOI: 10.1097/qai.0000000000003325] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Cost-effectiveness analysis of HIV self-testing using patient-level data from a randomized clinical trial can inform HIV prevention funding decisions. Cost-effectiveness analysis using net-benefit regression addresses the sampling uncertainty in the trial data and the variability of policymakers' willingness to pay (WTP). METHODS We used published data from a 12-month longitudinal randomized clinical trial that enrolled 2665 men who had sex with men randomly assigned to the self-testing arm (participants receiving self-test kits) and control arm (participants receiving standard-of-care), and the self-testing arm identified 48 additional new HIV cases. We used net-benefit regression to investigate the cost-effectiveness of an HIV self-testing intervention, which compared the incremental cost per new HIV diagnosis with policymakers' WTP thresholds. We addressed the uncertainties in estimating the incremental cost and the policymakers' WTP per new diagnosis through the incremental net-benefit (INB) regression and cost-effectiveness acceptability curve (CEAC) analyses. RESULTS From the health care provider's perspective, the INB analysis showed a positive net benefit of HIV self-testing compared with standard-of-care when policymakers' WTP per new HIV diagnosis was $9365 (95% confidence interval: $5700 to $25,500) or higher. The CEAC showed that the probability of HIV self-testing being cost-effective compared with standard-of-care was 58% and >99% at a WTP of $10 000 and $50 000 per new HIV diagnosis, respectively. CONCLUSION The INB and CEAC analyses suggest that HIV self-testing has the potential to be cost-effective for relatively low values of policymakers' WTP.
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Affiliation(s)
- Md Hafizul Islam
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ram K Shrestha
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA
| | - Paul G Farnham
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
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Yu N, Hoch JS, Martin AR, Shahlaie K. Trends in successfully matched neurosurgery residency applicants. J Neurosurg 2023; 139:1456-1462. [PMID: 37086164 DOI: 10.3171/2023.3.jns222397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/06/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The United States Medical Licensing Examination (USMLE) Step 1 recently transitioned to a pass/fail outcome, renewing interest in how programs select neurosurgical residents. This study investigates the association between match status and key academic metrics over time. METHODS Data are from the National Resident Matching Program from 2009 to 2022 for matched and unmatched US allopathic (MD) seniors. Investigated metrics included the mean number of contiguous ranks; mean number of distinct specialties ranked; mean USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores; mean number of abstracts, presentations, and publications; mean number of research, work, and volunteer experiences; Alpha Omega Alpha status; attendance at a top 40 NIH-funded institution; PhD degree; and other degree. Multiple linear regression without an interaction term was used to evaluate how these have varied between the two groups during the study period and whether there is a difference between unmatched and matched MD seniors applying for a neurosurgical residency. Multiple linear regression with an interaction term was then used to test whether the difference in variables between the two groups changed over time. RESULTS Regardless of match status, MD senior neurosurgical residency applicants exhibited an increase in USMLE Step 1 and 2 scores; average research experiences; abstracts, presentations, and publications; and work and volunteer experiences (p < 0.001). The percentage of applicants from a top 40 NIH-funded school decreased (p = 0.018), and the percentage who held an additional degree increased (p = 0.007). Between groups, there were significant differences in all categories except work experiences and other degree obtained. Over time, the difference between USMLE Step 2 scores between matched and unmatched seniors diminished (p = 0.027); in contrast, the difference in abstracts, presentations, and publications between the two groups increased over time (p < 0.001). CONCLUSIONS From 2009 to 2022, neurosurgical residency applicants grew in their achievements across many metrics. In the advent of Step 1 becoming pass/fail, this study suggests that Step 2 is not viewed by programs as an adequate replacement. However, the Step 1 grading transition may serve as an opportunity for other factors to be considered that may better predict success in neurosurgical residency.
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Affiliation(s)
- Nina Yu
- 1University of California, Davis, School of Medicine, Sacramento
| | - Jeffrey S Hoch
- 2Department of Public Health Sciences, Division of Health Policy and Management, Center for Healthcare Policy and Research, University of California, Davis, School of Medicine, Sacramento
| | - Allan R Martin
- 3Department of Neurological Surgery, University of California, Davis, Medical Center, Sacramento, California
| | - Kiarash Shahlaie
- 3Department of Neurological Surgery, University of California, Davis, Medical Center, Sacramento, California
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Kim J, Fairman NP, Dove MS, Hoch JS, Keegan TH. Cancer survivors with sub-optimal patient-centered communication before and during the early COVID-19 pandemic. Patient Educ Couns 2023; 115:107876. [PMID: 37406471 PMCID: PMC10299944 DOI: 10.1016/j.pec.2023.107876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Patient-Centered Communication (PCC) is an essential element of patient-centered cancer care. Thus, this study aimed to examine the prevalence of and factors associated with optimal PCC among cancer survivors during COVID-19, which has been less studied. METHODS We used national survey (Health Information National Trends Survey) among cancer survivors (n = 2579) to calculate the prevalence (%) of optimal PCC in all 6 PCC domains and overall (mean) by time (before COVID-19, 2017-19 vs. COVID-19, 2020). Multivariable logistic regressions were performed to explore the associations of sociodemographic (age, birth gender, race/ethnicity, income, education, usual source of care), and health status (general health, depression/anxiety symptoms, time since diagnosis, cancer type) factors with optimal PCC. RESULTS The prevalence of optimal PCC decreased during COVID-19 overall, with the greatest decrease in managing uncertainty (7.3%). Those with no usual source of care (odd ratios, ORs =1.53-2.29), poor general health (ORs=1.40-1.66), depression/anxiety symptoms (ORs=1.73-2.17) were less likely to have optimal PCC in most domains and overall PCC. CONCLUSIONS We observed that the decreased prevalence of optimal PCC, and identified those with suboptimal PCC during COVID-19. PRACTICE IMPLICATIONS More efforts to raise awareness and improve PCC are suggested, including education and guidelines, given the decreased prevalence during this public health emergency.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA; Stanford Center for Digital Health, Stanford Medicine, Stanford, CA, USA.
| | - Nathan P Fairman
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Melanie S Dove
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Theresa H Keegan
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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Conombo B, Guertin JR, Hoch JS, Lauzier F, Turgeon AF, Stelfox HT, Moore L. Potential Avoidable Costs of Low-Value Clinical Practices in Acute Injury Care in an Integrated Canadian Provincial Trauma System. JAMA Surg 2023; 158:977-979. [PMID: 37436756 PMCID: PMC10339214 DOI: 10.1001/jamasurg.2023.2510] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/06/2023] [Indexed: 07/13/2023]
Abstract
This economic evaluation estimated the direct health care costs associated with 11 low-value clinical practices in acute trauma care in the integrated health care system of Quebec, Canada.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
| | - Jason R. Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F. Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
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Kim J, Linos E, Dove MS, Hoch JS, Keegan TH. Impact of COVID-19, cancer survivorship and patient-provider communication on mental health in the US Difference-In-Difference. Npj Ment Health Res 2023; 2:14. [PMID: 38609572 PMCID: PMC10955924 DOI: 10.1038/s44184-023-00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/15/2023] [Indexed: 04/14/2024]
Abstract
Poor mental health has been found to be more prevalent among those with cancer and is considered a public health crisis since COVID-19. This study assessed the impact of COVID-19 and cancer survivorship on mental health and investigated factors, including online patient-provider communications (OPPC; email/internet/tablet/smartphone), associated with poor mental health prior to and during the early COVID-19. Nationally representative Health Information National Trends Survey data during 2017-2020 (n = 15,871) was used. While the prevalence of poor mental health was high (40-42%), Difference-In-Difference analyses revealed that cancer survivorship and COVID-19 were not associated with poor mental health. However, individuals that used OPPC had 40% higher odds of poor mental health. Low socioeconomic status (low education/income), younger age (18-64 years), and female birth gender were also associated with poor mental health. Findings highlight the persistence of long-standing mental health inequities and identify that OPPC users might be those who need mental health support.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
- Stanford Center for Digital Health, School of Medicine, Stanford, CA, USA.
| | - Eleni Linos
- Stanford Center for Digital Health, School of Medicine, Stanford, CA, USA
- Program for Clinical Research & Technology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Melanie S Dove
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Theresa H Keegan
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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Trenaman L, Harrison M, Hoch JS. Medicare Beneficiaries' Perspectives on the Quality of Hospital Care and Their Implications for Value-Based Payment. JAMA Netw Open 2023; 6:e2319047. [PMID: 37342041 DOI: 10.1001/jamanetworkopen.2023.19047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Importance Medicare's Hospital Value-Based Purchasing (HVBP) program adjusts hospital payments according to performance on 4 equally weighted quality domains: clinical outcomes, safety, patient experience, and efficiency. The assumption that performance on each domain is equally important may not reflect the preferences of Medicare beneficiaries. Objective To estimate the relative importance (ie, weight) of the 4 quality domains in the HVBP program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in fiscal year 2019. Design, Setting, and Participants An online survey was conducted in March 2022. A nationally representative sample of Medicare beneficiaries was recruited through Ipsos KnowledgePanel. Value weights were estimated using a discrete choice experiment that asked respondents to choose between 2 hospitals and indicate which they preferred. Hospitals were described using 6 attributes, including (1) clinical outcomes, (2) patient experience, (3) safety, (4) Medicare spending per patient, (5) distance, and (6) out-of-pocket cost. Data analysis was performed from April to November 2022. Main Outcomes and Measures An effects-coded mixed logit regression model was used to estimate the relative importance of quality domains. HVBP program performance was linked to Medicare payment data in the Medicare Inpatient Hospitals by Provider and Service data set and hospital characteristics from the American Hospital Association Annual Survey data set, and the estimated impact of using beneficiary value weights on hospital payments was estimated. Results A total of 1025 Medicare beneficiaries (518 women [51%]; 879 individuals [86%] aged ≥65 years; 717 White individuals [70%]) responded to the survey. A hospital's performance on clinical outcomes was most highly valued by beneficiaries (49%), followed by safety (22%), patient experience (21%), and efficiency (8%). Nearly twice as many hospitals would see a payment reduction when using beneficiary value weights than would see an increase (1830 vs 922 hospitals); however, the average net decrease was smaller (mean [SD], -$46 978 [$71 211]; median [IQR], -$24 628 [-$53 507 to -$9562]) than the comparable increase (mean [SD], $93 243 [$190 654]; median [IQR], $35 358 [$9906 to $97 348]). Hospitals seeing a net reduction with beneficiary value weights were more likely to be smaller, lower volume, nonteaching, and non-safety-net hospitals located in more deprived areas that served less complex patients. Conclusions and Relevance This survey study of Medicare beneficiaries found that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Department of Public Health Sciences, University of California, Davis
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Department of Public Health Sciences, University of California, Davis
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12
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Kim J, Linos E, Fishman DA, Dove MS, Hoch JS, Keegan TH. Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study. JMIR Cancer 2023; 9:e44339. [PMID: 37074951 DOI: 10.2196/44339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Online Patient-Provider Communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited. OBJECTIVE Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID vs. pre-COVID. METHODS Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 1,900) and adults without a history of cancer (n= 13, 292). COVID included data from February to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs. 49.7%, email/internet; 32.2% vs. 37.9%, tablet/smartphone; 19.0% vs. 30.0%, EHR). Cancer survivors (OR=1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID. Among cancer survivors, email/internet (OR=1.61, 1.08-2.40) and EHR (OR=1.92, 1.22-3.02) were more likely to be used during COVID than pre-COVID. During COVID, subgroups of cancer survivors, including Hispanics (OR=0.26, 0.09-0.71 vs. non-Hispanic Whites), or those with the lowest income (OR=6.14, 1.99-18.92 $50,000 to <$75,000; OR=0.42, 1.56-11.28 ≥ $75,000 vs. <$20,000), with no usual source of care (OR=6.17, 2.12-17.99), or reporting depression (OR=0.33, 0.14-0.78) were less likely to use email/internet and those who were the oldest (OR=9.33, 2.18-40.01 age 35-49; OR=3.58, 1.20-10.70 age 50-64; OR=3.09, 1.09-8.76 age 65-74 vs. ≥75), unmarried (OR=2.26, 1.06-4.86) or had public/no health insurance (ORs=0.19-0.21 Medicare, Medicaid, or Other, vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR=6.23, 1.66-23.39) or healthcare office visits within a year (ORs=7.55-8.25) were significantly more likely to use EHR to communicate. While not observed in cancer survivors, lower education level was associated with lower OPPC among adults without a history of cancer during COVID. CONCLUSIONS Our findings identified vulnerable subgroups of cancer survivors who were left behind in online patient-provider communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities. CLINICALTRIAL Not applicable.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shields Ave, Davis, US
| | - Eleni Linos
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, US
- Department of Dermatology, School of Medicine, Stanford University, Stanford, US
| | - Debra A Fishman
- Health Management and Education, UC Davis Health Cardiac Rehabilitation, Davis, US
| | - Melanie S Dove
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, US
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, Center for Healthcare Policy and Research, University of California, Davis, Davis, US
| | - Theresa H Keegan
- Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, US
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Barr HK, Guggenbickler AM, Hoch JS, Dewa CS. Real-World Cost-Effectiveness Analysis: How Much Uncertainty Is in the Results? Curr Oncol 2023; 30:4078-4093. [PMID: 37185423 PMCID: PMC10136635 DOI: 10.3390/curroncol30040310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
Cost-effectiveness analyses of new cancer treatments in real-world settings (e.g., post-clinical trials) inform healthcare decision makers about their healthcare investments for patient populations. The results of these analyses are often, though not always, presented with statistical uncertainty. This paper identifies five ways to characterize statistical uncertainty: (1) a 95% confidence interval (CI) for the incremental cost-effectiveness ratio (ICER); (2) a 95% CI for the incremental net benefit (INB); (3) an INB by willingness-to-pay (WTP) plot; (4) a cost-effectiveness acceptability curve (CEAC); and (5) a cost-effectiveness scatterplot. It also explores their usage in 22 articles previously identified by a rapid review of real-world cost effectiveness of novel cancer treatments. Seventy-seven percent of these articles presented uncertainty results. The majority those papers (59%) used administrative data to inform their analyses while the remaining were conducted using models. Cost-effectiveness scatterplots were the most commonly used method (34.3%), with 40% indicating high levels of statistical uncertainty, suggesting the possibility of a qualitatively different result from the estimate given. Understanding the necessity for and the meaning of uncertainty in real-world cost-effectiveness analysis will strengthen knowledge translation efforts to improve patient outcomes in an efficient manner.
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Affiliation(s)
- Heather K Barr
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Andrea M Guggenbickler
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Jeffrey S Hoch
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Center for Healthcare Policy and Research, University of California, Davis, CA 95616, USA
| | - Carolyn S Dewa
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, CA 95817, USA
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14
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Kim J, Aryee LMD, Bang H, Prajogo S, Choi YK, Hoch JS, Prado EL. Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis. JMIR Ment Health 2023; 10:e43066. [PMID: 36939820 PMCID: PMC10131603 DOI: 10.2196/43066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/29/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. OBJECTIVE We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. RESULTS Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. CONCLUSIONS Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. TRIAL REGISTRATION PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Lois M D Aryee
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Steffi Prajogo
- Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Yong K Choi
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Elizabeth L Prado
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
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15
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Singh S, Hoch JS, Hearps S, Dalziel K, Cheek JA, Holmes J, Anderson V, Kuppermann N, Babl FE. Sports-related traumatic brain injuries and acute care costs in children. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001723. [PMID: 36720502 PMCID: PMC9890755 DOI: 10.1136/bmjpo-2022-001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/17/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To estimate traumatic brain injuries (TBIs) and acute care costs due to sports activities. METHODS A planned secondary analysis of 7799 children from 5 years old to <18 years old with head injuries enrolled in a prospective multicentre study between 2011 and 2014. Sports-related TBIs were identified by the epidemiology codes for activity, place and injury mechanism. The sports cohort was stratified into two age groups (younger: 5-11 and older: 12-17 years). Acute care costs from the publicly funded Australian health system perspective are presented in 2018 pound sterling (£). RESULTS There were 2903 children (37%) with sports-related TBIs. Mean age was 12.0 years (95% CI 11.9 to 12.1 years); 78% were male. Bicycle riding was associated with the most TBIs (14%), with mean per-patient costs of £802 (95% CI £644 to £960) and 17% of acute costs. The highest acute costs (21%) were from motorcycle-related TBIs (3.8% of injuries), with mean per-patient costs of £3795 (95% CI £1850 to £5739). For younger boys and girls, bicycle riding was associated with the highest TBIs and total costs; however, the mean per-patient costs were highest for motorcycle and horse riding, respectively. For older boys, rugby was associated with the most TBIs. However, motorcycle riding had the highest total and mean per-patient acute costs. For older girls, horse riding was associated with the most TBIs and highest total acute costs, and motorcycle riding was associated with the highest mean per-patient costs. CONCLUSION Injury prevention strategies should focus on age-related and sex-related sports activities to reduce the burden of TBIs in children. TRIAL REGISTRATION NUMBER ACTRN12614000463673.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia .,Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA.,Department of Public Health Sciences, University of California, Davis, California, USA
| | - Stephen Hearps
- Child Neuropsychology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - John Alexander Cheek
- Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - James Holmes
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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16
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Kleber KT, Kravitz-Wirtz N, Buggs SL, Adams CM, Sardo AC, Hoch JS, Brown IE. Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review. Am J Surg 2023; 225:162-167. [PMID: 35871849 DOI: 10.1016/j.amjsurg.2022.07.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Analysis of the costs associated with emergency department (ED) visits after discharge for violent injury could highlight subgroups for the development of cost-effective interventions to support healing and prevent treatment failures in violently injured patients. METHODS A retrospective cohort review was conducted of all patients with return ED visits within 90 days of discharge after treatment for a violent injury occurring between July 1, 2016, and June 30, 2018. Hospital costs were calculated for each incidence and analyzed against demographic and injury type variables to identify trends. RESULTS 218 return ED visits were identified. Hospital costs showed a high frequency of low-cost visits. For more complex visits, distinct cost patterns were observed for Black and LatinX males compared to White males as a function of age. CONCLUSIONS Analysis of hospital cost per visit identified trends among different subgroups. Underlying etiologies presumably vary between groups, but hypothesis-driven further investigation and needs assessment is required. Understanding the driving forces behind these cost trends may aid in developing effective interventions.
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Affiliation(s)
- Kara T Kleber
- Department of Surgery, University of California Davis School of Medicine, 235 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Nicole Kravitz-Wirtz
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Shani L Buggs
- Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Christy M Adams
- Trauma Prevention Program, UC Davis Health, University of California Davis, 4900 Broadway, Suite 1650, Sacramento, CA, 95820, USA.
| | - Angela C Sardo
- University of California Davis School of Medicine, 4610 X St, Sacramento, CA, 95817, USA.
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences and Center for Healthcare Policy and Research, University of California Davis, 4900 Broadway, Suite 1430, Sacramento, CA, 95820, USA.
| | - Ian E Brown
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery University of California Davis Medical Center, 2335 Stockton Blvd, Sacramento, CA, 95817, USA.
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Forchuk C, Rudnick A, Corring D, Lizotte D, Hoch JS, Booth R, Frampton B, Mann R, Serrato J. A Smart Technology Intervention in the Homes of People with Mental Illness and Physical Comorbidities. Sensors (Basel) 2022; 23:406. [PMID: 36617004 PMCID: PMC9823432 DOI: 10.3390/s23010406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Appropriate support in the home may not be readily available for people living in the community with mental illness and physical comorbidities. This mixed-method study evaluated a smart home technology intervention for individuals within this population as well as providing health care providers with health monitoring capabilities. The study recruited 13 participants who were offered a smartphone, a touchscreen monitor, and health devices, including smartwatches, weigh scales, and automated medication dispensers. Healthcare providers were able to track health device data, which were synchronized with the Lawson Integrated DataBase. Participants completed interviews at baseline as well as at 6-month and 12-month follow-ups. Focus groups with participants and care providers were conducted separately at 6-month and 12-month time points. As the sample size was too small for meaningful statistical inference, only descriptive statistics were presented. However, the qualitative analyses revealed improvements in physical and mental health, as well as enhanced communication with care providers and friends/family. Technical difficulties and considerations are addressed. Ethics analyses revealed advancement in equity and fairness, while policy analyses revealed plentiful opportunities for informing policymakers. The economic costs are also discussed. Further studies and technological interventions are recommended to explore and expand upon in-home technologies that can be easily implemented into the living environment.
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Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada
| | - Abraham Rudnick
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Nova Scotia Operational Stress Injury Clinic, Nova Scotia Health Authority, Dartmouth, NS B3B 1Y6, Canada
| | - Deborah Corring
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada
| | - Daniel Lizotte
- Department of Computer Science, Western University, London, ON N6A 3K7, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON N6A 3K7, Canada
| | - Jeffrey S. Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA 95616, USA
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada
| | - Barbara Frampton
- Ontario Peer Development Initiative, Toronto, ON M5S 2R4, Canada
| | - Rupinder Mann
- Lawson Health Research Institute, London, ON N6C 2R5, Canada
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Marcin JP, Tancredi DJ, Galante JM, Rinderknecht TN, Haus BM, Leshikar HB, Zwienenberg M, Rosenthal JL, Grether-Jones KL, Hamline MY, Hoch JS, Kuppermann N. Measuring the impact of a "Virtual Pediatric Trauma Center" (VPTC) model of care using telemedicine for acutely injured children versus the standard of care: study protocol for a prospective stepped-wedge trial. Trials 2022; 23:1051. [PMID: 36575536 PMCID: PMC9793356 DOI: 10.1186/s13063-022-06996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The current standard of care in the treatment of children with physical trauma presenting to non-designated pediatric trauma centers is consultation with a pediatric trauma center by telephone. This includes contacting a pediatric trauma specialist and transferring any child with a potentially serious injury to a regionalized level I pediatric trauma center. This approach to care frequently results in medically unnecessary transfers and may place undue burdens on families. A newer model of care, the "Virtual Pediatric Trauma Center" (VPTC), uses telemedicine to make the expertise of a level I pediatric trauma center virtually available to any hospital. While the use of the VPTC model of care is increasing, there have been no studies comparing the VPTC to standard care of injured children at non-designated trauma centers with respect to patient- and family-centered outcomes. The goal of this study is to compare the current standard of care to the VPTC with respect to family-centered outcomes developed by parents and community advisory boards. METHODS We will use a stepped-wedge trial design to enroll children with physical trauma presenting to ten hospitals, including level II, level III, and non-designated trauma centers. The primary outcome measures are parent/family experience of care and distress 3 days following injury. Secondary aims include 30-day healthcare utilization, parent/family out-of-pocket costs at 3 days and 30 days after injury, transfer rates, and parent/family distress 30 days following injury. We expect at least 380 parents/families of children will be eligible for the study following an emergency department physician's request for a level I pediatric trauma center consultation. We will evaluate parent/family experience of care and distress using previously validated instruments, healthcare utilization by family recollection and medical record abstraction, and out-of-pocket costs using standard economic analyses. DISCUSSION We expect that the findings from this study will inform other level I pediatric trauma centers and non-pediatric trauma centers on how to improve their systems of care for injured children. The results will help to optimize communication, confidence, and shared decision-making between parents/families and clinical staff from both the transferring and receiving hospitals. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04469036. Registered July 13, 2020 before start of inclusion.
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Affiliation(s)
- James P. Marcin
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Daniel J. Tancredi
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Joseph M. Galante
- grid.27860.3b0000 0004 1936 9684Department of Surgery, University of California, Davis, Sacramento, CA USA
| | - Tanya N. Rinderknecht
- grid.27860.3b0000 0004 1936 9684Department of Surgery, University of California, Davis, Sacramento, CA USA
| | - Brian M. Haus
- grid.27860.3b0000 0004 1936 9684Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA USA
| | - Holly B. Leshikar
- grid.27860.3b0000 0004 1936 9684Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA USA
| | - Marike Zwienenberg
- grid.27860.3b0000 0004 1936 9684Department of Neurological Surgery, University of California, Davis, Sacramento, CA USA
| | - Jennifer L. Rosenthal
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Kendra L. Grether-Jones
- grid.27860.3b0000 0004 1936 9684Department of Emergency Medicine, University of California, Davis, Sacramento, CA USA
| | - Michelle Y. Hamline
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA
| | - Jeffrey S. Hoch
- grid.27860.3b0000 0004 1936 9684Department of Public Health Sciences, University of California, Davis, Sacramento, CA USA
| | - Nathan Kuppermann
- grid.27860.3b0000 0004 1936 9684Department of Pediatrics, University of California, Davis, Sacramento, CA USA ,grid.27860.3b0000 0004 1936 9684Department of Emergency Medicine, University of California, Davis, Sacramento, CA USA
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Boozé ZL, Le H, Shelby M, Wagner JL, Hoch JS, Roberto R. Socioeconomic and geographic disparities in pediatric scoliosis surgery. Spine Deform 2022; 10:1323-1329. [PMID: 35841474 DOI: 10.1007/s43390-022-00551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/13/2021] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the population of pediatric patients undergoing surgery for scoliosis in California by gender, race, and ethnicity and identify any underlying differences in social determinants of health as measured by the child opportunity index (COI), social deprivation index (SDI), and insurance category among them. METHODS This project extracted demographic reports including patient sex, race, zip code, insurance type, and associated diagnosis and procedure codes from the Office of Statewide Health Planning and Development (OSHPD). These data were combined with COI and SDI data, which further describe the socioeconomic environment of each patient. Census data were referenced to compare the population of patients receiving scoliosis procedures to the general population by race and ethnicity. Chi-square tests were performed for categorical data. Independent t-test and one-way analysis of variance (ANOVA) were performed for continuous data, with significance set at 0.05. RESULTS Unfavorable SDI and COI scores were observed among males, Hispanics, and Black patients, and these patients were more likely to be covered by Medi-Cal. Length of stay was significantly higher among males and Medi-Cal recipients. CONCLUSION The data demonstrate significant differences in social determinants of health as measured by race, ethnicity, gender, insurance type, COI, and SDI among patients ≤ 20 years undergoing surgery for idiopathic scoliosis in California. The noted differences in socioeconomic status (SES) and insurance are known and/or expected to have an impact on access to quality health care, exposing a need for future studies to determine whether COI and SDI influence patient-reported outcomes after scoliosis surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Hai Le
- University of California, Davis, Sacramento, CA, USA
| | - Marcus Shelby
- University of California, Davis, Sacramento, CA, USA
| | | | | | - Rolando Roberto
- University of California, Davis, Sacramento, CA, USA. .,Shriners Children's Hospital Northern California, Sacramento, CA, USA.
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20
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Guggenbickler AM, Barr HK, Hoch JS, Dewa CS. Rapid Review of Real-World Cost-Effectiveness Analyses of Cancer Interventions in Canada. Curr Oncol 2022; 29:7285-7304. [PMID: 36290851 PMCID: PMC9600856 DOI: 10.3390/curroncol29100574] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Cost-effectiveness analysis (CE Analysis) provides evidence about the incremental gains in patient outcomes costs from new treatments and interventions in cancer care. The utilization of "real-world" data allows these analyses to better reflect differences in costs and effects for actual patient populations with comorbidities and a range of ages as opposed to randomized controlled trials, which use a restricted population. This rapid review was done through PubMed and Google Scholar in July 2022. Relevant articles were summarized and data extracted to summarize changes in costs (in 2022 CAD) and effectiveness in cancer care once funded by the Canadian government payer system. We conducted statistical analyses to examine the differences between means and medians of costs, effects, and incremental cost effectiveness ratios (ICERs). Twenty-two studies were selected for review. Of those, the majority performed a CE Analysis on cancer drugs. Real-world cancer drug studies had significantly higher costs and effects than non-drug therapies. Studies that utilized a model to project longer time-horizons saw significantly smaller ICER values for the treatments they examined. Further, differences in drug costs increased over time. This review highlights the importance of performing real-world CE Analysis on cancer treatments to better understand their costs and impacts on a general patient population.
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Affiliation(s)
- Andrea M. Guggenbickler
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Heather K. Barr
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Center for Healthcare Policy and Research, University of California, Davis, CA 95820, USA
- Correspondence:
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95817, USA
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21
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Hoch JS, Barr HK, Guggenbickler AM, Dewa CS. Lessons from Cost-Effectiveness Analysis of Smoking Cessation Programs for Cancer Patients. Curr Oncol 2022; 29:6982-6991. [PMID: 36290826 PMCID: PMC9600008 DOI: 10.3390/curroncol29100549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Smoking among patients diagnosed with cancer poses important health and financial challenges including reduced effectiveness of expensive cancer therapies. This study explores the value of smoking cessation programs (SCPs) for patients already diagnosed with cancer. It also identifies conditions under which SPCs may be wise investments. METHODS Using a simplified decision analytic model combined with insights from a literature review, we explored the cost-effectiveness of SCPs. RESULTS The findings provide insights about the potential impact of cessation probabilities among cancer patients in SCPs and the potential impact of SCPs on cancer patients' lives. CONCLUSION The evidence suggests that there is good reason to believe that SCPs are an economically attractive way to improve outcomes for cancer patients when SCPs are offered in conjunction with standard cancer care.
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Affiliation(s)
- Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
- Center for Healthcare Policy and Research, University of California, Sacramento, CA 95820, USA
- Correspondence:
| | - Heather K. Barr
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Andrea M. Guggenbickler
- Graduate Group in Public Health Sciences, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Carolyn S. Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA 95616, USA
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22
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Chen S, Hoch JS. Net-benefit regression with censored cost-effectiveness data from randomized or observational studies. Stat Med 2022; 41:3958-3974. [PMID: 35665527 PMCID: PMC9427707 DOI: 10.1002/sim.9486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/25/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022]
Abstract
Cost-effectiveness analysis is an essential part of the evaluation of new medical interventions. While in many studies both costs and effectiveness (eg, survival time) are censored, standard survival analysis techniques are often invalid due to the induced dependent censoring problem. We propose methods for censored cost-effectiveness data using the net-benefit regression framework, which allow covariate-adjustment and subgroup identification when comparing two intervention groups. The methods provide a straightforward way to construct cost-effectiveness acceptability curves with censored data. We also propose a more efficient doubly robust estimator of average causal incremental net benefit, which increases the likelihood that the results will represent a valid inference in observational studies. Lastly, we conduct extensive numerical studies to examine the finite-sample performance of the proposed methods, and illustrate the proposed methods with a real data example using both survival time and quality-adjusted survival time as the measures of effectiveness.
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Affiliation(s)
- Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Sacramento, California, USA
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
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Singh S, Hearps S, Nishijima DK, Cheek JA, Borland M, Dalziel S, Holmes J, Kuppermann N, Babl FE, Hoch JS. Cost-effectiveness of patient observation on cranial CT use with minor head trauma. Arch Dis Child 2022; 107:712-718. [PMID: 35193874 DOI: 10.1136/archdischild-2021-323701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/10/2021] [Accepted: 02/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of planned observation on cranial CT use in children with minor head trauma. DESIGN Planned secondary analysis of a multicentre prospective observation study. SETTING Australia and New Zealand. PATIENTS An analytic cohort of 18 471 children aged <18 years with Glasgow Coma Scale scores 14-15 presenting <24 hours after blunt head trauma stratified by the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk categories. INTERVENTION A plan for observation and immediate CT scan were documented after the initial assessment. The planned observation group included those with planned observation and no immediate plan for CT. MAIN OUTCOME MEASURES Taking an Australian public-funded healthcare perspective, we estimated the cost-effectiveness of planned observation on the adjusted mean costs per child and CT use reduction by net benefit regression analysis using ordinary least squares with robust SEs and bootstrapping. All costs presented in 2018 euros. RESULTS Planned observation in 4945 (27%) children was cost-saving of €85 (95% CI -120 to -51) with 10.4% lower CT use (95% CI 9.6 to 11.2). This strategy was cost-saving for the PECARN high-risk (-€757 (95% CI -961 to -554)) and intermediate-risk (-€52 (95% CI -99 to -4.3)) categories, with 43% (95% CI 39 to 47) and 11% (95% CI 9.6 to 12.4) lower CT use, respectively. The very low-risk category incurred more cost of €86 (95% CI 67 to 104) with planned observation and 0.05% lower CT use (95% CI -0.61 to 0.71). CONCLUSION Planned ED observation in selected children with minor head trauma is cost-effective for reducing CT use for the PECARN intermediate-risk and high-risk categories. TRIAL REGISTRATION NUMBER ACTRN12614000463673.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia .,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Stephen Hearps
- Child Neuropsychology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - John Alexander Cheek
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Meredith Borland
- Emergency Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - James Holmes
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA.,Department of Public Health Sciences, University of California Davis, Davis, California, USA
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24
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Johnson S, Hoch JS, Halabi WJ, Ko J, Nolta J, Dave M. Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn's Disease Fistulas. Front Immunol 2022; 13:859954. [PMID: 35784367 PMCID: PMC9248358 DOI: 10.3389/fimmu.2022.859954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/22/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Crohn's disease (CD) is an inflammatory bowel disease with increasing incidence and prevalence worldwide. Perianal fistulas are seen in up to 26% of CD patients and are often refractory to medical therapy. Current treatments for CD perianal fistulas (pCD) include antibiotics, biologics, and for refractory cases, fecal diversion (FD) with ileostomy or colostomy. Mesenchymal stem/stromal cell therapy (MSCs) is a new modality that have shown efficacy in treating pCD. MSCs locally injected into pCD can lead to healing, and a phase III clinical trial (ADMIRE-CD) showed 66% clinical response, leading to approval of MSCs (Alofisel, Takeda) in the European Union. It is unclear if MSCs would be more cost-effective than the current standard of FD. We therefore developed a decision tree model to determine the cost-effectiveness of MSCs compared to FD for pCD. Our study showed that both autologous and allogeneic MSCs are more cost-effective than FD in an academic medical center and even in a worst-case scenario with 100% chance of all complications for MSCs treatment and 0% chance of complications for FD, both allogeneic and autologous MSCs are still cost saving compared to FD.
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Affiliation(s)
- Sheeva Johnson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California (UC) Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California (UC) Davis, Davis, CA, United States
| | - Wissam J. Halabi
- Division of Colorectal Surgery, Department of Surgery, University of California (UC) Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Jeffrey Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California (UC) Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Jan Nolta
- Department of Internal Medicine, Institute for Regenerative Cures, University of California (UC) Davis, Sacramento, CA, United States
| | - Maneesh Dave
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California (UC) Davis Medical Center, University of California Davis School of Medicine, Sacramento, CA, United States
- Department of Internal Medicine, Institute for Regenerative Cures, University of California (UC) Davis, Sacramento, CA, United States
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25
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Hoch JS, Haynes SC, Hearney SM, Dewa CS. Analyzing a Cost-Effectiveness Dataset: A Speech and Language Example for Clinicians. Semin Speech Lang 2022; 43:244-254. [PMID: 35858609 PMCID: PMC9300047 DOI: 10.1055/s-0042-1750347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cost-effectiveness analysis, the most common type of economic evaluation, estimates a new option's additional outcome in relation to its extra costs. This is crucial to study within the clinical setting because funding for new treatments and interventions is often linked to whether there is evidence showing they are a good use of resources. This article describes how to analyze a cost-effectiveness dataset using the framework of a net benefit regression. The process of creating estimates and characterizing uncertainty is demonstrated using a hypothetical dataset. The results are explained and illustrated using graphs commonly employed in cost-effectiveness analyses. We conclude with a call to action for researchers to do more person-level cost-effectiveness analysis to produce evidence of the value of new treatments and interventions. Researchers can utilize cost-effectiveness analysis to compare new and existing treatment mechanisms.
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Affiliation(s)
- Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California.,Center for Healthcare Policy and Research, University of California, Davis, California
| | - Sarah C Haynes
- Department of Pediatrics, University of California, Davis, California.,Center for Health and Technology, UC Davis Health, Sacramento, California
| | - Shannon M Hearney
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
| | - Carolyn S Dewa
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
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26
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Hoch JS, Smith BP, Kim J, Dewa CS. The Rationale for Economic Evaluation in Speech and Language: Cost, Effectiveness, and Cost-effectiveness. Semin Speech Lang 2022; 43:208-217. [PMID: 35858606 DOI: 10.1055/s-0042-1750345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Economic evaluation studies the costs and outcomes of two or more alternative activities to estimate the relative efficiency of each course of action. Economic evaluation is both important and necessary in the management of speech and language issues. Economic evaluation can help focus attention on interventions that provide value for improving population health. The purpose of this article is to introduce readers to fundamental economic concepts. Readers are also introduced to common issues when conducting economic evaluations and how to address them in practice.
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Affiliation(s)
- Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California.,Center for Healthcare Policy and Research, University of California, Davis, California
| | - Bridgette P Smith
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
| | - Jiyeong Kim
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
| | - Carolyn S Dewa
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California.,Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
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27
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Conombo B, Guertin JR, Tardif PA, Gagnon MA, Duval C, Archambault P, Berthelot S, Lauzier F, Turgeon AF, Stelfox HT, Chassé M, Hoch JS, Gabbe B, Champion H, Lecky F, Cameron P, Moore L. Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review. Value Health 2022; 25:844-854. [PMID: 35500953 DOI: 10.1016/j.jval.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/27/2021] [Accepted: 10/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. METHODS Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). RESULTS Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars -467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. CONCLUSIONS This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Marc-Aurèle Gagnon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada; VITAM-Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada; Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Uniformed Services University of the Health Sciences Annapolis, Bethesda, MD, USA
| | - Fiona Lecky
- School of Health and Related Research, Sheffield, England, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia .,Emergency Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Li Huang
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Child Neuropsychology, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John Alexander Cheek
- Department of Paediatrics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, California, USA.,Center for Healthcare Policy and Research, University of California Davis Health System, Sacramento, California, USA
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Psychology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Kim Dalziel
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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29
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Singh S, Babl FE, Hearps SJC, Hoch JS, Dalziel K, Cheek JA. Trends of paediatric head injury and acute care costs in Australia. J Paediatr Child Health 2022; 58:274-280. [PMID: 34523175 DOI: 10.1111/jpc.15699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/20/2020] [Revised: 05/01/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
AIM Paediatric head injuries (PHI) are the most common cause of trauma-related emergency department (ED) presentations. This study sought to report the incidence of PHI in Australia, examine the temporal trends from 2014 to 2018 and estimate the patient and population-level acute care costs. METHODS Taking a public-sector health-care perspective, we applied direct and indirect hospital costs for PHI-related ED visits and acute admissions. All costs were inflated to 2018 Australian dollars ($). The patient-level analysis was performed with data from 17 841 children <18 years old enrolled in the prospective Australasian Paediatric Head Injury Study. Mechanisms of injury were characterised by the total and average acute care costs. The population-level data of PHI-related ED presentations were obtained from the Independent Hospital Pricing Authority. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated, and negative binomial regression examined the temporal trend. RESULTS The age-standardised IR for PHI was 2734 per 100 000 population in 2018, with a significant increase over 5 years (IRR 1.13, 95% confidence interval (CI) 1.12-1.14; P < 0.001) and acute care costs of $154 million. Falls occurred in 70% of the study cohort, with average costs per episode of $666 (95% CI: $627-$706), accounting for 47% of acute care costs. Transportation-related injuries occurred in 4.1% of the study cohort, with average costs per episode of $8555 (95% CI: $6193-$10 917), accounting for 35% of acute care costs. CONCLUSION PHI have increased significantly in Australia and are associated with substantial acute care costs. Population-based efforts are required for road safety and injury prevention.
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Affiliation(s)
- Sonia Singh
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California, United States
| | - Franz E Babl
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jeffrey S Hoch
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California, United States.,Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, California, United States
| | - Kim Dalziel
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - John A Cheek
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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Perry LM, Bold RJ, Hoch JS. Cost-Effectiveness Analysis and Volume-Based Surgical Care. J Am Coll Surg 2022; 234:249-250. [PMID: 35213449 DOI: 10.1097/xcs.0000000000000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Finnes A, Hoch JS, Enebrink P, Dahl J, Ghaderi A, Nager A, Feldman I. Economic evaluation of return-to-work interventions for mental disorder-related sickness absence: two years follow-up of a randomized clinical trial. Scand J Work Environ Health 2022; 48:264-272. [PMID: 35094095 PMCID: PMC9524165 DOI: 10.5271/sjweh.4012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The objective was to (i) assess the long-term cost-effectiveness of acceptance and commitment therapy (ACT), a workplace dialog intervention (WDI), and ACT+WDI compared to treatment as usual (TAU) for common mental disorders and (ii) investigate any differences in cost-effectiveness between diagnostic groups. Methods An economic evaluation from the healthcare and limited welfare perspectives was conducted alongside a randomized clinical trial with a two-year follow-up period. Persons with common mental disorders receiving sickness benefits were invited to the trial. We used registry data for cost analysis alongside participant data collected during the trial and the reduction in sickness absence days as treatment effect. A total of 264 participants with a diagnosis of depression, anxiety, or stress-induced exhaustion disorder participated in a two-year follow-up of a four-arm trial: ACT (N=74), WDI (N=60), ACT+WDI (N=70), and TAU (N=60). Results For all patients in general, there were no statistically significant differences between interventions in terms of costs or effect. The subgroup analyses suggested that from a healthcare perspective, ACT was a cost-effective option for depression or anxiety disorders and ACT+WDI for stress-induced exhaustion disorder. With a two-year time horizon, the probability of WDI to be cost-saving in terms of sickness benefits costs was 80% compared with TAU. Conclusions ACT had a high probability of cost-effectiveness from a healthcare perspective for employees on sick leave due to depression or anxiety disorders. For participants with stress-induced exhaustion disorder, adding WDI to ACT seems to reduce healthcare costs, while WDI as a stand-alone intervention seems to reduce welfare costs.
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Affiliation(s)
- Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
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Haynes SC, Tancredi DJ, Tong K, Hoch JS, Ong MK, Ganiats TG, Evangelista LS, Black JT, Auerbach A, Romano PS. The Effect of Rehospitalization and Emergency Department Visits on Subsequent Adherence to Weight Telemonitoring. J Cardiovasc Nurs 2021; 36:482-488. [PMID: 32398500 PMCID: PMC8091911 DOI: 10.1097/jcn.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Weight telemonitoring may be an effective way to improve patients' ability to manage heart failure and prevent unnecessary utilization of health services. However, the effectiveness of such interventions is dependent upon patient adherence. OBJECTIVE The purpose of this study was to determine how adherence to weight telemonitoring changes in response to 2 types of events: hospital readmissions and emergency department visits. METHODS The Better Effectiveness After Transition-Heart Failure trial examined the effectiveness of a remote telemonitoring intervention compared with usual care for patients discharged to home after hospitalization for decompensated heart failure. Participants were followed for 180 days and were instructed to transmit weight readings daily. We used Poisson regression to determine the within-person effects of events on subsequent adherence. RESULTS A total of 625 events took place during the study period. Most of these events were rehospitalizations (78.7%). After controlling for the number of previous events and discharge to a skilled nursing facility, the rate for adherence decreased by nearly 20% in the 2 weeks after a hospitalization compared with the 2 weeks before (adjusted rate ratio, 0.81; 95% confidence interval: 0.77-0.86; P < .001). CONCLUSIONS Experiencing a rehospitalization had the effect of diminishing adherence to daily weighing. Providers using telemonitoring to monitor decompensation and manage medications should take advantage of the potential "teachable moment" during hospitalization to reinforce the importance of adherence.
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Hoch JS, Trenaman L, Hearney SM, Dewa CS. How Economic Decision Modeling Can Facilitate Health Equity. AMA J Ethics 2021; 23:E624-630. [PMID: 34459730 DOI: 10.1001/amajethics.2021.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This article offers examples of how modeling can motivate health equity inquiry and research. This article also considers how equity fits into cost-effectiveness frameworks, how economic modeling can broaden the range of options for improving health equity, and how information other than results of cost-effectiveness analyses can inform health technology assessment.
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Affiliation(s)
- Jeffrey S Hoch
- Professor and the chief of the Division of Health Policy and Management in the Department of Public Health Sciences at the University of California, Davis
| | - Logan Trenaman
- Postdoctoral fellow in the Department of Public Health Sciences and the Center for Healthcare Policy and Research at the University of California, Davis
| | - Shannon M Hearney
- Second-year student in the public health sciences doctoral degree program at the University of California, Davis
| | - Carolyn S Dewa
- Professor in the Department of Psychiatry and Behavioral Health and the Department of Public Health Sciences at the University of California, Davis
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Perry LM, Bateni SB, Bold RJ, Hoch JS. Is Improved Survival in Early-Stage Pancreatic Cancer Worth the Extra Cost at High-Volume Centers? J Am Coll Surg 2021; 233:90-98. [PMID: 33766724 PMCID: PMC8272961 DOI: 10.1016/j.jamcollsurg.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Volume of operative cases may be an important factor associated with improved survival for early-stage pancreatic cancer. Most high-volume pancreatic centers are also academic institutions, which have been associated with additional healthcare costs. We hypothesized that at high-volume centers, the value of the extra survival outweighs the extra cost. STUDY DESIGN This retrospective cohort study used data from the California Cancer Registry linked to the Office of Statewide Health Planning and Development database from January 1, 2004 through December 31, 2012. Stage I-II pancreatic cancer patients who underwent resection were included. Multivariable analyses estimated overall survival and 30-day costs at low- vs high-volume pancreatic surgery centers. The incremental cost-effectiveness ratio (ICER) and incremental net benefit (INB) were estimated, and statistical uncertainty was characterized using net benefit regression. RESULTS Of 2,786 patients, 46.5% were treated at high-volume centers and 53.5% at low-volume centers. There was a 0.45-year (5.4 months) survival benefit (95% CI 0.21-0.69) and a $7,884 extra cost associated with receiving surgery at high-volume centers (95% CI $4,074-$11,694). The ICER was $17,529 for an additional year of survival (95% CI $7,997-$40,616). For decision-makers willing to pay more than $20,000 for an additional year of life, high-volume centers appear cost-effective. CONCLUSIONS Although healthcare costs were greater at high-volume centers, patients undergoing pancreatic surgery at high-volume centers experienced a survival benefit (5.4 months). The extra cost of $17,529 per additional year is quite modest for improved survival and is economically attractive by many oncology standards.
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Affiliation(s)
- Lauren M Perry
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Davis, Sacramento, CA
| | - Sarah B Bateni
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Ontario, Canada
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Davis, Sacramento, CA
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Sacramento, CA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA.
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Nystrand C, Sampaio F, Hoch JS, Osman F, Feldman I. The cost-effectiveness of a culturally tailored parenting program: estimating the value of multiple outcomes. Cost Eff Resour Alloc 2021; 19:23. [PMID: 33892740 PMCID: PMC8066436 DOI: 10.1186/s12962-021-00278-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022] Open
Abstract
Background Parenting programs can be economically attractive interventions for improving the mental health of both parents and their children. Few attempts have been made to analyse the value of children’s and parent’s outcomes simultaneously, to provide a qualified support for decision making. Methods A within trial cost-effectiveness evaluation was conducted, comparing Ladnaan, a culturally tailored parenting program for Somali-born parents, with a waitlist control. Quality-adjusted life years (QALY) for parents were estimated by mapping the General Health Questionnaire-12 to Euroqol’s EQ-5D-3L to retrieve utilities. Behavioural problems in children were measured using the Child Behaviour Checklist (CBCL). Intervention costs were estimated for the trial. A net benefit regression framework was employed to study the cost-effectiveness of the intervention, dealing with multiple effects in the same analysis to estimate different combinations of willingness-to pay (WTP) thresholds. Results For a WTP of roughly €300 for a one point improvement in total problems on the CBCL scale (children), Ladnaan is cost-effective. In contrast, the WTP would have to be roughly €580,000 per QALY (parents) for it to be cost-effective. Various combinations of WTP values for the two outcomes (i.e., CBCL and QALY) may be used to describe other scenarios where Ladnaan is cost-effective. Conclusions Decision-makers interested in multiple effects must take into account combinations of effects in relation to budget, in order to obtain cost-effective results. A culturally adapted parenting program may be cost-effective, depending on the primary outcome, or multiple outcomes of interest. Trial registration clinicaltrials.gov, NCT02114593. Registered 15 April 2014—prospectively registered, https://www.clinicaltrials.gov/ct2/results?recrs=&cond=&term=NCT02114593&cntry=&state=&city=&dist=
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Affiliation(s)
- Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Fatumo Osman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Dewa CS, Hoch JS, Loong D, Trojanowski L, Bonato S. Evidence for the Cost-Effectiveness of Return-to-Work Interventions for Mental Illness Related Sickness Absences: A Systematic Literature Review. J Occup Rehabil 2021; 31:26-40. [PMID: 32495150 DOI: 10.1007/s10926-020-09904-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this systematic literature review (SLR) is to examine the state of knowledge about the cost-effectiveness of return-to-work (RTW) interventions targeted at workers with medically certified sickness absences related to mental disorders. Our SLR addresses the question, "What is the evidence for the cost-effectiveness of RTW interventions for mental illness related sickness absences?" Methods This SLR used a reviewer pair multi-phase screening of publically available peer-reviewed studies published between 2002 and 2019. Five electronic databases were searched: (1) MEDLINE 1946-Present, (2) MEDLINE: Epub-Ahead of Print and In-Process, (3) PsycINFO, (4) Econlit, and (5) Web of Science. Results 6138 unique citations were identified. Ten articles were included in the review. Eight of the ten studies were conducted in the Netherlands, one in Sweden, and one in Canada. Results of this SLR suggest there is evidence that RTW interventions for workers with medically certified sickness absences can be cost-effective. Conclusions Although this SLR's results suggest that economic evaluations of RTW interventions can be cost-effective, the use of economic evaluations for studies of these program types is in its infancy. Some jurisdictions (e.g., the Netherlands) seem to have recognized the need for economic evaluations. However, more research is needed in different disability system contexts. Furthermore, use of the standard economic evaluation approaches for healthcare interventions may limit the usefulness of results if the end-user is an employer or non-health organization. This may present the opportunity to introduce newer approaches that include work-related measures of effectiveness and analytical approaches.
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Affiliation(s)
- Carolyn S Dewa
- Department of Psychiatry and Behavioral Sciences and Department of Public Health Sciences, University of California, Davis, 2450 48th Street, Sacramento, CA, 95817, USA.
| | - Jeffrey S Hoch
- Department of Public Health Sciences, Division of Health Policy and Management, University of California, Davis, 2103 Stockton Boulevard, Sacramento, CA, 95817, USA
| | - Desmond Loong
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Lucy Trojanowski
- ECHO Ontario Mental Health, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
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Benzies KM, Aziz K, Shah V, Faris P, Isaranuwatchai W, Scotland J, Larocque J, Mrklas KJ, Naugler C, Stelfox HT, Chari R, Soraisham AS, Akierman AR, Phillipos E, Amin H, Hoch JS, Zanoni P, Kurilova J, Lodha A. Effectiveness of Alberta Family Integrated Care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial. BMC Pediatr 2020; 20:535. [PMID: 33246430 PMCID: PMC7697372 DOI: 10.1186/s12887-020-02438-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Parents of infants in neonatal intensive care units (NICUs) are often unintentionally marginalized in pursuit of optimal clinical care. Family Integrated Care (FICare) was developed to support families as part of their infants’ care team in level III NICUs. We adapted the model for level II NICUs in Alberta, Canada, and evaluated whether the new Alberta FICare™ model decreased hospital length of stay (LOS) in preterm infants without concomitant increases in readmissions and emergency department visits. Methods In this pragmatic cluster randomized controlled trial conducted between December 15, 2015 and July 28, 2018, 10 level II NICUs were randomized to provide Alberta FICare™ (n = 5) or standard care (n = 5). Alberta FICare™ is a psychoeducational intervention with 3 components: Relational Communication, Parent Education, and Parent Support. We enrolled mothers and their singleton or twin infants born between 32 0/7 and 34 6/7 weeks gestation. The primary outcome was infant hospital LOS. We used a linear regression model to conduct weighted site-level analysis comparing adjusted mean LOS between groups, accounting for site geographic area (urban/regional) and infant risk factors. Secondary outcomes included proportions of infants with readmissions and emergency department visits to 2 months corrected age, type of feeding at discharge, and maternal psychosocial distress and parenting self-efficacy at discharge. Results We enrolled 654 mothers and 765 infants (543 singletons/111 twin cases). Intention to treat analysis included 353 infants/308 mothers in the Alberta FICare™ group and 365 infants/306 mothers in the standard care group. The unadjusted difference between groups in infant hospital LOS (1.96 days) was not statistically significant. Accounting for site geographic area and infant risk factors, infant hospital LOS was 2.55 days shorter (95% CI, − 4.44 to − 0.66) in the Alberta FICare™ group than standard care group, P = .02. Secondary outcomes were not significantly different between groups. Conclusions Alberta FICare™ is effective in reducing preterm infant LOS in level II NICUs, without concomitant increases in readmissions or emergency department visits. A small number of sites in a single jurisdiction and select group infants limit generalizability of findings. Trial registration ClinicalTrials.gov Identifier NCT02879799, retrospectively registered August 26, 2016.
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Affiliation(s)
- Karen M Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada. .,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Khalid Aziz
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Northern Alberta Neonatal Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Vibhuti Shah
- Faculty of Medicine, University of Toronto, and Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter Faris
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Analytics, Data Integration, Measurement & Reporting, Alberta Health Services, Calgary, AB, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jeanne Scotland
- Neonatal Intensive Care Unit, Rockyview General Hospital, Alberta Health Services, Calgary, AB, Canada
| | - Jill Larocque
- Northern Alberta Neonatal Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Kelly J Mrklas
- Strategic Clinical Networks™, System Innovation and Programs, Alberta Health Services, Calgary, AB, Canada
| | | | - H Thomas Stelfox
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Radha Chari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | - Ernest Phillipos
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Northern Alberta Neonatal Program, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Harish Amin
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA.,Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA, USA
| | - Pilar Zanoni
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Jana Kurilova
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Abhay Lodha
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Singh S, Hearps SJC, Borland ML, Dalziel SR, Neutze J, Donath S, Cheek JA, Kochar A, Gilhotra Y, Phillips N, Williams A, Lyttle MD, Bressan S, Hoch JS, Oakley E, Holmes JF, Kuppermann N, Babl FE. The Effect of Patient Observation on Cranial Computed Tomography Rates in Children With Minor Head Trauma. Acad Emerg Med 2020; 27:832-843. [PMID: 32064711 DOI: 10.1111/acem.13942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Management of children with minor blunt head trauma often includes a period of observation to determine the need for cranial computed tomography (CT). Our objective was to estimate the effect of planned observation on CT use for each Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk group among children with minor head trauma. METHODS This was a secondary analysis of a prospective observational study at 10 emergency departments (EDs) in Australia and New Zealand, including 18,471 children < 18 years old, presenting within 24 hours of blunt head trauma, with Glasgow Coma Scale scores of 14 to 15. The planned observation cohort was defined by those with planned observation and no immediate plan for cranial CT. The comparison cohort included the rest of the patients who were either not observed or for whom a decision to obtain a cranial CT was made immediately after ED assessment. The outcome clinically important TBI (ciTBI) was defined as death due to head trauma, neurosurgery, intubation for > 24 hours for head trauma, or hospitalization for ≥ 2 nights in association with a positive cranial CT scan. We estimated the odds of cranial CT use with planned observation, adjusting for patient characteristics, PECARN TBI risk group, history of seizure, time from injury, and hospital clustering, using a generalized linear model with mixed effects. RESULTS The cranial CT rate in the total cohort was 8.6%, and 0.8% had ciTBI. The planned observation group had 4,945 (27%) children compared to 13,526 (73%) in the no planned observation group. Cranial CT use was significantly lower with planned observation (adjusted odds ratio [OR] = 0.2, 95% confidence interval [CI] = 0.1 to 0.1), with no difference in missed ciTBI rates. There was no difference in the odds of cranial CT use with planned observation for the group at very low risk for ciTBI (adjusted OR = 0.9, 95% CI = 0.5 to 1.4). Planned observation was associated with significantly lower cranial CT use in patients at intermediate risk (adjusted OR = 0.2, 95% CI = 0.2 to 0.3) and high risk (adjusted OR = 0.1, 95% CI = 0.0 to 0.1) for ciTBI. CONCLUSIONS Even in a setting with low overall cranial CT rates in children with minor head trauma, planned observation was associated with decreased cranial CT use. This strategy can be safely implemented on selected patients in the PECARN intermediate- and higher-risk groups for ciTBI.
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Affiliation(s)
- Sonia Singh
- From the Murdoch Children's Research Institute Melbourne Australia
- the Department of Paediatrics University of Melbourne Melbourne Australia
- and the University of California Davis Medical Center Sacramento CA USA
| | | | - Meredith L. Borland
- the Perth Children's Hospital Perth Australia
- and the Divisions of Paediatrics and Emergency Medicine School of Medicine University of Western Australia Perth Australia
| | - Stuart R. Dalziel
- the Starship Children's Health Auckland New Zealand
- and the Departments of Surgery and Paediatrics: Child and Youth Health University of Auckland Auckland New Zealand
| | | | - Susan Donath
- From the Murdoch Children's Research Institute Melbourne Australia
- the Department of Paediatrics University of Melbourne Melbourne Australia
| | - John A. Cheek
- From the Murdoch Children's Research Institute Melbourne Australia
- the Department of Paediatrics University of Melbourne Melbourne Australia
- the Royal Children's Hospital Melbourne Australia
| | - Amit Kochar
- the Women's & Children's Hospital Adelaide Australia
| | - Yuri Gilhotra
- the Queensland Children's Hospital Brisbane Australia
| | - Natalie Phillips
- the Queensland Children's Hospital Brisbane Australia
- and the Child Health Research Centre University of Queensland Brisbane Australia
| | - Amanda Williams
- From the Murdoch Children's Research Institute Melbourne Australia
| | - Mark D. Lyttle
- From the Murdoch Children's Research Institute Melbourne Australia
- the Bristol Royal Hospital for Children Bristol UK
- and the Academic Department of Emergency Care University of the West of England Bristol UK
| | - Silvia Bressan
- From the Murdoch Children's Research Institute Melbourne Australia
- the Department of Women's and Children's Health University of Padova Padova Italy
| | - Jeffrey S. Hoch
- the Division of Health Policy and Management Department of Public Health Sciences University of California at Davis Davis CA USA
- and the Center for Healthcare Policy and Research University of California at Davis Sacramento CA USA
| | - Ed Oakley
- From the Murdoch Children's Research Institute Melbourne Australia
- the Department of Paediatrics University of Melbourne Melbourne Australia
- the Royal Children's Hospital Melbourne Australia
| | - James F. Holmes
- the Division of Health Policy and Management Department of Public Health Sciences University of California at Davis Davis CA USA
- and the Department of Emergency Medicine University of California Davis School of Medicine Sacramento CA USA
| | - Nathan Kuppermann
- and the Department of Emergency Medicine University of California Davis School of Medicine Sacramento CA USA
- and the Department of Pediatrics University of California Davis School of Medicine Sacramento CA USA
| | - Franz E. Babl
- From the Murdoch Children's Research Institute Melbourne Australia
- the Department of Paediatrics University of Melbourne Melbourne Australia
- the Royal Children's Hospital Melbourne Australia
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Haynes SC, Tancredi DJ, Tong K, Hoch JS, Ong MK, Ganiats TG, Evangelista LS, Black JT, Auerbach A, Romano PS. Association of Adherence to Weight Telemonitoring With Health Care Use and Death: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2010174. [PMID: 32648924 PMCID: PMC7352152 DOI: 10.1001/jamanetworkopen.2020.10174] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Adherence to telemonitoring may be associated with heart failure exacerbation but is not included in telemonitoring algorithms. OBJECTIVE To assess whether telemonitoring adherence is associated with a patient's risk of hospitalization, emergency department visit, or death. DESIGN, SETTING, AND PARTICIPANTS This post hoc secondary analysis of the Better Effectiveness After Transition-Heart Failure randomized clinical trial included patients from 6 academic medical centers in California who were eligible if they were hospitalized for decompensated heart failure and excluded if they were discharged to a skilled nursing facility, were expected to improve because of a medical procedure, or did not have the cognitive or physical ability to participate. The trial compared a telemonitoring intervention with usual care for patients with heart failure after hospital discharge from October 12, 2011, to September 30, 2013. Data analysis was performed from November 8, 2016, to May 10, 2019. INTERVENTIONS The intervention group (n = 722) received heart failure education, telephone check-ins, and a wireless telemonitoring system that allowed the patient to transmit weight, blood pressure, heart rate, and selected symptoms. The control group (n = 715) received usual care. Patients were followed up for 180 days after discharge. MAIN OUTCOMES AND MEASURES The main outcome was within-person risk of hospitalization, emergency department visit, or death by week during the study period. Poisson regression was used to determine the within-person association of adherence to daily weighing with the risk of experiencing these events in the following week. RESULTS Among the 538 participants (mean [SD] age, 70.9 [14.1] years; 287 [53.8%] male; 269 [50.7%] white) in the present analysis, adherence was lowest during the first week after enrollment but steadily increased, peaking between days 26 and 60 at 69%, or 371 transmissions. Adherence to weight telemonitoring was associated with events in the following week; an increase in adherence by 1 day was associated with a 19% decrease in the rate of death in the following week (incidence rate ratio, 0.81; 95% CI, 0.73-0.90) and an 11% decrease in the rate of hospitalization (incidence rate ratio, 0.89; 95% CI, 0.86-0.91). Adherence in the previous week was not associated with reduced rates of emergency department visits (incidence rate ratio, 0.95; 95% CI, 0.90-1.02). CONCLUSIONS AND RELEVANCE In this study, lower adherence to weight telemonitoring in a given week was associated with an increased risk of subsequent hospitalization or death in the following week. It is unlikely that this is a result of the telemonitoring intervention; rather, adherence may be an important factor associated with a patient's health status.
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Affiliation(s)
- Sarah C. Haynes
- Center for Health and Technology, Department of Pediatrics, University of California, Davis, Sacramento
| | - Daniel J. Tancredi
- Center for Healthcare Policy and Research, Department of Pediatrics, University of California, Davis, Sacramento
| | - Kathleen Tong
- Adventist Heart and Vascular Institute, St Helena, California
| | - Jeffrey S. Hoch
- Center for Healthcare Policy and Research, Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Michael K. Ong
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Theodore G. Ganiats
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla
| | | | - Jeanne T. Black
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Andrew Auerbach
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
| | - Patrick S. Romano
- Center for Healthcare Policy and Research, Division of General Medicine, University of California, Davis, Sacramento
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Alvarez EM, Malogolowkin M, Hoch JS, Li Q, Brunson A, Pollock BH, Muffly L, Wun T, Keegan THM. Treatment Complications and Survival Among Children and Young Adults With Acute Lymphoblastic Leukemia. JCO Oncol Pract 2020; 16:e1120-e1133. [PMID: 32525752 DOI: 10.1200/jop.19.00572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We previously demonstrated lower early mortality for young adults (YAs) with acute lymphoblastic leukemia (ALL) who received induction treatment at specialized cancer centers (SCCs) versus community hospitals. The aim of this study is to determine the impact of inpatient location of treatment throughout therapy on long-term survival, complications, and cost-associations that have not yet been evaluated at the population level. METHODS Using the California Cancer Registry linked to a hospitalization database, we identified patients, 0-39 years of age, diagnosed with first primary ALL who received inpatient treatment between 1991 and 2014. Patients were classified as receiving all or part or none of their inpatient treatment at an SCC within 3 years of diagnosis. Inverse probability-weighted, multivariable Cox regression models estimated the associations between location of treatment and sociodemographic and clinical factors with survival. We compared 3-year inpatient costs overall and per day by age group and location of care. RESULTS Eighty-four percent (0-18 years; n = 4,549) of children and 36% of YAs (19-39 years; n = 683) received all treatment at SCCs. Receiving all treatment at an SCC was associated with superior leukemia-specific (hazard ratio [HR], 0.76; 95% CI, 0.67 to 0.88) and overall survival (HR, 0.87; 95% CI, 0.77 to 0.97) in children and in YAs (HR, 0.71; 95% CI, 0.61 to 0.83; HR, 0.70; 95% CI, 0.62 to 0.80) even after controlling for complications. The cost of inpatient care during the full course of therapy was higher in patients receiving all of their care at SCCs. CONCLUSION Our results demonstrate that inpatient treatment at an SCC throughout therapy is associated with superior survival; therefore, strong consideration should be given to referring these patients to SCCs.
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Affiliation(s)
- Elysia M Alvarez
- Division of Pediatric Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Brad H Pollock
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA
| | - Lori Muffly
- Division of Bone Marrow and Transplantation, Stanford University, Stanford, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA.,University of California Davis Clinical and Translational Science Center, Sacramento, CA
| | - Theresa H M Keegan
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA.,Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
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Crossen SS, Xing G, Hoch JS. Changing costs of type 1 diabetes care among US children and adolescents. Pediatr Diabetes 2020; 21:644-648. [PMID: 32061049 PMCID: PMC7217720 DOI: 10.1111/pedi.12996] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Modern therapy for type 1 diabetes (T1D) increasingly utilizes technology such as insulin pumps and continuous glucose monitors (CGMs). Prior analyses suggest that T1D costs are driven by preventable hospitalizations, but recent escalations in insulin prices and use of technology may have changed the cost landscape. METHODS We conducted a retrospective analysis of T1D medical costs from 2012 to 2016 using the OptumLabs Data Warehouse, a comprehensive database of deidentified administrative claims for commercial insurance enrollees. Our study population included 9445 individuals aged ≤18 years with T1D and ≥13 months of continuous enrollment. Costs were categorized into ambulatory care, hospital care, insulin, diabetes technology, and diabetes supplies. Mean costs for each category in each year were adjusted for inflation, as well as patient-level covariates including age, sex, race, census region, and mental health comorbidity. RESULTS Mean annual cost of T1D care increased from $11 178 in 2012 to $17 060 in 2016, driven primarily by growth in the cost of insulin ($3285 to $6255) and cost of diabetes technology ($1747 to $4581). CONCLUSIONS Our findings suggest that the cost of T1D care is now driven by mounting insulin prices and growing utilization and cost of diabetes technology. Given the positive effects of pumps and CGMs on T1D health outcomes, it is possible that short-term costs are offset by future savings. Long-term cost-effectiveness analyses should be undertaken to inform providers, payers, and policy-makers about how to support optimal T1D care in an era of increasing reliance on therapeutic technology.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of California, Davis,OptumLabs Visiting Fellow, Cambridge, MA
| | - Guibo Xing
- Center for Healthcare Policy and Research, University of California, Davis
| | - Jeffrey S. Hoch
- Center for Healthcare Policy and Research, University of California, Davis,Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis
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Trenaman L, Pearson SD, Hoch JS. How Are Incremental Cost-Effectiveness, Contextual Considerations, and Other Benefits Viewed in Health Technology Assessment Recommendations in the United States? Value Health 2020; 23:576-584. [PMID: 32389223 DOI: 10.1016/j.jval.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/16/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To review assessments from the Institute for Clinical and Economic Review (ICER) and describe how cost-effectiveness, other benefits or disadvantages, and contextual considerations affect Council members' assessments of value. METHODS Assessments published by the ICER between December 2014 and April 2019 were reviewed. Data on the assessment, intervention, results from cost-effectiveness analyses, and Council members' votes were extracted. Voting data were examined using bar charts and radar plots. Spearman's correlations between the number of votes for other benefits and contextual considerations were estimated. Two case studies (tisagenlecleucel and voretigene neparvovec) explored the relationship between different aspects of value and the vote. RESULTS Thirty-one ICER assessments were reviewed, which included 51 value votes and 17 votes on other benefits and contextual considerations. On average, interventions with lower cost-effectiveness ratios received a higher proportion of high and intermediate value votes; however, there was heterogeneity across assessments. Of other benefits or disadvantages, having a novel mechanism of action received the most votes (n = 138), and reducing health disparities received the fewest (n = 24). Of contextual considerations, treating a condition that has a severe impact on length and quality of life received the most votes (n = 164). There was a strong positive correlation between votes for reduced caregiver/family burden and improving return to work/productivity (ρ = 0.88, P < .05). Two case studies highlighted that factors beyond cost-effectiveness can lead to lower (tisagenlecleucel) or higher (voretigene neparvovec) assessments of value. CONCLUSION Council members' judgments about the value of interventions are influenced by other benefits or disadvantages and contextual considerations but anchored by cost-effectiveness.
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Affiliation(s)
- Logan Trenaman
- Division of Health Policy and Management, Department of Public Sciences, University of California, Davis, Davis, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, USA.
| | | | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Sciences, University of California, Davis, Davis, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, USA
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Sigal I, Dayal P, Hoch JS, Mouzoon JL, Morrow E, Marcin JP. Travel, Time, and Cost Savings Associated with a University Medical Center's Video Medical Interpreting Program. Telemed J E Health 2020; 26:1234-1239. [PMID: 32045323 DOI: 10.1089/tmj.2019.0220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022] Open
Abstract
Background: Patients with limited English proficiency experience disparities in health care access, quality, costs, and outcomes. Providing qualified medical interpreting services (MIS) in the health care setting can reduce these disparities. Unfortunately, health organizations face logistical and financial difficulties in meeting the need for qualified medical interpreters. Introduction: This descriptive review evaluated travel, time, and cost savings associated with video interpreting services compared to traditional in-person services. Materials and Methods: We conducted a retrospective review of all inpatient and outpatient medical interpreting encounters at a large academic hospital delivered through video and in person between 2006 and 2017. Outcome measures included interpreter travel distance, time, and cost for in-person encounters and savings associated with avoided travel for services provided through video. Results: We reviewed 281,701 interpreting encounters, including 249,357 in person and 32,344 by video. Video encounters occurred both for on-site and off-site visits. For on-site encounters, the use of video resulted in an average round trip walking distance saved of 0.75 miles (SD = 0.33) and an average round trip walking time saved of 14.75 min (SD = 6.30) per encounter. For off-site encounters, the use of video resulted in an average round trip driving distance saved of 8.63 miles (SD = 9.13), an average round trip driving time saved of 23.78 min (SD = 9.50), and an average round trip driving cost savings of $4.66 per encounter. Conclusions: This single institution review of the travel, time, and cost savings associated with providing MIS through video demonstrates the opportunity for more efficient use of time and resources.
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Affiliation(s)
- Ilana Sigal
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Parul Dayal
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Sacramento, California, USA
| | - Jamie L Mouzoon
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
| | - Elena Morrow
- Medical Interpreting Services, University of California, Davis, Sacramento, California, USA
| | - James P Marcin
- Department of Pediatrics, University of California, Davis, Sacramento, California, USA
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Oliveira C, de Silva NT, Ungar WJ, Bayoumi AM, Avitzur Y, Hoch JS, Maxwell J, Wales PW. Health-related quality of life in neonates and infants: a conceptual framework. Qual Life Res 2020; 29:1159-1168. [PMID: 31997081 DOI: 10.1007/s11136-020-02432-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE With reduced mortality of neonatal conditions, health-related quality of life (HRQOL) has become an important clinical outcome. However, since the meaning of HRQOL in dependent, non-autonomous infants and neonates remains largely undefined, HRQOL measurement and economic evaluation are limited due to the lack of age-specific methodology. The objective was to construct a conceptual framework of neonatal and infant HRQOL (NIHRQOL) which identifies factors relevant to the neonate and infant, their relationship with each other and the caregiving environment. METHODS Using qualitative methods, a concept was developed based on in-depth analysis of verbatim records of two focus groups (6 caregivers, 6 healthcare providers) and five interviews with caregivers of chronically ill neonates/infants (n = 2), and healthcare professionals of a pediatric tertiary healthcare center (n = 3). Two analysts independently performed thematic analysis using an inductive and contextual approach. RESULTS The majority of participants regarded NIHRQOL as an individual entity, which was closely related and strongly influenced by caregivers and family. It may be gauged by the perceived degree of effort required to achieve expected normalcy in everyday life for the neonate/infant and its family. The importance of individual HRQOL factors is developmental stage-dependent. CONCLUSION Neonatal and infant HRQOL is a multidimensional, multilayered and interconnected concept, where the child's needs contribute most directly, and the caregiver's and society's ability to meet those needs characterize the interdependence between the child and its caregiving environment. Developmental stage-specific HRQOL instruments for premature and mature neonates, and infants are warranted to allow for valid HRQOL measurement.
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Affiliation(s)
- Carol Oliveira
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Nicole T de Silva
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Centre for Research On Inner City Health, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Yaron Avitzur
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Jeffrey S Hoch
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Canada
| | - Julia Maxwell
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada
| | - Paul W Wales
- Group for Improvement of Intestinal Function and Treatment Program (GIFT), The Hospital for Sick Children, Toronto, Canada.,Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Forchuk C, Fisman S, Reiss JP, Collins K, Eichstedt J, Rudnick A, Isaranuwatchai W, Hoch JS, Wang X, Lizotte D, Macpherson S, Booth R. Improving Access and Mental Health for Youth Through Virtual Models of Care. Lecture Notes in Computer Science 2020. [PMCID: PMC7313297 DOI: 10.1007/978-3-030-51517-1_17] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The overall objective of this research is to evaluate the use of a mobile health smartphone application (app) to improve the mental health of youth between the ages of 14–25 years, with symptoms of anxiety/depression. This project includes 115 youth who are accessing outpatient mental health services at one of three hospitals and two community agencies. The youth and care providers are using eHealth technology to enhance care. The technology uses mobile questionnaires to help promote self-assessment and track changes to support the plan of care. The technology also allows secure virtual treatment visits that youth can participate in through mobile devices. This longitudinal study uses participatory action research with mixed methods. The majority of participants identified themselves as Caucasian (66.9%). Expectedly, the demographics revealed that Anxiety Disorders and Mood Disorders were highly prevalent within the sample (71.9% and 67.5% respectively). Findings from the qualitative summary established that both staff and youth found the software and platform beneficial.
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Djalalov S, Beca J, Ewara EM, Hoch JS. A Comparison of Different Analysis Methods for Reconstructed Survival Data to Inform Cost‑Effectiveness Analysis. Pharmacoeconomics 2019; 37:1525-1536. [PMID: 31571137 DOI: 10.1007/s40273-019-00830-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The aim of this study was to use Microsoft Excel spreadsheet software to fit parametric survival distributions. We also explain the differences between individual patient data (IPD) and survival data reconstructed in Excel and SAS. METHODS Three sets of patient data on overall survival were compared using different methods: 'original' IPD, 'reconstructed SAS', and 'reconstructed Excel'. The best-fit distribution was selected using visual observation, supported by linear plots of predicted probabilities, goodness-of-fit coefficients, and the sum of squared error of prediction. Outcomes included the incremental cost-effectiveness ratio (ICER), incremental net benefit (INB), incremental cost, and life-years gained over short-term and lifetime horizons. These were compared for different data sets. RESULTS In this example, log-normal, log-logistic, and Weibull distributions showed best-fit with the visual tests and goodness-of-fit statistics. Weibull and exponential distributions showed significant differences compared with IPD data. Data on short-term (5 years) time horizons produced by different data re-creation methods showed closeness with data reconstructed from SAS. The ICER and INB results were dependent on the time horizon and selected parametric distribution from the model. CONCLUSIONS Different approaches used in fitting parametric survival distributions yielded predicted probabilities that substantially differed from those using original IPD. Our study highlights the importance of following guidelines for economic evaluations with a systematic approach to parametric survival analysis techniques in order to select best fitting parametric survival distributions.
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Affiliation(s)
- Sandjar Djalalov
- Westminster International University in Tashkent, 12 Istiqbol St., 100047, Tashkent, Uzbekistan.
- Tashkent Pharmaceutical Institute, 45 Aybek Street, 100015, Tashkent, Uzbekistan.
- Toronto Health Economics and Technology Assessment (THETA) Collaborative Toronto General Hospital, Eaton Building, 10th Floor, Room 248, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | | | | | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
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Beca J, Majeed H, Chan KK, Hotte SJ, Loblaw A, Hoch JS. Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer. Can Urol Assoc J 2019; 13:396-403. [PMID: 31039109 PMCID: PMC6892688 DOI: 10.5489/cuaj.5889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone- sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. METHODS The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. RESULTS In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. CONCLUSIONS The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.
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Bremner KE, Yabroff KR, Coughlan D, Liu N, Zeruto C, Warren JL, de Oliveira C, Mariotto AB, Lam C, Barrett MJ, Chan KKW, Hoch JS, Krahn MD. Patterns of Care and Costs for Older Patients With Colorectal Cancer at the End of Life: Descriptive Study of the United States and Canada. JCO Oncol Pract 2019; 16:e1-e18. [PMID: 31647697 DOI: 10.1200/jop.19.00061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE End-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery. METHODS Patients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age ≥ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV). RESULTS In all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004). CONCLUSION These findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.
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Affiliation(s)
- Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Diarmuid Coughlan
- National Cancer Institute, Rockville, MD.,Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | | | - Claire de Oliveira
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Clara Lam
- National Cancer Institute, Rockville, MD
| | | | - Kelvin K-W Chan
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada and Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- University of Toronto, Toronto, Ontario, Canada.,University of California, Davis, Davis, CA
| | - Murray D Krahn
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Carolyn S Dewa
- University of California, Davis, Sacramento, California (C.S.D., J.S.H.)
| | - Karen Nieuwenhuijsen
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands (K.N.)
| | - Jeffrey S Hoch
- University of California, Davis, Sacramento, California (C.S.D., J.S.H.)
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Bateni SB, Gingrich AA, Hoch JS, Canter RJ, Bold RJ. Defining Value for Pancreatic Surgery in Early-Stage Pancreatic Cancer. JAMA Surg 2019; 154:e193019. [PMID: 31433465 PMCID: PMC6704743 DOI: 10.1001/jamasurg.2019.3019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 03/05/2019] [Accepted: 05/26/2019] [Indexed: 12/15/2022]
Abstract
Importance Value-based care is increasingly important, with rising health care costs and advances in cancer treatment leading to greater survival for patients with cancer. Regionalization of surgical care for pancreatic cancer has been extensively studied as a strategy to improve perioperative outcomes, but investigation of long-term outcomes relative to health care costs (ie, value) is lacking. Objective To identify patient and hospital characteristics associated with improved overall survival, decreased costs, and greater value among patients with pancreatic cancer undergoing curative resection. Design, Setting, and Participants This retrospective cohort study identified 2786 patients with stages I to II pancreatic cancer who underwent pancreatic resection at 157 hospitals from January 1, 2004, through December 31, 2012. The study used the California Cancer Registry, which collects data from all California residents newly diagnosed with cancer, linked to the Office of Statewide Health Planning and Development database, which collects administrative data from all California licensed hospitals. Data were analyzed from November 11, 2017, through September 4, 2018. Exposures Pancreatic resection at high-volume and/or National Cancer Institute (NCI)-designated cancer centers. Main Outcomes and Measures The primary outcomes were overall survival, surgical hospitalization costs, and value. High value was defined as the fourth quintile or higher for survival and the second quintile or less for costs. Costs were calculated from charges using cost-charge ratios and adjusted for geographic variation and inflation. Multivariable regression models were used to determine factors associated with overall survival, costs, and high value. Results Among the 2786 patients included (1394 [50.0%] male; mean [SD] age, 67.0 [10.7] years), postoperative chemotherapy (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.64-0.79; P < .001) and high-volume centers (aHR, 0.78; 95% CI, 0.61-0.99; P = .04) were associated with greater overall survival. Higher Elixhauser comorbidity index scores (estimate, 0.006; 95% CI, 0.003-0.008), complications (estimate, 0.22; 95% CI, 0.17-0.27), readmissions (estimate, 0.34; 95% CI, 0.29-0.39), and longer lengths of stay (estimate, 0.03; 95% CI, 0.03-0.04) were associated with higher costs (P < .001), whereas postoperative chemotherapy was associated with lower costs (estimate, -0.06; 95% CI, -0.11 to -0.02; P = .006). National Cancer Institute-designated and high-volume centers were not associated with costs. Although grades III and IV tumors (odds ratio [OR], 0.65; 95% CI, 0.39-0.91; P = .001), T3 category disease (OR, 0.71; 95% CI, 0.46-0.95; P = .005), complications (OR, 0.68; 95% CI, 0.49-0.86; P < .001), readmissions (OR, 0.64; 95% CI, 0.44-0.84; P < .001), and length of stay (OR, 0.82; 95% CI, 0.78-0.85; P < .001) were inversely associated with high-value care, NCI designation (OR, 1.07; 95% CI, 0.66-1.49; P = .74) and high-volume centers (OR, 1.08; 95% CI, 0.54-1.61; P = .07) were not. Conclusions and Relevance In this study, high-value care was associated with important patient characteristics and postoperative outcomes. However, NCI-designated and high-volume centers were not associated with greater value. These data suggest that targeted measures to enhance value may be needed in these centers.
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Affiliation(s)
- Sarah B. Bateni
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
| | - Alicia A. Gingrich
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
| | - Jeffrey S. Hoch
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Divison of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Medical Center, Sacramento
| | - Robert J. Canter
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
| | - Richard J. Bold
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
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