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Price G, Devaney S, French DP, Holley R, Holm S, Kontopantelis E, McWilliam A, Payne K, Proudlove N, Sanders C, Willans R, van Staa T, Hamrang L, Turner B, Parsons S, Faivre-Finn C. Can Real-world Data and Rapid Learning Drive Improvements in Lung Cancer Survival? The RAPID-RT Study. Clin Oncol (R Coll Radiol) 2022; 34:407-410. [PMID: 35000827 DOI: 10.1016/j.clon.2021.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Affiliation(s)
- G Price
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.
| | - S Devaney
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
| | - D P French
- Manchester Centre of Health Psychology, The University of Manchester, Manchester, UK
| | - R Holley
- Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - S Holm
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
| | - E Kontopantelis
- Centre for Health Services Research, Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
| | - A McWilliam
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - K Payne
- Manchester Centre for Health Economics, Health Sciences Research Group, The University of Manchester, Manchester, UK
| | - N Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - C Sanders
- NIHR Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - R Willans
- Data Analytics Unit, National Institute for Health and Care Excellence, Manchester, UK
| | - T van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, The University of Manchester, Manchester, UK
| | - L Hamrang
- RAPID-RT PPI Advisory Group, Manchester, UK
| | - B Turner
- RAPID-RT PPI Advisory Group, Manchester, UK
| | | | - C Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
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Dalal G, Wright SJ, Vass CM, Davison NJ, Vander Stichele G, Smith CH, Griffiths CEM, Payne K. Patient preferences for stratified medicine in psoriasis: a discrete choice experiment. Br J Dermatol 2021; 185:978-987. [PMID: 33991338 DOI: 10.1111/bjd.20482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND New technologies have enabled the potential for stratified medicine in psoriasis. It is important to understand patients' preferences to enable the informed introduction of stratified medicine, which is likely to involve a number of individual tests that could be collated into a prescribing algorithm for biological drug selection to be used in clinical practice. OBJECTIVES To quantify patient preferences for an algorithm-based approach to prescribing biologics ('biologic calculator') in psoriasis. METHODS An online survey comprising a discrete choice experiment (DCE) was conducted to elicit the preferences of two purposive samples of adults living with psoriasis in the UK, identified from a psoriasis patient organization (Psoriasis Association) and an online panel provider (Dynata). Respondents chose between two biologic calculators and conventional prescribing described using five attributes: treatment delay; positive predictive value; negative predictive value; risk of infection; and cost saving to the National Health Service. Each participant selected their preferred alternative from six hypothetical choice sets. Additional data, including sociodemographic characteristics, were collected. Choice data were analysed using conditional logit and fully correlated random parameters logit models. RESULTS Data from 212 respondents (67 from the Psoriasis Association and 145 from Dynata) were analysed. The signs of all estimated coefficients were consistent with a priori expectations. Respondents had a strong preference for a high predictive accuracy and avoiding serious infection, but there was evidence of systematic differences in preferences between the samples. CONCLUSIONS This study indicates that individuals with psoriasis would value a biologic calculator and suggested that such a biologic calculator should have sufficient accuracy to predict future response and risk of serious infection from the biologic.
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Affiliation(s)
- G Dalal
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK
| | - S J Wright
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK
| | - C M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK.,RTI Health Solutions, Manchester, M20 2LS, UK
| | - N J Davison
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK.,BresMed Health Solutions, Manchester, M1 4BT, UK
| | | | - C H Smith
- St John's Institute of Dermatology, Guy's and St. Thomas' NHS Foundation Trust and Kings College London, London, UK
| | - C E M Griffiths
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - K Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, M13 9PL, UK
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Payne K, Maras KL, Russell AJ, Brosnan MJ, Mills R. Self-reported motivations for engaging or declining to engage in cyber-dependent offending and the role of autistic traits. Res Dev Disabil 2020; 104:103681. [PMID: 32474231 DOI: 10.1016/j.ridd.2020.103681] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Cyber-dependent offending, i.e. criminal behaviour reliant on computing and the online domain, has been reportedly associated with particular characteristics and motivations such as being young, male, autistic and motivated by challenge. These associations are anecdotal however and empirical evidence is limited. The present study investigated reasons for engaging or declining to commit cyber-dependent offending in cyber-skilled non-offenders (n = 175) and offenders (n = 7) via an online survey measuring cyber-dependent criminality. The potential role of autism and autistic traits was also considered. Qualitative interviews about motivations for offending were carried out with the offenders. The cyber-dependent offenders reported seven main reasons for engaging in cyber-dependent offending: (1) lack of understanding; (2) entertainment; (3) peer influence; (4) experience and career; (5) anonymity and risk perception; (6) life events; and (7) morals. Twenty-nine (approximately 17 %) of the non-offenders had been asked to engage in cyber-dependent offending but had declined. Their reasons and motivations for declining to commit cyber-dependent offences were compared with the cyber-dependent offenders reasons and motivations for engaging in cybercrime. Seven main reasons for declining to offend were identified: (1) moral principles; (2) perception of risk; (3) fear of consequences; (4) not wanting to; (5) wanting to adhere to the law; (6) behaviour being too complicated; and (7) price being too low. Implications for practise are discussed.
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Affiliation(s)
- K Payne
- University of Northampton, UK.
| | - K L Maras
- University of Northampton, UK; Centre for Applied Autism Research, Department of Psychology, University of Bath, UK
| | - A J Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, UK
| | - M J Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, UK
| | - R Mills
- Centre for Applied Autism Research, Department of Psychology, University of Bath, UK
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Trenaman L, Stacey D, Bryan S, Payne K, Hawker G, Bansback N. Long-term effect of patient decision aids on use of joint replacement and health care costs. Osteoarthritis Cartilage 2020; 28:819-823. [PMID: 32173628 DOI: 10.1016/j.joca.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Shared decision-making supported by patient decisions aids may improve care and reduce healthcare costs for persons considering total joint replacement. Observational studies and randomized controlled trials (RCTs) have evaluated the short-term impact of decision aids on uptake of surgery and costs, however the long-term effects are unclear. This analysis aimed to evaluate the effect of patient decision aids on 1) use of joint replacement up to 7-years of follow-up, and 2) osteoarthritis-related health system costs. METHODS 324 participants in a Canadian RCT with 2-years follow-up who were randomized to either a decision aid (n = 161) or usual care (n = 163) had their trial and health administrative data linked. The proportion undergoing surgery up to 7-years were compared using cumulative incidence plots and competing risk regression. Mean per-patient costs were compared using two sample t-tests. RESULTS At 2-years, 119 of 161 (73.9%) patients in the decision aid arm and 129 of 163 (79.1%) patients in the usual care arm had surgery. Between two and 7-years, 17 additional patients in both the decision aid (of 42, 40.4%) and usual care (of 34, 50.0%) arms underwent surgery. At 7-years, patients exposed to decision aids had a similar likelihood of undergoing surgery (HR = 0.92, 95% CI:0.73 to 1.17, p = 0.49) and mean per-patient costs ($21,965 vs $23,681, incremental cost: -$1,717, 95% CI:-$5,631 to $2,198) compared to those in usual care. CONCLUSIONS This is the first study to assess the long-term impact of decision aids on use of joint replacement and healthcare costs. These results are not conclusive but can inform future trial design. CLINICAL TRIAL REGISTRATION The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
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Affiliation(s)
- L Trenaman
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - D Stacey
- University of Ottawa, Ottawa, Canada
| | - S Bryan
- University of British Columbia, Vancouver, Canada
| | - K Payne
- The University of Manchester, Manchester, UK
| | - G Hawker
- The University of Toronto, Toronto, Canada
| | - N Bansback
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada.
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5
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Pickford R, Edwards R, Nicolas S, Payne K. Determining the information needs of patients undergoing lumbar fusion. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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Payne K, Barnard N, Earl P, McVeigh K, Sen J. Impact of a structured oculoplastic surgery rotation on specialist training in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 2018; 56:351-352. [PMID: 29628169 DOI: 10.1016/j.bjoms.2017.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/13/2017] [Indexed: 10/17/2022]
Affiliation(s)
- K Payne
- Worcestershire Royal Hospital.
| | | | - P Earl
- Worcestershire Royal Hospital.
| | | | - J Sen
- Worcestershire Royal Hospital.
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Powis Z, Farwell Hagman K, Mroske C, McWalter K, Cohen J, Colombo R, Serretti A, Fatemi A, David K, Reynolds J, Immken L, Nagakura H, Cunniff C, Payne K, Barbaro-Dieber T, Gripp K, Baker L, Stamper T, Aleck K, Jordan E, Hersh J, Burton J, Wentzensen I, Guillen Sacoto M, Willaert R, Cho M, Petrik I, Huether R, Tang S. Expansion and further delineation of the SETD5
phenotype leading to global developmental delay, variable dysmorphic features, and reduced penetrance. Clin Genet 2018; 93:752-761. [DOI: 10.1111/cge.13132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Z. Powis
- Division of Emerging Genetics Medicine; Ambry Genetics; Aliso Viejo California
| | | | - C. Mroske
- Division of Clinical Genomics; Ambry Genetics; Aliso Viejo California
| | | | - J.S. Cohen
- Division of Neurogenetics, Hugo W. Moser Research Institute; Kennedy Krieger Institute; Baltimore Maryland
| | - R. Colombo
- Faculty of Medicine, Institute of Clinical Biochemistry; Catholic University and Policlinico Agostino Gemelli; Rome Italy
- Center for the Study of Rare Hereditary Disease; Niguarda Ca’ Granda Metropolitan Hospital; Milan Italy
| | - A. Serretti
- Department of Biomedical and NeuroMotor Sciences; University of Bologna; Bologna Italy
| | - A. Fatemi
- Division of Neurogenetics, Hugo W. Moser Research Institute; Kennedy Krieger Institute; Baltimore Maryland
- Department of Neurology and Pediatrics; The Johns Hopkins Hospital; Baltimore Maryland
| | - K.L. David
- Department of Medicine, Division of Genetics, New York Methodist Hospital; Brooklyn New York
| | - J. Reynolds
- Department of Medical Genetics, Shodair Children's Hospital; Helena Montana
| | - L. Immken
- Department of Genetics Specially for Children Genetics; Austin Texas
| | - H. Nagakura
- Department of Genetics Specially for Children Genetics; Austin Texas
| | - C.M. Cunniff
- Department of Pediatrics, Weill Cornell Medicine; New York New York
| | - K. Payne
- Child Neurology; Riley Hospital for Children; Indianapolis Indiana
| | - T. Barbaro-Dieber
- Department of Genetics, Cook Children's Medical Center; Fort Worth Texas
| | - K.W. Gripp
- Department of Genetics, Cook Children's Medical Center; Fort Worth Texas
| | - L. Baker
- Division of Medical Genetics; A.I. duPont Hospital for Children; Wilmington Delaware
| | - T. Stamper
- Department of Pediatrics, Section on Medical Genetics; Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - K.A. Aleck
- Department of Genetics and Metabolism, Phoenix Children's Hospital; Phoenix Arizona
| | - E.S. Jordan
- Weisskopf Center, University of Louisville Clinical Genetics Unit; Louisville Kentucky
| | - J.H. Hersh
- Weisskopf Center, University of Louisville Clinical Genetics Unit; Louisville Kentucky
| | - J. Burton
- Department of Genetics, University of Illinois College of Medicine at Peoria; Peoria Illinois
| | | | | | | | | | - I. Petrik
- Division of Clinical Genomics; Ambry Genetics; Aliso Viejo California
| | - R. Huether
- Division of Clinical Genomics; Ambry Genetics; Aliso Viejo California
| | - S. Tang
- Division of Clinical Genomics; Ambry Genetics; Aliso Viejo California
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Davison N, Warren R, Mason K, McElhone K, Kirby B, Burden A, Smith C, Payne K, Griffiths C. Identification of factors that may influence the selection of first‐line biological therapy for people with psoriasis: a prospective, multicentre cohort study. Br J Dermatol 2017; 177:828-836. [DOI: 10.1111/bjd.15551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 12/18/2022]
Affiliation(s)
- N.J. Davison
- Manchester Centre for Health Economics The University of Manchester Manchester U.K
- BADBIR (on behalf of the PSORT consortium) The University of Manchester Manchester U.K
| | - R.B. Warren
- The Dermatology Centre Salford Royal NHS Foundation Trust The University of Manchester Manchester Academic Health Science Centre Manchester U.K
| | - K.J. Mason
- BADBIR (on behalf of the PSORT consortium) The University of Manchester Manchester U.K
| | - K. McElhone
- BADBIR (on behalf of the PSORT consortium) The University of Manchester Manchester U.K
| | - B. Kirby
- Department of Dermatology St Vincent's University Hospital Dublin Ireland
| | - A.D. Burden
- Department of Dermatology Western Infirmary Glasgow U.K
| | - C.H. Smith
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
| | - K. Payne
- Manchester Centre for Health Economics The University of Manchester Manchester U.K
| | - C.E.M. Griffiths
- The Dermatology Centre Salford Royal NHS Foundation Trust The University of Manchester Manchester Academic Health Science Centre Manchester U.K
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9
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Vivero M, Cho MT, Begtrup A, Wentzensen IM, Walsh L, Payne K, Zarate YA, Bosanko K, Schaefer GB, DeBrosse S, Pollack L, Mason K, Retterer K, DeWard S, Juusola J, Chung WK. Additional de novo missense genetic variants in NALCN associated with CLIFAHDD syndrome. Clin Genet 2017; 91:929-931. [PMID: 28133733 DOI: 10.1111/cge.12899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M Vivero
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - M T Cho
- GeneDx, Gaithersburg, MD, USA
| | | | | | - L Walsh
- Department of Child Neurology, Riley Hospital for Children, Indianapolis, IN, USA
| | - K Payne
- Department of Child Neurology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Y A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - K Bosanko
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - G B Schaefer
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - S DeBrosse
- Center for Human Genetics, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - L Pollack
- Division of Genetics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - K Mason
- Division of Genetics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | | | | | | | - W K Chung
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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Manning W, Payne K, Stykes B. Counting Marriages in the United States: The Value of County-Level Administrative Data. Stat J IAOS 2017; 33:719-725. [PMID: 29682096 DOI: 10.3233/sji-160338] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapid family change has occurred in the United States, but it has not been accurately charted at the local level. Our capacity to understand spatial variation in marriage is hindered by the deterioration and defunding of the U.S. marriage and divorce vital statistics system. While there is easily accessible state-level data, there is no central depository of county-level administrative marriage data preventing researchers from addressing questions about the geographic concentration as well as variation in marriage rates. We compiled 2010 county-level administrative marriage data from over 3000 counties in 49 states. We find there is wide variation in marriage rates within states with marriage rates varying more across states than within states. While the American Community Survey (ACS) is often used to study marriage rates in the U.S., we find that ACS data can only be used to assess local marriage rates for less than one in ten counties. Our findings demonstrate the high level of spatial variation in marriage and the significance of relying on county- rather than state-level marriage rates.
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Affiliation(s)
- Wendy Manning
- Department of Sociology, Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio 43403
| | - Krista Payne
- Department of Sociology, Center for Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio 43403
| | - Bart Stykes
- Department of Sociology, Sam Houston State University, Huntsville, Texas 77340
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11
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Payne K, Davison N, Thompson AJ, O'Brien K, Bruce IA. Use of a structured elicitation exercise to estimate the prevalence of OME in children with cleft palate. Clin Otolaryngol 2016; 42:904-907. [PMID: 27743503 DOI: 10.1111/coa.12771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- K Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - N Davison
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - A J Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - K O'Brien
- School of Dentistry, The University of Manchester, Manchester, UK
| | - I A Bruce
- Royal Manchester Children's Hospital and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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12
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Gavan S, Daker-White G, Barton A, Payne K. OP0198-HPR Exploring Factors Which Influence Anti-TNF Treatment Decisions for Rheumatoid Arthritis in England – A Qualitative Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Tahim A, Goodson A, Bansal H, Payne K, Sabharwal S. A study of current practices in open access publishing in OMFS research. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Tahim A, Goodson A, Payne K, Fan K. Developing intra-oral suturing skills in OMFS junior trainees. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Goodson A, Payne K, Simmons J, Jain A. Telemonitoring of free-flaps with handheld portable devices. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Vass CM, Rigby D, Campbell S, Payne K. Investigating the Framing-Effects of Risk Attributes in Discrete Choice Experiments: A Pilot Study. Value Health 2014; 17:A648. [PMID: 27202331 DOI: 10.1016/j.jval.2014.08.2349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C M Vass
- University of Manchester, Manchester, UK
| | - D Rigby
- University of Manchester, Manchester, UK
| | - S Campbell
- University of Manchester, Manchester, UK
| | - K Payne
- University of Manchester, Manchester, UK
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17
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Long CG, Harding S, Payne K, Collins L. Nursing and health-care assistant experience of supervision in a medium secure psychiatric service for women: implications for service development. J Psychiatr Ment Health Nurs 2014; 21:154-62. [PMID: 23551325 DOI: 10.1111/jpm.12066] [Citation(s) in RCA: 15] [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] [Accepted: 02/17/2013] [Indexed: 11/26/2022]
Abstract
In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.
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Affiliation(s)
- C G Long
- St Andrew's Academic Centre, Kings College Institute of Psychiatry, Northampton, UK
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18
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Jordan K, Proskorovsky I, Lewis P, Ishak J, Payne K, Lordan N, Kyriakou C, Williams CD, Peters S, Davies FE. Effect of general symptom level, specific adverse events, treatment patterns, and patient characteristics on health-related quality of life in patients with multiple myeloma: results of a European, multicenter cohort study. Support Care Cancer 2014; 22:417-26. [PMID: 24122403 PMCID: PMC3882558 DOI: 10.1007/s00520-013-1991-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 09/17/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Novel multiple myeloma (MM) therapies have increased patient longevity but are often associated with notable symptom burden. This study quantified the effect of general symptom level, specific symptoms, and treatment-related adverse events (AEs) on MM patients' health-related quality of life (HRQoL). METHODS The European Organization for Research and Treatment of Cancer (EORTC) generic cancer questionnaire (Quality of Life Questionnaire Core 30) and MM-specific questionnaire (QLQ-MY20) were used in this study to assess patients' HRQoL. Data were collected on sociodemographics, disease and treatment history, and the presence/severity of MM-related symptoms or treatment-related AEs from patients with MM in UK and German centers. Multiple regression analyses were conducted. RESULTS Of 154 patients (63 % male; mean age, 66.4 years; mean time since diagnosis, 3.7 years; 52 % currently on treatment; and 43 % with ≥ 1 prior MM therapy), 25, 32, 31, and 11 % were severely symptomatic, moderately symptomatic, mildly symptomatic, and asymptomatic, respectively. Fatigue (59 %), bone pain (51 %), sleepiness (36 %), hypoesthesia or paresthesia (33 %), and muscle cramps (31 %) were most commonly reported. Moderate and severe general symptom levels, bone symptoms, depression, and mental status changes were identified as strong determinants of HRQoL. CONCLUSIONS Severity, type of disease symptoms, and treatment related AEs are important HRQoL determinants in patients with MM, allowing for targeted treatment.
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Robinson D, Reynolds M, Casper C, Dispenzieri A, Vermeulen J, Payne K, Schramm J, Ristow K, Desrosiers MP, Yeomans K, Teltsch D, Swain R, Habermann TM, Rotella P, Van de Velde H. Clinical epidemiology and treatment patterns of patients with multicentric Castleman disease: results from two US treatment centres. Br J Haematol 2014; 165:39-48. [PMID: 24387011 DOI: 10.1111/bjh.12717] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/02/2013] [Indexed: 12/22/2022]
Abstract
Multicentric Castleman disease (MCD) is a rare lymphoproliferative disease with little known about its epidemiology or treatment modalities. Clinical and demographic data of MCD patients identified between 2000 and 2009 were collected from medical records at two United States (US) MCD referral centres. ZIP codes identified patient residences; prevalence and incidence were estimated based on catchment areas. Patient clinical, demographic, and biochemical characteristics, drug therapies and medical utilization were descriptively reported. MCD patients (n = 59) were 61% male, mean age of 53 years (median = 55 years) and 68% Caucasian. Of those with known human immunodeficiency virus (HIV) status (n = 41), 85% (n = 35) were negative, 15% (n = 6) were positive. Most frequent physician-reported symptoms (n = 33) were fatigue (49%, n = 16), fever (39%, n = 13), and night sweats (30%, n = 10). The estimated US 10-year prevalence was 2·4 per million. During first year of follow-up after study entry, the top two systemic therapies (n = 27) were monotherapies: prednisone (33%, n = 9) and rituximab (19%, n = 5). After a follow-up of 2 years, 92% of patients were alive. This study provides new information on MCD population demographics, treatment patterns, and medical utilization; a minimal US period prevalence rate is proposed. Study replication is needed to improve external validity.
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Payne K, Goodson A, Tahim A, Cabot L, Fan K. What do UK medical undergraduates know about oral and maxillofacial surgery as a specialty and potential career? Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Heather EM, Payne K, Harrison MJ, Hyrich KL, Symmons DP. OP0065 Quantifying the Economic Impact of Serious Infections from Anti-TNFS for Rheumatoid Arthritis: Results from the BSRBR-RA. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shreay S, Desrosiers MP, Corey-Lisle P, Payne K. A retrospective study to evaluate the time burden associated with outpatient red blood transfusions indicated for anemia due to concomitantly administered chemotherapy in cancer patients. Support Care Cancer 2012; 21:1335-40. [PMID: 23262807 PMCID: PMC3612587 DOI: 10.1007/s00520-012-1671-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 11/19/2012] [Indexed: 11/14/2022]
Abstract
Purpose Anemia in cancer patients can be treated with red blood cell (RBC) transfusions. The patient burden associated with a treatment in terms of total time spent is an important factor to consider when measuring the benefits and challenges of a therapy. This study estimates the time-related patient burden associated with outpatient RBC transfusion. Methods A retrospective chart review of outpatient cancer patients receiving a RBC transfusion was conducted at 10 US centers. RBC transfusion time was measured as time elapsed from pre- to post-transfusion vital sign assessment and from transfusion start to stop time. Elapsed time from hemoglobin level testing and blood draw for cross-match to transfusion, estimated travel time and distance, and clinical and demographic data were also collected. Results Data from 110 patients (48.2 % male; mean age 64 ± 12 years) showed that the mean elapsed time between pre- and post-vital sign assessment was 4.2 h (95 % confidence interval (CI), 3.64–4.81) including 3.6 h (95 % CI, 3.0–4.1) on average to receive the actual RBC transfusion treatment. Hemoglobin level testing (mean Hg level, 8.33 g/dL ± 0.67) and blood drawn for cross-match were completed in an average of 31.2 h (95 % CI, 17.0–45.5) and 18.2 h (95 % CI, 12.1–24.2) prior to transfusion, respectively. Patient one-way travel time averaged 30.0 min (95 % CI, 25.9–34.3). Conclusions In the US, CIA patients experience an important time burden when being treated with RBC transfusion in addition to the burden already added by chemotherapy.
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Newman WG, Murphy BF, Callard A, Payne K. A role for genetic counsellors and clinical geneticists in pharmacogenetics? Clin Genet 2012; 82:201-2; author reply 203. [DOI: 10.1111/j.1399-0004.2012.01872.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Fleeman N, Martin Saborido C, Payne K, Boland A, Dickson R, Dundar Y, Fernández Santander A, Howell S, Newman W, Oyee J, Walley T. The clinical effectiveness and cost-effectiveness of genotyping for CYP2D6 for the management of women with breast cancer treated with tamoxifen: a systematic review. Health Technol Assess 2012; 15:1-102. [PMID: 21906462 DOI: 10.3310/hta15330] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer affecting women in the UK. Tamoxifen (TAM) is considered as the standard of care for many women with oestrogen receptor positive breast cancer. However, wide variability in the response of individuals to drugs at the same doses may occur, which may be a result of interindividual genetic differences (pharmacogenetics). TAM is known to be metabolised to its active metabolites N-desmethyl TAM and 4-hydroxytamoxifen by a number of CYP450 enzymes, including CYP2D6, CYP3A4, CYP2C9, CYP2C19 and CYP2B6. N-desmethyl TAM is further metabolised to endoxifen by CYP2D6. Endoxifen, which is also formed via the action of CYP2D6, is 30- to 100-fold more potent than TAM in suppressing oestrogen-dependent cell proliferation, and is considered an entity responsible for significant pharmacological effects of TAM. Thus, an association between the cytochrome P450 2D6 (CYP2D6) genotype and phenotype (expected drug effects) is believed to exist and it has been postulated that CYP2D6 testing may play a role in optimising an individual's adjuvant hormonal treatment. OBJECTIVES To determine whether or not testing for cytochrome P450 2D6 (CYP2D6) polymorphisms in women with early hormone receptor positive breast cancer leads to improvement in outcomes, is useful for health decision-making and is a cost-effective use of health-care resources. DATA SOURCES Relevant electronic databases and websites including MEDLINE, EMBASE and HuGENet [Centers for Disease Control and Prevention (Office of Public Health Genomics), Human Genome Epidemiology Network] were searched until July 2009. Further studies that became known to the authors via relevant conferences or e-mail alerts from an automatically updated search of the Scopus database were also included as the review progressed, up to March 2010. REVIEW METHODS A systematic review of the clinical effectiveness and cost-effectiveness of CYP2D6 testing was undertaken. As it was not possible to conduct meta-analyses, data were extracted into structured tables and narratively discussed. An exploratory analysis of sensitivity and specificity was undertaken. A review of economic evaluations and models of CYP2D6 testing for patients treated with TAM was also carried out. RESULTS A total of 25 cohorts were identified which examined clinical efficacy (overall survival and relapse/recurrence), adverse events and endoxifen plasma concentrations by genotype/phenotype. Significantly, six cohorts suggest extensive metabolisers (Ems) appear to have better outcomes than either poor metabolisers (PMs) or PMs + intermediate metabolisers in terms of relapse/recurrence; however, three cohorts report apparently poorer outcomes for EMs (albeit not statistically significant). There was heterogeneity across the studies in terms of the patient population, alleles tested and outcomes used and defined. One decision model proposing a strategy for CYP2D6 testing for TAM was identified, but this was not suitable for developing a model to examine the cost-effectiveness of CYP2D6 testing. It was not possible to produce a de novo model because of a lack of data to populate it. CONCLUSION This is a relatively new area of research that is evolving rapidly and, although international consortia are collaborating, the data are limited and conflicting. Therefore, it is not possible to recommend pharmacogenetic testing in this patient population. Future research needs to focus on which alleles (including, or in addition to, those related to CYP2D6) reflect patient response, the link between endoxifen levels and clinical outcomes, and the appropriate pathways for implementation of such pharmacogenetic testing in patient care pathways.
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Affiliation(s)
- N Fleeman
- Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
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Abstract
This case report presents an unusual incidental radiographic finding on a dental panoramic radiograph that caused diagnostic confusion. A 46-year-old female presented with symmetrical sclerotic cortical thickening of the anterior mandible visible on radiograph, with no other major clinical examination findings. The patient subsequently showed no change in radiographic appearance over a 6 year period. Based on this evidence, and the benign nature of the history, we propose a diagnosis of Worth syndrome. This report aims to clarify the difference in terminology and presentation of two conditions known to produce mandibular osteosclerosis: Worth syndrome and Van Buchem disease, both of which are often quoted synonymously in the literature.
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Affiliation(s)
- K Payne
- Royal Derby Hospital, Derby, UK
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Payne K, Dickenson A, Jones K. The oral and maxillofacial surgery operative note: current national practice. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.03.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Elliott RA, Payne K, Davies LM, Moore JK, Moore EW. Children's outcomes and parents' preferences for the induction and maintenance of anaesthesia for day-case surgery. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2002.tb00671.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- R A Elliott
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester
| | - K Payne
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester
- Health Economics Research at Manchester, School of Psychiatry and Behavioural Sciences, University of Manchester
| | - L M Davies
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester
- Health Economics Research at Manchester, School of Psychiatry and Behavioural Sciences, University of Manchester
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Payne K. Pharmacogenetics: towards the safe, effective and cost-effective use of medicines? International Journal of Pharmacy Practice 2010. [DOI: 10.1111/j.2042-7174.2010.tb00503.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Payne
- Senior Research Fellow, The University of Manchester, Manchester, United Kingdom
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Liu H, Brais R, Lavergne-Slove A, Jeng Q, Payne K, Ye H, Liu Z, Carreras J, Huang Y, Bacon CM, Hamoudi RA, Save V, Venkatraman L, Isaacson PG, Woodward J, Du MQ. Continual monitoring of intraepithelial lymphocyte immunophenotype and clonality is more important than snapshot analysis in the surveillance of refractory coeliac disease. Gut 2010; 59:452-60. [PMID: 19996326 DOI: 10.1136/gut.2009.186007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE An aberrant immunophenotype and monoclonality of intraepithelial lymphocytes (IELs) are frequently found in refractory coeliac disease (RCD). However, the utility of continual monitoring of IEL immunophenotype and clonality in the surveillance of RCD remains to be studied. DESIGN The diagnostic and follow-up biopsies from 33 patients with CD, 7 with suspected RCD, 41 with RCD and 20 with enteropathy-associated T cell lymphoma (EATL) (including 11 evolved from RCD) were investigated by CD3epsilon/CD8 double immunohistochemistry and PCR-based clonality analysis of the rearranged T cell receptor (TCR) genes. RESULTS An aberrant immunophenotype (CD3epsilon(+)CD8(-) IELs > or =40%) and monoclonality were detected occasionally in CD biopsies, either transiently in patients with CD not compliant with a gluten-free diet or in those who subsequently developed suspected RCD, RCD or EATL. In contrast, the aberrant immunophenotype and monoclonality were found in 30 of 41 (73%) and 24 of 37 (65%) biopsies, respectively, at the time of RCD diagnosis. Among the patients with RCD who did not show these abnormalities in their diagnostic biopsies, 8 of 10 (80%) and 5 of 11 (45%) cases gained an aberrant immunophenotype and monoclonality, respectively, during follow-up. Irrespective of whether detected in diagnostic or follow-up biopsies, persistence of both abnormalities was characteristic of RCD. Importantly, the presence of concurrent persistent monoclonality and aberrant immunophenotype, especially > or =80% CD3epsilon(+)CD8(-) IELs, was a strong predictor of EATL development in patients with RCD (p=0.001). CONCLUSIONS Continual monitoring of both immunophenotype and clonality of IELs is more important than snapshot analysis for RCD diagnosis and follow-up, and could provide a useful tool for surveillance of patients at risk of EATL.
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Affiliation(s)
- H Liu
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK.
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Fleeman N, McLeod C, Bagust A, Beale S, Boland A, Dundar Y, Jorgensen A, Payne K, Pirmohamed M, Pushpakom S, Walley T, de Warren-Penny P, Dickson R. The clinical effectiveness and cost-effectiveness of testing for cytochrome P450 polymorphisms in patients with schizophrenia treated with antipsychotics: a systematic review and economic evaluation. Health Technol Assess 2010; 14:1-157, iii. [PMID: 20031087 DOI: 10.3310/hta14030] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine whether testing for cytochrome P450 (CYP) polymorphisms in adults entering antipsychotic treatment for schizophrenia leads to improvement in outcomes, is useful in medical, personal or public health decision-making, and is a cost-effective use of health-care resources. DATA SOURCES The following electronic databases were searched for relevant published literature: Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Technology Assessment database, ISI Web of Knowledge, MEDLINE, PsycINFO, NHS Economic Evaluation Database, Health Economic Evaluation Database, Cost-effectiveness Analysis (CEA) Registry and the Centre for Health Economics website. In addition, publicly available information on various genotyping tests was sought from the internet and advisory panel members. REVIEW METHODS A systematic review of analytical validity, clinical validity and clinical utility of CYP testing was undertaken. Data were extracted into structured tables and narratively discussed, and meta-analysis was undertaken when possible. A review of economic evaluations of CYP testing in psychiatry and a review of economic models related to schizophrenia were also carried out. RESULTS For analytical validity, 46 studies of a range of different genotyping tests for 11 different CYP polymorphisms (most commonly CYP2D6) were included. Sensitivity and specificity were high (99-100%). For clinical validity, 51 studies were found. In patients tested for CYP2D6, an association between genotype and tardive dyskinesia (including Abnormal Involuntary Movement Scale scores) was found. The only other significant finding linked the CYP2D6 genotype to parkinsonism. One small unpublished study met the inclusion criteria for clinical utility. One economic evaluation assessing the costs and benefits of CYP testing for prescribing antidepressants and 28 economic models of schizophrenia were identified; none was suitable for developing a model to examine the cost-effectiveness of CYP testing. CONCLUSIONS Tests for determining genotypes appear to be accurate although not all aspects of analytical validity were reported. Given the absence of convincing evidence from clinical validity studies, the lack of clinical utility and economic studies, and the unsuitability of published schizophrenia models, no model was developed; instead key features and data requirements for economic modelling are presented. Recommendations for future research cover both aspects of research quality and data that will be required to inform the development of future economic models.
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Affiliation(s)
- N Fleeman
- Liverpool Reviews and Implementation Group, University of Liverpool, UK
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Meile C, Porubsky WP, Walker RL, Payne K. Natural attenuation of nitrogen loading from septic effluents: Spatial and environmental controls. Water Res 2010; 44:1399-1408. [PMID: 19948353 DOI: 10.1016/j.watres.2009.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 10/02/2009] [Accepted: 11/11/2009] [Indexed: 05/28/2023]
Abstract
We assess the role of septic systems as potential nitrogen (N) sources to coastal open water bodies. To quantify the potential role of septic tanks, we document the distribution pattern and functionality of septic tanks in McIntosh County in Georgia, USA, and examine factors governing the mitigation of septic N loading in coastal groundwater. Employing a field calibrated 2D variable-density reaction-transport model, we focus on the role of setback distance of a leaky septic source from the receiving surface waters, on transport and biogeochemical characteristics of the subsurface environment, and on leachate composition and reactivity. We conclude that the removal of bioavailable nitrogen via denitrification may be increased by increasing the septic system setback distance, in particular in brackish and saline coastal settings where sulfide produced in sulfate reduction can limit N(2) production.
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Affiliation(s)
- C Meile
- Department of Marine Sciences, The University of Georgia, Athens, GA 30602, USA.
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Payne K, Myhr G. Increasing Access to Cognitive-Behavioural Therapy (CBT) for the Treatment of Mental Illness in Canada: A Research Framework and Call for Action. Healthc Policy 2010. [DOI: 10.12927/hcpol.2013.21647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bharmal M, Payne K, Atkinson MJ, Desrosiers MP, Morisky DE, Gemmen E. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. Health Qual Life Outcomes 2009; 7:36. [PMID: 19397800 PMCID: PMC2678998 DOI: 10.1186/1477-7525-7-36] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/27/2009] [Indexed: 11/22/2022] Open
Abstract
Background The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM) Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9), derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS)-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication. Methods A total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA). Results A total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test-retest reliability with high intraclass correlation coefficients exceeding 0.70. As expected, the TSQM-9 domains were able to differentiate between individuals who were low, medium and high compliers of medication, with moderate to high effect sizes. There was evidence of convergent validity with significant correlations with the medication adherence scale. Conclusion The IVRS-administered TSQM-9 was found to be a reliable and valid measure to assess treatment satisfaction in naturalistic study designs, in which there is potential that the administration of the side effects domain of the TSQM would interfere with routine clinical care.
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Turbyville J, Payne K, Gada S, Nelson M. Post-tussive Emesis as a Symptom of Asthma in Children. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rofail D, Abetz L, Viala M, Gait C, Baladi JF, Payne K. Satisfaction and adherence in patients with iron overload receiving iron chelation therapy as assessed by a newly developed patient instrument. Value Health 2009; 12:109-117. [PMID: 18637142 DOI: 10.1111/j.1524-4733.2008.00390.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES This study assesses satisfaction with iron chelation therapy (ICT) based on a reliable and valid instrument, and explores the relationship between satisfaction and adherence to ICT. METHODS Patients in the USA and UK completed a new "Satisfaction with ICT" (SICT) instrument consisting of 28 items, three pertaining to adherence. Simple and multivariate regression analyses assessed the relationship between satisfaction with different aspects of ICT and adherence. RESULTS First assessments of the SICT instrument indicate its validity and reliability. Recommended thresholds for internal consistency, convergent validity, discriminant validity, and floor and ceiling effects were met. A number of variables were identified in the simple linear regression analyses as significant predictors of "never thinking about stopping ICT," a proxy for adherence. These significant variables were entered into the multivariate model to assess the combined factor effects, explaining 42% of the total variance of "never thinking about stopping ICT." A significant and positive relationship was demonstrated between "never thinking about stopping ICT" and age (P = 0.04), Perceived Effectiveness of ICT (P = 0.003), low Burden of ICT (P = 0.002), and low Side Effects of ICT (P = 0.01). CONCLUSIONS The SICT is a reliable and valid instrument which will be useful in ICT clinical trials. Furthermore, the administration of ICT by slow subcutaneous infusion negatively impacts on satisfaction with ICT which was shown to be a determinant of adherence. This points to the need for new more convenient and less burdensome oral iron chelators to increase adherence, and ultimately to improve patient outcomes.
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Fargher EA, Tricker K, Newman W, Elliott R, Roberts SA, Shaffer JL, Bruce I, Payne K. Current use of pharmacogenetic testing: a national survey of thiopurine methyltransferase testing prior to azathioprine prescription. J Clin Pharm Ther 2007; 32:187-95. [PMID: 17381669 DOI: 10.1111/j.1365-2710.2007.00805.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Azathioprine is an immunosuppressant prescribed for the treatment of inflammatory conditions and after organ transplantation. Risk of neutropaenia has limited the effective use of azathioprine (AZA) and driven requirements for careful monitoring and blood tests. Thiopurine methyltransferase (TPMT) is a genetically moderated key enzyme involved in the metabolism of AZA that can be used to stratify individuals into different levels of risk of developing neutropaenia. Two techniques can be used to measure TPMT status: enzyme-level testing (phenotype testing) and DNA based testing (genotype testing). OBJECTIVE To identify the current uptake of TPMT enzyme-level testing, TPMT genotype testing, and, the role of guidelines; to inform the prescribing and monitoring of AZA. METHOD A survey was mailed to a consultant dermatologist, gastroenterologist, and rheumatologist at every NHS Hospital Trust in England. The survey comprised mainly closed questions exploring: use of AZA and monitoring; use of TPMT enzyme-level testing and genotype testing; and, the role of guidelines to guide prescribing practice. RESULTS A 70% (n=287) response rate was obtained. The majority of respondents reported prescribing AZA (99%, n=283). Prescribing and monitoring patterns differed between individual respondents and between the three disciplines. TPMT enzyme-level testing was reportedly used by 67% (n=189) of respondents, but this differed by discipline (dermatologists 94%, gastroenterologists 60%, rheumatologists 47%). In 91% of cases enzyme-level testing was carried out prior to prescribing AZA. Genotype testing is not typically available to NHS clinicians but 15 clinicians (six dermatologists, six gastroenterologists, three rheumatologists) reported using it. Most consultants (82%) reported using guidelines to inform their AZA prescribing and monitoring (dermatologists 81%, gastroenterologists 75%, rheumatologists 94%). CONCLUSION Two-thirds of the consultants surveyed in England are using TPMT enzyme-level testing, prior to AZA treatment. Uptake differs between specialities. High uptake of TPMT enzyme-level testing by dermatologists, compared with gastroenterologists and rheumatologists, may reflect national guidelines advocating its use prior to AZA. Uptake of enzyme-level testing may alter in other specialties as other guidelines are developed.
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Affiliation(s)
- E A Fargher
- North West Genetics Knowledge Park (Nowgen), Manchester, UK
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Gemmell I, Heller RF, Payne K, Edwards R, Roland M, Durrington P. Potential population impact of the UK government strategy for reducing the burden of coronary heart disease in England: comparing primary and secondary prevention strategies. Qual Saf Health Care 2007; 15:339-43. [PMID: 17074870 PMCID: PMC2565818 DOI: 10.1136/qshc.2005.017061] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To use population impact measures to help prioritise the National Service Framework (NSF) strategies recommended by the UK government for reducing the population burden of coronary heart disease (CHD). DESIGN Modelling study. SETTING Primary care. DATA SOURCES Published data on incidence, baseline risk and prevalence of risk factors for CHD and the proportion treated, eligible for treatment, and adhering to the different interventions. Data from meta-analyses and systematic reviews for relative risk and relative risk reduction associated with different risk factors and interventions. MAIN OUTCOME MEASURES Population impact measures for the decline in the prevalence of a risk factor and the increased uptake of interventions expressed as number of CHD events prevented in the population. RESULTS If lifestyle targets for primary prevention are met, 73 522 (95% CI 54,117 to 95,826) CHD events would be prevented per year, with the greatest gain coming from reduced cholesterol and blood pressure levels. In those at high risk of developing CHD, achieving target levels for lifestyle interventions would prevent 4410 (95% CI 1993 to 8014) CHD events and for pharmacological treatments 2008 (95% CI 790 to 3627) CHD events. For patients with established CHD, achieving NSF targets will result in the prevention of 3067 (95% CI 1572 to 5878) CHD events through improved drug treatment and 1103 (95% CI 179 to 2097) events through lifestyle interventions. CONCLUSION Current strategies focus largely on secondary prevention, but many more cardiovascular events would be prevented by meeting the government's public health and primary prevention targets than targeting people at high risk or those with established heart disease.
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Affiliation(s)
- I Gemmell
- Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT, UK.
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Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C. Cost-effectiveness of cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion: a systematic review and economic model. Health Technol Assess 2007; 10:iii-iv, ix-x, 1-210. [PMID: 17049141 DOI: 10.3310/hta10440] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare patient outcomes, resource use and costs to the NHS and NHS Blood Transfusion Authority (BTA) associated with cell salvage and alternative methods of minimising perioperative allogeneic blood transfusion. DATA SOURCES Electronic databases covering the period 1996-2004 for systematic reviews and 1994-2004 for economic evidence. REVIEW METHODS Existing systematic reviews were updated with data from selected randomised controlled trials (RCTs) that involved adults scheduled for elective non-urgent surgery. Any resource use or cost data were extracted for potential use in populating an economic model. Relative risks or weighted mean difference of each outcome for each intervention were assessed, taking into account the number of RCTs included in each outcome and intervention and the presence of any heterogeneity. This allowed indirect comparison of the relative effectiveness of each intervention when the intervention is compared with allogeneic blood transfusion. A decision analytic model synthesised clinical and economic data from several sources, to estimate the relative cost-effectiveness of cell salvage for people undergoing elective surgery with moderate to major expected blood loss. The perspective of the NHS and patients and a time horizon of 1 month were used. The economic model was developed from reviews of effectiveness and cost-effectiveness and clinical experts. Secondary analysis explored the robustness of the results to changes in the timing and costs of cell salvage equipment, surgical procedure, use of transfusion protocols and time horizon of analysis. RESULTS Overall, 668 studies were identified electronically for the update of the two systematic reviews. This included five RCTs, of which two were cell salvage and three preoperative autologous donation (PAD). Five published systematic reviews were identified for antifibrinolytics, fibrin sealants and restrictive transfusion triggers, PAD plus erythropoietin, erythropoietin alone and acute normovolaemic haemodilution (ANH). Twelve published studies reported full economic evaluations. All but two of the transfusion strategies significantly reduced exposure to allogeneic blood. The relative risk of exposure to allogeneic blood was 0.59 for the pooled trials of cell salvage (95% confidence interval: 0.48 to 0.73). This varied by the type and timing of cell salvage and type of surgical procedure. For cell salvage, the relative risk of allogeneic blood transfusion was higher in cardiac surgery than in orthopaedic surgery. Cell salvage had lower costs and slightly higher quality-adjusted life years compared with all of the alternative transfusion strategies except ANH. The likelihood that cell salvage is cost-effective compared with strategies other than ANH is over 50%. Most of the secondary analyses indicated similar results to the primary analysis. However, the primary and secondary analyses indicated that ANH may be more cost-effective than cell salvage. CONCLUSIONS The available evidence indicates that cell salvage may be a cost-effective method to reduce exposure to allogeneic blood transfusion. However, ANH may be more cost-effective than cell salvage. The results of this analysis are subject to the low quality and reliability of the data used and the use of indirect comparisons. This may affect the reliability and robustness of the clinical and economic results. There is a need for further research that includes adequately powered high-quality RCTs to compare directly various blood transfusion strategies. These should include measures of health status, health-related quality of life and patient preferences for alternative transfusion strategies. Observational and tracking studies are needed to estimate reliably the incidence of adverse events and infections transmitted during blood transfusion and to identify the lifetime consequences of the serious hazards of transfusion on mortality, health status and health-related quality of life.
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Affiliation(s)
- L Davies
- Health Economics Research, University of Manchester, UK
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Payne K, Newman W, Fargher E, Tricker K, Bruce IN, Ollier WER. TPMT testing in rheumatology: any better than routine monitoring? Rheumatology (Oxford) 2007; 46:727-9. [PMID: 17255139 DOI: 10.1093/rheumatology/kel427] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Power A, McCrickard B, Mitchell M, Covington E, Sweeney-Reeves M, Payne K, Walker R. Perkinsus marinus in coastal Georgia, USA, following a prolonged drought. Dis Aquat Organ 2006; 73:151-8. [PMID: 17260834 DOI: 10.3354/dao073151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Oysters Crassostrea virginica are 'keystone' estuarine species in the southeastern USA, providing essential fish habitat, food for human consumption, filtration of water bodies, and protection against shoreline erosion. Relatively few oyster pathology studies have been conducted in Georgia. The parasitic protozoan Perkinsus marinus was first observed here in the 1960s, but has not been investigated since the late 1990s, when increasing oyster infection levels were apparent. In the late 1990s and early 2000s, the region suffered a prolonged drought, resulting in elevated salinities and the proliferation of various diseases in the marine environment. By 2003, salinities had returned to normal levels, but the effect of the drought on oysters was unknown. In June 2003, oyster reefs throughout Chatham County were sampled to evaluate the prevalence and intensity of P. marinus. The disease appears to have remained prevalent in the coastal waters of Georgia (100% prevalence at some sites), but the intensity was low, ranging from 0 to 1.83 on a scale where heavy infections rated a score of 5. While the disease did not occur at levels high enough to cause oyster mortalities, further monitoring, particularly on a temporal scale, is warranted.
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Affiliation(s)
- A Power
- University of Georgia Marine Extension Service, Shellfish Research Laboratory, 20 Ocean Science Circle, Savannah, Georgia 31411-1011, USA.
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Brown TJ, Hooper L, Elliott RA, Payne K, Webb R, Roberts C, Rostom A, Symmons D. A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling. Health Technol Assess 2006; 10:iii-iv, xi-xiii, 1-183. [PMID: 17018227 DOI: 10.3310/hta10380] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [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] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the relative effectiveness, patient acceptability, costs and cost-effectiveness of four strategies for the prevention of non-steroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal (GI) toxicity: (1) Cox-1 NSAIDs plus histamine-2 receptor antagonist (H2RA), (2) Cox-1 NSAIDs plus proton pump inhibitors (PPIs), (3) Cox-1 NSAIDs plus misoprostol, and (4) Cox-2 NSAIDs (later expanded to 4a Cox-2 coxibNSAIDs and 4b Cox-2 preferential NSAIDs). DATA SOURCES Electronic databases up to May 2002. REVIEW METHODS Relevant studies were selected, assessed and analysed. Pooled relative risk ratios (RR) from the systematic review were combined with up-to-date UK resource use and unit costs data in an incremental economic analysis. A probabilistic decision-analytic model was designed and populated with data to carry out incremental economic analysis. Incremental cost-effectiveness ratios (ICERs) were generated for the outcome measure, endoscopic ulcer or serious GI event averted, against total cost, and non-parametric bootstrapping was used to simulate variance of these ICERs. RESULTS Of 118 selected trials, including 125 relevant comparisons (which included 76,322 participants) only 138 deaths and 248 serious GI events were reported. Seven comparisons were judged to be at low risk of bias. Comparing the gastroprotective strategies against placebo, there was no evidence of effectiveness of H2RAs against any primary outcomes (few events reported), PPIs may reduce the risk of symptomatic ulcers [RR 0.09, 95% confidence interval (CI) 0.02 to 0.47], misoprostol reduces the risk of serious GI complications (RR 0.57, 95% CI 0.36 to 0.91) and symptomatic ulcers (RR 0.36, 95% CI 0.20 to 0.67), Cox-2 'preferentials' reduce the risk of symptomatic ulcers (RR 0.41, 95% CI 0.26 to 0.65) and Cox-2 'coxibs' reduce the risk of symptomatic ulcers (RR 0.49, 95% CI 0.38 to 0.62) and possibly serious GI events (RR 0.55, 95% CI 0.38 to 0.80). All strategies except Cox-2 'preferentials' reduce the risk of endoscopic ulcers. There were only 12 direct comparisons between gastroprotective strategies. All they suggest is that Cox-2 preferentials are better than misoprostol for preventing GI complications. Indirect comparisons suggested that PPIs may prevent symptomatic ulcers better than Cox-2 coxibs, but this is very weak evidence. For prevention of endoscopic ulcers PPIs and misoprostol appear more successful than H2RAs and misoprostol is better than Cox-2 preferentials. There were no UK head-to-head published economic analyses with regard to the main gastroprotective strategies. There were generally insufficient data with regards to cardiac or renal outcomes, serious GI outcomes or life-years gained to populate the mode. Mean (2.5th and 97.5th percentile) costs per endoscopic ulcer averted compared with Cox-1 NSAIDs alone were as follows: Cox-1 plus H2RAs, -186 pounds (-555 to 804); Cox-1 plus PPIs, 454 pounds (251 to 877); Cox-1 plus misoprostol, 54 pounds (-112 to 238); Cox-2 selective NSAIDs, 263 pounds (-570 to 1280), or Cox-2 specific NSAIDs, 301 pounds (189 to 418). With regard to the prevention of endoscopic ulcers, Cox-1 NSAID plus H2RA is a dominant option. Cost-effectiveness acceptability analysis showed a 95% probability that this combination was less costly and more effective. Cost-effectiveness acceptability frontiers showed that if the decision-maker is willing to pay up to 750 pounds to avoid an endoscopic ulcer, then Cox-1 plus H2RA is the optimal strategy. If the decision-maker is willing to pay over 750 pounds, the optimal strategy is NSAID plus misoprostol. Between 1900 pounds and 3750 pounds, Cox-2 selective inhibitors are optimal, and over 3750 pounds, Cox-2 specific inhibitors become optimal. NSAID plus PPI is never the optimal strategy. Sensitivity and subgroup analyses suggest that Cox-1 NSAID plus H2RA and Cox-1 NSAID plus misoprostol become more cost-effective in the older age group. Some conclusions were associated with high levels of uncertainty. CONCLUSIONS Although there is a very large body of evidence comparing Cox-2 NSAIDs with Cox-1 NSAIDs, this is not matched by studies of the other types of gastroprotectors or by studies directly comparing active gastroprotective strategies. This lack of direct comparisons led to the use of indirect comparisons to help understand the relative efficacy of these strategies. Indirect evidence in itself is weak and was also hampered by lack of evidence in the underlying studies (where the gastroprotectors were compared with placebo). Economic modelling suggests that Cox-1 NSAID plus H2RA or Cox-1 NSAID plus PPI are the most cost-effective strategies for avoiding endoscopic ulcers in patients requiring long-term NSAID therapy. All strategies other than Cox-2 selective inhibitors reduce the rate of endoscopic ulcer compared with Cox-1 alone. The economic analysis suggests that there may be a case for prescribing H2RAs in all patients requiring NSAIDs. Misoprostol is more effective, but is associated with a greater cost and GI side-effects which may be unacceptable for patients. However, when assessing serious GI events, the economic analysis is sufficiently weakened by the data available as to render clear practice recommendations impossible. Further large, independent RCTs directly comparing various gastroprotective strategies are needed. These should report items such as major outcomes, primary data, adverse events, assessment of practice and patient preference.
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Affiliation(s)
- T J Brown
- arc Epidemiology Unit, University of Manchester, UK
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Myhr G, Payne K. Cost-effectiveness of cognitive-behavioural therapy for mental disorders: implications for public health care funding policy in Canada. Can J Psychiatry 2006; 51:662-70. [PMID: 17052034 DOI: 10.1177/070674370605101006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. METHOD We searched the literature for economic analyses of CBT in the treatment of mental disorders. RESULTS We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. CONCLUSIONS International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.
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Affiliation(s)
- Gail Myhr
- Department of Psychiatry, McGill University Health Centre (Royal Victoria Hospital), Montreal, Quebec.
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Gemmell I, Heller RF, McElduff P, Payne K, Butler G, Edwards R, Roland M, Durrington P. Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease. J Epidemiol Community Health 2006; 59:1041-6. [PMID: 16286491 PMCID: PMC1732977 DOI: 10.1136/jech.2005.035717] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVE To assess the potential number of lives saved associated with the full implementation of aspects of the National Service Framework (NSF) for coronary heart disease (CHD) in England using recently developed population impact measures. DESIGN Modelling study. SETTING Primary care. DATA SOURCES Published data on prevalence of acute myocardial infarction and heart failure, baseline risk of mortality, the relative risk reduction associated with different interventions and the proportion treated, eligible for treatment and adhering to each intervention. MAIN RESULTS Adopting the NSF recommendations for pharmacological interventions would prevent an extra 1027 (95% CI 418 to 1994) deaths in post-acute myocardial infarction (AMI) patients and an extra 37 899 (95% CI 25 690 to 52 503) deaths in heart failure patients in the first year after diagnosis. Lifestyle based interventions would prevent an extra 848 (95% CI 71 to 1 614) deaths in post-AMI patients and an extra 7249 (95% CI 995 to 16 696) deaths in heart failure patients. CONCLUSIONS Moving from current to "best" practice as recommended in the NSF will have a much greater impact on one year mortality rates among heart failure patients compared with post-AMI patients. Meeting pharmacological based recommendations for heart failure patients will prevent more deaths than meeting lifestyle based recommendations. Population impact numbers can help communicate the impact on a population of the implementation of guidelines and, when created using local data, could help policy makers assess the local impact of implementing a range of health care targets.
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Affiliation(s)
- I Gemmell
- Evidence for Public Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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Elliott RA, Hooper L, Payne K, Brown TJ, Roberts C, Symmons D. Preventing non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: are older strategies more cost-effective in the general population? Rheumatology (Oxford) 2005; 45:606-13. [PMID: 16368733 DOI: 10.1093/rheumatology/kei241] [Citation(s) in RCA: 31] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the relative cost-effectiveness of five gastroprotective strategies for patients in the general population not judged to be at high gastrointestinal (GI) risk requiring regular traditional (t) non-steroidal anti-inflammatory drugs (NSAIDs) for over 3 weeks: tNSAID/H(2) receptor antagonists (H(2)RAs); tNSAID/proton pump inhibitors (PPIs); tNSAID/misoprostol; COX-2 preferential NSAIDs or COX-2-specific NSAIDs (COXIBs). METHODS A systematic review of outcomes and UK cost data were combined in an incremental economic analysis. Incremental cost-effectiveness ratios were generated for quality-adjusted life years (QALYs) gained. RESULTS Cost-utility analysis showed a tNSAID with a H(2)RA is safer and less costly than tNSAIDs alone, and equally effective and less costly than COXIBs. tNSAID/misoprostol was also dominated by tNSAID/H(2)RA due to withdrawal caused by side-effects reducing overall health status. The incremental increase in QALYs gained by using COXIBs instead of tNSAID/H(2)RA would cost 670,000 pounds per QALY gained. The incremental increase in QALYs gained by using tNSAID/PPI instead of COXIBs would cost 26,000 pounds per QALY gained. If the decision-maker will pay up to 140,000 pounds per extra QALY, the optimal strategy is tNSAID/H(2)RA. If the decision-maker will pay over this the optimal strategy is tNSAID/PPI. CONCLUSION The economic analysis suggests that there may be a case for prescribing H(2)RAs in all patients requiring NSAIDs. Our recommendations are tentative due to the quality of the data available and the assumptions we have had to make in our model, and it is possible that other strategies may be preferred in patients with higher baseline GI risk.
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Affiliation(s)
- R A Elliott
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester M13 9PL, UK.
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Abstract
Although routine use of vaccines has diminished the incidence of pertussis disease, it has not eliminated the pathogen. Epidemiologic data confirm that pertussis remains a significant health problem in all age groups. Disease burden is highest in infants, in whom pertussis disease frequently leads to severe complications and mortality, although it is also a significant health burden in adolescents and adults, in whom the reported incidence of pertussis is increasing. The Global Pertussis Initiative reviewed the literature to find data that express the economic impact of this health burden and to review economic evaluations of pertussis immunization. Although only limited data on the direct and indirect costs of pertussis are available, they suggest that it poses a significant economic burden and indicate that the direct medical costs of pertussis depend on the rate of hospitalization and the severity of complications, and are highest in infants. The indirect costs of pertussis also appear to be considerable, particularly among adults, in whom the disease reduces work productivity, because of either personal illness or child care responsibilities. Several health economic models on the cost effectiveness of childhood immunization strategies have been published, and although constrained by missing data, have generally found childhood immunization strategies to be cost-effective. Economic analyses of adolescent and adult immunization strategies have also been conducted, but the findings of these studies have been inconsistent. The most recent evaluations, using much higher estimates of incidence than reported previously, suggest that immunization of adolescents and specific adult subgroups may be cost-effective. The literature review confirmed that the economic burden of pertussis is substantial, but there are gaps in existing information. In the short term, further economic analyses are required, particularly of adolescent and adult immunization. More importantly, collection of primary epidemiologic and economic data should be undertaken in parallel. Despite the existing gaps in data, further research using the most current data should facilitate decisions on new vaccination strategies by describing conditions for favorable results and quantifying the margin of uncertainty.
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Affiliation(s)
- J Jaime Caro
- Caro Research Institute, Concord, MA 01742, USA.
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Abstract
The incidence of reported pertussis has increased during the past decade and poses a growing health and economic burden in developed countries, despite high rates of primary vaccination. Administration of a booster dose of acellular pertussis vaccine to adolescents may help reduce this burden, not only by reducing infections in vaccinated individuals but also by reducing transmission of Bordetella pertussis to other individuals, particularly infants. An epidemiologic model was created to assess the health and economic impact of implementing a program of routine acellular pertussis immunization in adolescents 11-18 years of age in the United States, considering both the reduction in cases in those vaccinated and among the unvaccinated population (due to herd immunity). Inputs for the base case were defined according to information derived from published literature and were supplemented by estimates provided by members of the Global Pertussis Initiative. Both direct and indirect costs were included (in 2002 US dollars) using U.S. data. Outcomes were evaluated over the lifetime of a cohort of potential adolescent vaccine candidates. Because of uncertainty in many of the inputs, extensive sensitivity analyses were conducted. With 80% vaccination coverage of adolescents and a 20% reduction of other cases because of herd immunity, >68,000 cases and 41 pertussis-related deaths would be avoided in the subsequent 10 years by routine administration of acellular pertussis boosters to a single cohort of adolescents in the United States. This strategy would be cost-effective, incurring from 6000 US dollars to 22,000 US dollars per life-year gained. The level of herd immunity attained and the true incidence of pertussis are critical determinants of cost effectiveness, as is the duration of immunity resulting from immunization. The cost of immunization and the discount rate also play a role. Although there is considerable uncertainty surrounding key inputs, the results indicate that the conditions required for adolescent immunization to be economically warranted are realistic.
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Affiliation(s)
- J Jaime Caro
- Caro Research Institute, Concord, MA 01742, USA.
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Getsios D, Caro JJ, Ishak KJ, El-Hadi W, Payne K. Canadian economic comparison of extended-release oxybutynin and immediate-release tolterodine in the treatment of overactive bladder. Clin Ther 2004; 26:431-8. [PMID: 15110136 DOI: 10.1016/s0149-2918(04)90039-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Overactive bladder (OAB) is a condition characterized by urgency, increased frequency of micturition, or urge incontinence. It affects a considerable segment of the population, particularly with increasing age. Pharmacotherapy is one of the most common approaches to the treatment of OAB. OBJECTIVE This article describes the development and results of a model comparing health-economic outcomes for the new extended-release (XL) formulation of oxybutynin and immediate-release (IR) tolterodine in a population of community-dwelling Canadian adults with OAB. METHODS A Markov model was developed to compare health-economic outcomes over the course of 1 year. Effectiveness and treatment-persistence data were derived from the OBJECT (Overactive Bladder: Judging Effective Control and Treatment) trial, a 3-month comparison of oxybutynin XL 10 mg and tolterodine IR 4 mg, and were used, together with data from the literature (identified through a MEDLINE search of articles published between 1990 and 2003), to project outcomes beyond the trial period. Severity-specific cost profiles for incontinence were developed. In the principal analyses, cost items were limited to drug therapy, physician visits, use of pads or other protection, and laundry costs. Costs are reported in 2002 Canadian dollars. RESULTS Costs after 1 year were estimated to be an average of $32 less per patient for oxybutynin XL compared with tolterodine IR, and 3.1 additional patients in every 100 who received oxybutynin XL were expected to attain complete continence compared with those who received tolterodine. During the course of 1 year, patients receiving oxybutynin XL were expected to have a mean 16.5 additional incontinence-free days compared with those receiving tolterodine IR. The results were sensitive to relative drug prices. In the other sensitivity analyses, however, oxybutyrin XL maintained its advantage over a wide range of inputs. CONCLUSION The results of these analyses suggest that when priced equivalently, oxybutynin XL would reduce costs and provide better results than tolterodine IR over 1 year of treatment.
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Affiliation(s)
- Denis Getsios
- Caro Research Institute, Hammonds Plains, Nova Scotia, Canada
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Getsios D, Caro JJ, Ishak KJ, El-Hadi W, Payne K, O'connel M, Albrecht D, Feng W, Dubois D. Oxybutynin Extended Release and Tolterodine Immediate Release. Clin Drug Investig 2004; 24:81-8. [PMID: 17516694 DOI: 10.2165/00044011-200424020-00003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a new extended-release (XL) formulation of oxybutynin relative to tolterodine immediate release (IR), currently the most prescribed treatment for overactive bladder in the UK. METHODS A state-transition model was developed to compare outcomes over 1 year. Effectiveness and treatment persistence data were derived from the OBJECT (Overactive Bladder: Judging Effective Control and Treatment) study, a 3-month clinical trial comparing oxybutynin XL 10 mg/day with tolterodine IR 4 mg/day. The daily costs of oxybutynin XL and tolterodine IR were pound0.82 and pound1.04, respectively. These data and information from the literature were used to project outcomes beyond the trial time. Severity-specific incontinence cost profiles were developed for the UK (2002 costings). RESULTS After 1 year, 3.1 more patients per 100 treated attained complete continence with oxybutynin XL compared with tolterodine IR, and 5.6% more had less than seven incontinent episodes per week. Over 1 year, patients receiving oxybutynin XL had almost 17 additional incontinence-free days and 95 fewer incontinent episodes. Estimated costs were pound86 lower per patient with oxybutynin XL. If drugs are priced equally, savings decrease to pound21 per patient. Oxybutynin XL maintains its advantage over wide ranges of inputs, and outcomes are similar if analyses are limited to 3 months. CONCLUSION Base-case analyses suggest that oxybutynin XL provides better effectiveness than tolterodine IR and reduces costs. Results indicate that oxybutynin XL is the dominant therapeutic option under a wide range of alternative inputs and assumptions.
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Affiliation(s)
- D Getsios
- Caro Research Institute, Hammonds Plains, Nova Scotia, Canada
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Elliott RA, Payne K, Moore JK, Davies LM, Harper NJN, St Leger AS, Moore EW, Thoms GMM, Pollard BJ, McHugh GA, Bennett J, Lawrence G, Kerr J. Which anaesthetic agents are cost-effective in day surgery? Literature review, national survey of practice and randomised controlled trial. Health Technol Assess 2003; 6:1-264. [PMID: 12709296 DOI: 10.3310/hta6300] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- R A Elliott
- School of Pharmacy & Pharmaceutical Sciences, University of Manchester, Manchester, UK
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