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Blane B, Coll F, Raven K, Allen O, Kappeler ARM, Pai S, Floto RA, Peacock SJ, Gouliouris T. Impact of a new hospital with close to 100% single-occupancy rooms on environmental contamination and incidence of vancomycin-resistant Enterococcus faecium colonization or infection: a genomic surveillance study. J Hosp Infect 2023; 139:192-200. [PMID: 37451408 DOI: 10.1016/j.jhin.2023.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus faecium (VRE) is a leading cause of nosocomial infection, driven by its ability to spread between patients and persist in the hospital environment. AIM To investigate the impact of a long-established cardiothoracic hospital moving to new premises with close to 100% single-occupancy rooms on the rates of environmental contamination and infection or colonization by VRE. METHODS Prospective environmental surveillance for VRE was conducted at five time-points between April and November 2019, once in the original building, and four times in the new building. Incidence rate ratios (IRRs) of VRE infection/colonization were determined for the one-year period before and after the hospital move, and compared to a nearby hospital. FINDINGS In the original location, the first environmental screen found 29% VRE positivity. The following four screens in the new location showed a significant reduction in positivity (1-6%; P<0.0001). The VRE infection/colonization rates were halved in the new location (IRR: 0.56; 95% confidence interval: 0.38-0.84), compared to the original location, contrasting with an increase in a nearby hospital (1.62; 1.17-2.27) over the same time-period. Genomic analysis of the environmental isolates was consistent with reduced transmission in the new hospital. CONCLUSION The use of single-occupancy rooms was associated with reduced environmental contamination with VRE, and lower transmission and isolation of VRE from clinical samples. The cost-effectiveness of single-occupancy room hospitals in reducing healthcare-associated infections should be reassessed in the context of operational costs of emerging pandemic and increasing antimicrobial resistance threats.
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Affiliation(s)
- B Blane
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
| | - F Coll
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - K Raven
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - O Allen
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - A R M Kappeler
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - S Pai
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - R A Floto
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - S J Peacock
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK
| | - T Gouliouris
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, UK
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2
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Regier DA, Pollard S, McPhail M, Bubela T, Hanna TP, Ho C, Lim HJ, Chan K, Peacock SJ, Weymann D. A perspective on life-cycle health technology assessment and real-world evidence for precision oncology in Canada. NPJ Precis Oncol 2022; 6:76. [PMID: 36284134 PMCID: PMC9596463 DOI: 10.1038/s41698-022-00316-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Health technology assessment (HTA) can be used to make healthcare systems more equitable and efficient. Advances in precision oncology are challenging conventional thinking about HTA. Precision oncology advances are rapid, involve small patient groups, and are frequently evaluated without a randomized comparison group. In light of these challenges, mechanisms to manage precision oncology uncertainties are critical. We propose a life-cycle HTA framework and outline supporting criteria to manage uncertainties based on real world data collected from learning healthcare systems. If appropriately designed, we argue that life-cycle HTA is the driver of real world evidence generation and furthers our understanding of comparative effectiveness and value. We conclude that life-cycle HTA deliberation processes must be embedded into healthcare systems for an agile response to the constantly changing landscape of precision oncology innovation. We encourage further research outlining the core requirements, infrastructure, and checklists needed to achieve the goal of learning healthcare supporting life-cycle HTA.
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Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Melanie McPhail
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Science, Queen's University, Kingston, ON, Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Howard J Lim
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kelvin Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada.
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3
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Freeman V, Hughes S, Carle C, Campbell D, Egger S, Hui H, Yap S, Deandrea S, Caruana M, Onyeka TC, IJzerman MJ, Ginsburg O, Bray F, Sullivan R, Aggarwal A, Peacock SJ, Chan KKW, Hanna TP, Soerjomataram I, O'Connell DL, Steinberg J, Canfell K. Are patients with cancer at higher risk of COVID-19-related death? A systematic review and critical appraisal of the early evidence. J Cancer Policy 2022; 33:100340. [PMID: 35680113 PMCID: PMC9169424 DOI: 10.1016/j.jcpo.2022.100340] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Early reports suggested that COVID-19 patients with cancer were at higher risk of COVID-19-related death. We conducted a systematic review with risk of bias assessment and synthesis of the early evidence on the risk of COVID-19-related death for COVID-19 patients with and without cancer. METHODS AND FINDINGS We searched Medline/Embase/BioRxiv/MedRxiv/SSRN databases to 1 July 2020. We included cohort or case-control studies published in English that reported on the risk of dying after developing COVID-19 for people with a pre-existing diagnosis of any cancer, lung cancer, or haematological cancers. We assessed risk of bias using tools adapted from the Newcastle-Ottawa Scale. We used the generic inverse-variance random-effects method for meta-analysis. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated separately. Of 96 included studies, 54 had sufficient non-overlapping data to be included in meta-analyses (>500,000 people with COVID-19, >8000 with cancer; 52 studies of any cancer, three of lung and six of haematological cancers). All studies had high risk of bias. Accounting for at least age consistently led to lower estimated ORs and HRs for COVID-19-related death in cancer patients (e.g. any cancer versus no cancer; six studies, unadjusted OR=3.30,95%CI:2.59-4.20, adjusted OR=1.37,95%CI:1.16-1.61). Adjusted effect estimates were not reported for people with lung or haematological cancers. Of 18 studies that adjusted for at least age, 17 reported positive associations between pre-existing cancer diagnosis and COVID-19-related death (e.g. any cancer versus no cancer; nine studies, adjusted OR=1.66,95%CI:1.33-2.08; five studies, adjusted HR=1.19,95%CI:1.02-1.38). CONCLUSIONS The initial evidence (published to 1 July 2020) on COVID-19-related death in people with cancer is characterised by multiple sources of bias and substantial overlap between data included in different studies. Pooled analyses of non-overlapping early data with adjustment for at least age indicated a significantly increased risk of COVID-19-related death for those with a pre-existing cancer diagnosis.
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Affiliation(s)
- Victoria Freeman
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Chelsea Carle
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Denise Campbell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Sarsha Yap
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Silvia Deandrea
- Directorate General for Health, Lombardy Region, Milano, Italy; Environmental Health Unit, Agency for Health Protection, Pavia, Italy
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Tonia C Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Nigeria
| | - Maarten J IJzerman
- University of Melbourne, Centre for Cancer Research and Centre for Health Policy, Australia; Department of Cancer Research, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Ophira Ginsburg
- Perlmutter Cancer Center and the Department of Population Health, NYU Grossman School of Medicine, New York, United States
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Sullivan
- King's Institute Cancer Policy, King's College London, United Kingdom
| | - Ajay Aggarwal
- King's Institute Cancer Policy, King's College London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; Cancer Control Research, BC Cancer, Canada; Faculty of Health Sciences, Simon Fraser University, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada; Department of Oncology and Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia.
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia.
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4
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Carle C, Hughes S, Freeman V, Campbell D, Egger S, Caruana M, Hui H, Yap S, Deandrea S, Onyeka TC, IJzerman MJ, Ginsburg O, Bray F, Sullivan R, Aggarwal A, Peacock SJ, Chan KKW, Hanna TP, Soerjomataram I, O'Connell DL, Canfell K, Steinberg J. The risk of contracting SARS-CoV-2 or developing COVID-19 for people with cancer: A systematic review of the early evidence. J Cancer Policy 2022; 33:100338. [PMID: 35671919 PMCID: PMC9167683 DOI: 10.1016/j.jcpo.2022.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The early COVID-19 literature suggested that people with cancer may be more likely to be infected with SARS-CoV-2 or develop COVID-19 than people without cancer, due to increased health services contact and/or immunocompromise. While some studies were criticised due to small patient numbers and methodological limitations, they created or reinforced concerns of clinicians and people with cancer. These risks are also important in COVID-19 vaccine prioritisation decisions. We performed a systematic review to critically assess and summarise the early literature. METHODS AND FINDINGS We conducted a systematic search of Medline/Embase/BioRxiv/MedRxiv/SSRN databases including peer-reviewed journal articles, letters/commentaries, and non-peer-reviewed pre-print articles for 1 January-1 July 2020. The primary endpoints were diagnosis of COVID-19 and positive SARS-CoV-2 test. We assessed risk of bias using a tool adapted from the Newcastle-Ottawa Scale. Twelve studies were included in the quantitative synthesis. All four studies of COVID-19 incidence (including 24,181,727 individuals, 125,649 with pre-existing cancer) reported that people with cancer had higher COVID-19 incidence rates. Eight studies reported SARS-CoV-2 test positivity for > 472,000 individuals, 48,370 with pre-existing cancer. Seven of these studies comparing people with any and without cancer, were pooled using random effects [pooled odds ratio 0.91, 95 %CI: 0.57-1.47; unadjusted for age, sex, or comorbidities]. Two studies suggested people with active or haematological cancer had lower risk of a positive test. All 12 studies had high risk of bias; none included universal or random COVID-19/SARS-CoV-2 testing. CONCLUSIONS The early literature on susceptibility to SARS-CoV-2/COVID-19 for people with cancer is characterised by pervasive biases and limited data. To provide high-quality evidence to inform decision-making, studies of risk of SARS-CoV-2/COVID-19 for people with cancer should control for other potential modifiers of infection risk, including age, sex, comorbidities, exposure to the virus, protective measures taken, and vaccination, in addition to stratifying analyses by cancer type, stage at diagnosis, and treatment received.
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Affiliation(s)
- Chelsea Carle
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Victoria Freeman
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Denise Campbell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Sarsha Yap
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Silvia Deandrea
- Directorate General for Health, Lombardy Region, Milano, Italy; Environmental Health Unit, Agency for Health Protection, Pavia, Italy
| | - Tonia C Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Nigeria
| | - Maarten J IJzerman
- University of Melbourne, Centre for Cancer Research and Centre for Health Policy, Australia; Department of Cancer Research, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Ophira Ginsburg
- Perlmutter Cancer Center and the Department of Population Health, NYU Grossman School of Medicine, New York, United States
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Sullivan
- King's Institute of Cancer Policy, King's College, London, United Kingdom
| | - Ajay Aggarwal
- King's Institute of Cancer Policy, King's College, London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; Cancer Control Research, BC Cancer, Canada; Faculty of Health Sciences, Simon Fraser University, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada; Department of Oncology and Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia.
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Australia.
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McTaggart-Cowan H, King MT, Norman R, Costa DSJ, Pickard AS, Viney R, Peacock SJ. The FACT-8D, a new cancer-specific utility algorithm based on the Functional Assessment of Cancer Therapies-General (FACT-G): a Canadian valuation study. Health Qual Life Outcomes 2022; 20:97. [PMID: 35710417 PMCID: PMC9205108 DOI: 10.1186/s12955-022-02002-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Utility instruments are used to assess patients’ health-related quality of life for cost-utility analysis (CUA). However, for cancer patients, the dimensions of generic utility instruments may not capture all the information relevant to the impact of cancer. Cancer-specific utilities provide a useful alternative. Under the auspices of the Multi-Attribute Utility in Cancer Consortium, a cancer-specific utility algorithm was derived from the FACT-G. The new FACT-8D contains eight dimensions: pain, fatigue, nausea, sleep, work, support from family/friends, sadness, and worry health will get worse. The aim of the study was to obtain a Canadian value set for the FACT-8D.
Methods A discrete choice experiment was administered to a Canadian general population online panel, quota sampled by age, sex, and province/territory of residence. Respondents provided responses to 16 choice sets. Each choice set consisted of two health states described by the FACT-8D dimensions plus an attribute representing survival duration. Sample weights were applied and the responses were analyzed using conditional logistic regression, parameterized to fit the quality-adjusted life year framework. The results were converted into utility weights by evaluating the marginal rate of substitution between each level of each FACT-8D dimension with respect to duration.
Results 2228 individuals were recruited. The analysis dataset included n = 1582 individuals, who completed at least one choice set; of which, n = 1501 completed all choice sets. After constraining to ensure monotonicity in the utility function, the largest decrements were for the highest levels of pain (− 0.38), nausea (− 0.30), and problems doing work (− 0.23). The decrements of the remaining dimensions ranged from − 0.08 to − 0.18 for their highest levels. The utility of the worst possible health state was defined as − 0.65, considerably worse than dead.
Conclusions The largest impacts on utility included three generic dimensions (i.e., pain, support, and work) and nausea, a symptom caused by cancer (e.g., brain tumours, gastrointestinal tumours, malignant bowel obstruction) and by common treatments (e.g., chemotherapy, radiotherapy, opioid analgesics). This may make the FACT-8D more informative for CUA evaluating in many cancer contexts, an assertion that must now be tested empirically in head-to-head comparisons with generic utility measures. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-02002-z.
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Affiliation(s)
- Helen McTaggart-Cowan
- Cancer Control Research, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | | | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Daniel S J Costa
- School of Psychology, University of Sydney, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Pain Management Research Institute, Royal North Shore Hospital, Sydney, Australia
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, USA
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia
| | - Stuart J Peacock
- Cancer Control Research, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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6
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Peacock SJ. Vaccine nationalism will persist: global public goods need effective engagement of global citizens. Global Health 2022; 18:14. [PMID: 35151344 PMCID: PMC8841044 DOI: 10.1186/s12992-022-00802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Covid-19 presents a unique opportunity to transform democratic engagement in the governance of global public goods. In this paper, I describe a global public goods framework and how it relates to Covid-19 vaccines, and summarize some of the global responses to Covid-19. I discuss some of the global threats to health and prosperity posed by the inequitable distribution of vaccines, and propose transformative thinking to democratically engage citizens in the governance of global public goods. In recent years, public-private partnerships and philanthropic organizations have successfully stepped in to help international organizations like the UN and WHO provide global public goods, but they are not democratically elected or publicly accountable. Global public goods are critical to addressing Covid-19, future pandemic preparedness, global health policy, health equity, and the unfolding climate crisis. To make us more resistant and resilient to future global health crises we need transformative thinking to democratically engage global citizens. We need to lay the foundations for a ‘global social contract’ on global public goods.
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7
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Seow H, Barbera LC, McGrail K, Burge F, Guthrie DM, Lawson B, Chan KKW, Peacock SJ, Sutradhar R. Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study. JCO Oncol Pract 2022; 18:e183-e192. [PMID: 34388021 PMCID: PMC8758090 DOI: 10.1200/op.21.00299] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs. METHODS Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life. RESULTS We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month (P < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; P < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; P < .001). CONCLUSION Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada,Hsien Seow, PhD, Department of Oncology, McMaster University, 699 Concession St, 4th Fl, Rm 4-229, Hamilton, ON L8V 5C2, Canada; e-mail:
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Kimberlyn McGrail
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Fred Burge
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | | | | | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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8
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Tesch ME, Speers C, Diocee RM, Gondara L, Peacock SJ, Nichol A, Lohrisch CA. Impact of TAILORx on chemotherapy prescribing and 21-gene recurrence score-guided treatment costs in a population-based cohort of patients with breast cancer. Cancer 2021; 128:665-674. [PMID: 34855202 DOI: 10.1002/cncr.33982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The trial assigning individualized options for treatment (Rx) (TAILORx) confirmed the predictive value of the 21-gene recurrence score (RS) assay in hormone receptor (HR)-positive, HER2-negative, node-negative breast cancer and established thresholds for chemotherapy benefit in younger and older patients. Real-world chemotherapy use and RS-guided treatment costs in British Columbia post-TAILORx were examined. METHODS The authors assembled 3 cohorts of HR-positive, HER2-negative, node-negative patients with breast cancer defined by diagnosis: before RS funding (cohort 1 [C1]: January 2013-December 2013), after introduction of public RS funding (cohort 2 [C2]: July 2015-June 2016), and after TAILORx results (cohort 3 [C3]: July 2018-June 2019). Chemotherapy use was compared between cohorts by age and RS. Budgetary impacts of RS testing on chemotherapy costs were evaluated pre- and post-TAILORx. RESULTS Among the 2066 patients included, chemotherapy use declined by 19% after RS funding was introduced and by an additional 23% after TAILORx publication (P = .001). Reduction in chemotherapy use was significant for RS 11-20 tumors (C3 vs C2, P = .004). There was no significant change in chemotherapy use in patients >50 years old (C2:12% vs C3:10%, P = .22). RS testing was associated with higher cost savings post-TAILORx, except in patients 70 to 80 years old, where testing led to excess costs when adjusting for the low rate of RS-concordant chemotherapy prescribed. CONCLUSIONS TAILORx has had population-based impacts on chemotherapy prescribing in intermediate RS tumors and patients ≤50 years old. The lower clinical use of RS and increased spending in patients 70-80 years old highlights the importance of careful selection of older candidates for high-cost genomic testing. LAY SUMMARY The 21-gene recurrence score (RS) test helps predict whether patients with hormone-positive, HER2-negative, lymph node-negative breast cancer are likely to benefit from chemotherapy. The recent trial assigning individualized options for treatment (Rx) (TAILORx) found that patients with intermediate RS tumors did not benefit from chemotherapy. The authors assessed whether TAILORx results translated to real-world changes in chemotherapy prescribing patterns. In this study, chemotherapy use decreased by 23% after TAILORx, with the greatest reductions seen among intermediate RS tumors and younger patients. In contrast, RS testing had lower clinical value and increased treatment costs in elderly patients, which requires further study to ensure optimal care for this age group.
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Affiliation(s)
- Megan E Tesch
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Caroline Speers
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - Rekha M Diocee
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Breast Cancer Outcomes Unit, BC Cancer, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Caroline A Lohrisch
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
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9
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Seow H, Guthrie DM, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R. Trajectory of End-of-Life Pain and Other Physical Symptoms among Cancer Patients Receiving Home Care. ACTA ACUST UNITED AC 2021; 28:1641-1651. [PMID: 33924801 PMCID: PMC8161760 DOI: 10.3390/curroncol28030153] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the trajectory of physical symptoms among cancer decedents who were receiving home care in the six months before death. PATIENTS AND METHODS An observational cohort study of cancer decedents in Ontario, Canada, who received home care services between 2007 and 2014. To be included, decedents had to use at least one home care service in the last six months of life. Outcomes were the presence of pain and several other physical symptoms at each week before death. RESULTS Our cohort included 27,295 cancer decedents (30,368 assessments). Forty-seven percent were female and 56% were age 75 years or older. The prevalence of all physical symptoms increased as one approached death, particularly in the last month of life. In the last weeks of life, 69% of patients reported having moderate-severe pain; however, only 20% reported that the pain was not controlled. Loss of appetite (63%), shortness of breath (59%), high health instability (50%), and self-reported poor health (44%) were also highly prevalent in the last week of life. Multivariate regression showed that caregiver distress, high health instability, social decline, uncontrolled pain, and signs of depression all worsened the odds of having a physical symptom in the last 3 months of life. CONCLUSION In this large home care cancer cohort, trajectories of physical symptoms worsened close to death. While presence of moderate-severe pain was common, it was also reported as mostly controlled. Covariates, such as caregiver distress and social decline, were associated with having more physical symptoms at end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;
- Correspondence: ; Tel.: +1-905-387-9711 (ext. 67175); Fax: +1-905-575-6308
| | - Dawn M. Guthrie
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (D.M.G.); (T.S.)
| | - Tara Stevens
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada; (D.M.G.); (T.S.)
| | - Lisa C. Barbera
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Kelvin K. W. Chan
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Sunnybrook Odette Cancer Centre, Toronto, ON M4N 3M5, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada;
| | - Stuart J. Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC V5Z 1L3, Canada;
- British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada;
- Division of Biostatistics, University of Toronto, Toronto, ON M5S 1A1, Canada
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10
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Raymakers AJN, Jenei KM, Regier DA, Burgess MM, Peacock SJ. Early-Phase Clinical Trials and Reimbursement Submissions to the Pan-Canadian Oncology Drug Review. Pharmacoeconomics 2021; 39:373-377. [PMID: 33462759 DOI: 10.1007/s40273-020-00995-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Adam J N Raymakers
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Kristina M Jenei
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael M Burgess
- School of Population and Public Health, W. Maurice Young Centre for Applied Ethics, University of British Columbia, Provost's Office, Kelowna, BC, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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11
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Seow H, Stevens T, Barbera LC, Burge F, McGrail K, Chan KKW, Peacock SJ, Sutradhar R, Guthrie DM. Trajectory of psychosocial symptoms among home care patients with cancer at end-of-life. Psychooncology 2020; 30:103-110. [PMID: 33007119 DOI: 10.1002/pon.5559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/14/2020] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE Understanding the end-of-life psychosocial needs of cancer patients at home is a knowledge gap. This study describes the trajectory of psychosocial symptoms in the last 6 months of life among cancer decedents who were receiving home care. METHODS Observational population-based cohort study of cancer decedents who were receiving home care services between 2007 and 2014. Decedents had to have at least one home care assessment in the last 6 months of life for inclusion. Outcomes were the presence of psychosocial symptoms (i.e., anxiety, loneliness, depression, social decline, caregiver distress, and cognitive decline) at each week before death. RESULTS Our cohort included 27,295 unique cancer decedents (30,368 assessments), of which 58% died in hospital. Fifty-six percent were older than 74, and 47% were female. The prevalence of all symptoms increased approaching death, except loneliness. Social decline (48%-78%) was the most prevalent psychosocial symptom, though loneliness was reported in less than 10% of the cohort. Caregiver distress rose over time from 15%-27%. A third of the cohort reported issues with cognitive impairment. Multivariate regression showed that physical symptoms such as uncontrolled pain, impairment in independent activities of daily living, and a high level of health instability all significantly worsened the odds of having a psychosocial symptom in the last 3 months of life. CONCLUSION In this large home care cancer cohort, trajectories of psychosocial symptoms worsened close to death. Physical symptoms, such as uncontrolled pain, were associated with having worse psychosocial symptoms at end of life.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tara Stevens
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa C Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.,British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Biostatistics, University of Toronto, Toronto, Ontario, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.,Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
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12
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Cressman S, Hogge DE, Minden MD, Couban S, Karsan A, Broady R, McPherson E, Halani K, Weng JY, Peacock SJ. Quality of life and socioeconomic indicators associated with survival of myeloid leukemias in Canada. eJHaem 2020; 1:69-78. [PMID: 35847696 PMCID: PMC9175748 DOI: 10.1002/jha2.62] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/06/2022]
Abstract
Understanding how patient‐reported quality of life (QoL) and socioeconomic status (SES) relate to survival of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) may improve prognostic information sharing. This study explores associations among QoL, SES, and survival through administration of the Euro‐QoL 5‐Dimension, 3‐level and Functional Assessment of Cancer Therapy‐Leukemia and financial impact questionnaires to 138 adult participants with newly diagnosed AML or MDS in a longitudinal, pan‐Canadian study. Cox regression and lasso variable selection models were used to explore associations among QoL, SES, and established predictors of survival. Secondary outcomes were changes in QoL, performance of the QoL instruments, and lost income. We found that higher QoL and SES were positively associated with survival. The Lasso model selected the visual analog scale of the EQ‐5D‐3L as the most important predictor among all other variables (P = .03; 92% selection). Patients with AML report improved QoL after treatment, despite higher mean out‐of‐pocket expenditures compared with MDS (up to $599 CDN/month for AML vs $239 for MDS; P = .05), greater loss of productivity‐related income (reaching $1786/month for AML vs $709 for MDS; P < .05), and greater caregiver effects (65% vs 35% caregiver productivity losses for AML vs MDS; P < .05). Our results suggest that including patient‐reported QoL and socioeconomic indicators can improve the accuracy of survival models.
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Affiliation(s)
- Sonya Cressman
- Faculty of Health SciencesSimon Fraser University Burnaby British Columbia Canada
- Department of Cancer Control ReasearchBC Cancer Research Centre Vancouver British Columbia Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC) Vancouver British Columbia Canada
| | - Donna E. Hogge
- Leukemia Bone Marrow Transplant Program of BCVancouver General Hospital Vancouver British Columbia Canada
- Terry Fox LaboratoriesBritish Columbia Cancer Research Centre Vancouver British Columbia Canada
| | - Mark D. Minden
- Department of Medical Oncology and HematologyPrincess Margaret Hospital Toronto Ontario Canada
| | - Stephen Couban
- Department of MedicineQueen Elizabeth II Health Sciences Centre Halifax Nova Scotia Canada
| | - Aly Karsan
- Centre for Clinical GenomicsMichael Smith Genome Sciences Centre Vancouver British Columbia Canada
- Cancer Genetics LaboratoryBritish Columbia Cancer Agency Vancouver British Columbia Canada
- Deptartment of Pathology and Laboratory MedicineUniversity of British Columbia Vancouver British Columbia Canada
| | - Raewyn Broady
- Leukemia Bone Marrow Transplant Program of BCVancouver General Hospital Vancouver British Columbia Canada
| | | | | | - Jing Yi Weng
- Department of Cancer Control ReasearchBC Cancer Research Centre Vancouver British Columbia Canada
| | - Stuart J. Peacock
- Faculty of Health SciencesSimon Fraser University Burnaby British Columbia Canada
- Department of Cancer Control ReasearchBC Cancer Research Centre Vancouver British Columbia Canada
- Canadian Centre for Applied Research in Cancer Control (ARCC) Vancouver British Columbia Canada
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13
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McBride ML, de Oliveira C, Duncan R, Bremner KE, Liu N, Greenberg ML, Nathan PC, Rogers PC, Peacock SJ, Krahn MD. Comparing Childhood Cancer Care Costs in Two Canadian Provinces. ACTA ACUST UNITED AC 2020; 15:76-88. [PMID: 32176612 PMCID: PMC7075448 DOI: 10.12927/hcpol.2020.26129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Cancer in children presents unique issues for diagnosis, treatment and survivorship care. Phase-specific comparative cost estimates are important for informing healthcare planning. Objectives: The aim of this paper is to compare direct medical costs of childhood cancer by phase of care in British Columbia (BC) and Ontario (ON). Methods: For cancer patients diagnosed at <15 years of age and propensity-score-matched non-cancer controls, we applied standard costing methodology using population-based healthcare administrative data to estimate and compare phase-based costs by province. Results: Phase-specific cancer-attributable costs were 2%–39% higher for ON than for BC. Leukemia pre-diagnosis costs and annual lymphoma continuing care costs were >50% higher in ON. Phase-specific in-patient hospital costs (the major cost category) represented 63%–82% of ON costs, versus 43%–73% of BC costs. Phase-specific diagnostic tests and procedures accounted for 1.0%–3.4% of ON costs and 2.8%–13.0% of BC costs. Conclusions: There are substantial cost differences between these two Canadian provinces, BC and ON, possibly identifying opportunities for healthcare planning improvement.
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Affiliation(s)
- Mary L McBride
- Emerita Scientist, Cancer Control Research, British Columbia Cancer, Vancouver, BC
| | - Claire de Oliveira
- Independent Scientist and Health Economist, Center for Addiction and Mental Health, Toronto, ON
| | - Ross Duncan
- Graduate Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Karen E Bremner
- Research Associate, Toronto General Hospital Research Institute, University Health Network, Toronto, ON
| | - Ning Liu
- Senior Research Analyst, Institute for Clinical Evaluative Sciences, Toronto, ON
| | - Mark L Greenberg
- Chair in Childhood Cancer Control and Professor of Paediatrics and Surgery, Pediatric Oncology Group of Ontario, Toronto, ON
| | - Paul C Nathan
- Staff Oncologist and Director, Aftercare Program, The Hospital for Sick Children, Toronto, ON
| | - Paul C Rogers
- Clinical Professor, Division of Hematology, Oncology & Bone Marrow Transplant, BC Children's Hospital, Vancouver, BC
| | - Stuart J Peacock
- Distinguished Scientist, Leslie Diamond Chair in Cancer Survivorship, Cancer Control Research, British Columbia Cancer, Vancouver, BC
| | - Murray D Krahn
- Senior Scientist and Director, THETA Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, ON
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14
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Abstract
Expenditure on cancer therapies is rising rapidly in many countries, particularly for cancer drugs. In recent years, this has stimulated a global debate among the public, patients, clinicians, decision-makers, and the pharmaceutical industry on value, affordability, and sustainability propositions relating to cancer therapies. In this article, we discuss some recent developments in evidence-based approaches to priority setting and resource allocation in Canadian cancer systems. These developments include new methods for deliberative public engagement, generating and using real-world evidence, multi-criteria decision analysis, and handling uncertainty with evidence for gene therapies.
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Affiliation(s)
- Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam J N Raymakers
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
- Sunnybrook Hospital Research Institute, Toronto, Ontario, Canada
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15
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Raymakers AJN, Regier DA, Peacock SJ. Health-related quality of life in oncology drug reimbursement submissions in Canada: A review of submissions to the pan-Canadian Oncology Drug Review. Cancer 2019; 126:148-155. [PMID: 31544234 DOI: 10.1002/cncr.32455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/18/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Canada, the Canadian Agency for Drugs and Technologies in Health (CADTH) evaluates and makes recommendations for the reimbursement of cancer drugs. One component of its recommendation is based on an economic evaluation, which typically takes the form of a cost-utility analysis. A cost-utility analysis measures the effects of competing therapies with quality-adjusted life-years (QALYs). The data for this calculation typically come from generic, preference-based measures of health-related quality of life (HRQOL). The objective of this review is to determine the frequency at which HRQOL data are collected alongside cancer drug trials and used in the cost-utility analysis submitted to the CADTH pan-Canadian Oncology Drug Review (pCODR). METHODS Submissions between 2015 and 2018 to pCODR, the group charged with evaluating cancer drug submissions at CADTH, were reviewed. All pCODR submissions, either in progress or completed, were publicly available online. The search was restricted to completed evaluations. RESULTS Forty-three submissions met the inclusion criteria. The incremental gain in QALYs in most submissions from the new technology was small (median incremental gain, 0.86; interquartile range, 0.6-1.39). More than half of the submissions (56%) did not include original data on HRQOL, with most relying on previous studies of variable relevance and quality. Re-analyses by pCODR based on concerns over HRQOL data used in the submitted model were common (52%). CONCLUSIONS Drug manufacturers do not consistently collect data on HRQOL alongside clinical trials and instead rely on evidence generated in previous studies to inform cost-utility analyses. These findings should induce manufacturers to collect original HRQOL data that are simultaneously relevant to patients and decision makers.
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Affiliation(s)
- Adam J N Raymakers
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.,Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.,Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada.,Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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16
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Raymakers AJ, Regier DA, Peacock SJ. Modelling uncertainty in survival and cost-effectiveness is vital in the era of gene therapies: the case of axicabtagene ciloleucel. Health Policy and Technology 2019. [DOI: 10.1016/j.hlpt.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Costa S, Scott DW, Steidl C, Peacock SJ, Regier DA. Real-world costing analysis for diffuse large B-cell lymphoma in British Columbia. ACTA ACUST UNITED AC 2019; 26:108-113. [PMID: 31043812 DOI: 10.3747/co.26.4565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Diffuse large B-cell lymphoma (dlbcl) accounts for 30%-40% of all non-Hodgkin lymphomas. Approximately 60% of patients are cured with standard treatment. Targeted treatments are being investigated and might improve disease outcomes; however, their effect on cancer drug budgets will be significant. For the present study, we conducted an analysis of real-world costs for dlbcl patients treated in British Columbia, useful for health care system planning. Methods Patient records from a retrospective cohort of patients diagnosed with dlbcl in British Columbia during 2004-2013 were anonymously linked across multiple administrative data sources: systemic therapy, radiotherapy, hospitalizations, oncologist services, outpatient medications, and fee-for-service physician services. Using generalized linear modelling regression, time-dependent costs (in 2015 Canadian dollars) were estimated in 6-month intervals over a 5-year period. The inverse probability weighting method was applied to account for censored observations. Nonparametric bootstrapping was used to estimate standard errors for the mean cost at each time interval. Results The cohort consisted of 678 patients (5-year overall survival: 67%). Mean age at diagnosis was 64 ± 14 years; median follow-up was 3.2 years. Mean total cost of care was highest in the first 6 months after diagnosis ($29,120; 95% confidence interval: $28,986 to $29,170) and after disease progression ($18,480; 95% confidence interval: $15,187 to $24,772). Systemic therapy and hospitalization costs were the largest cost drivers. At each time interval, costs were observed to be positively skewed. Conclusions Our results depict real-world costs for the treatment of dlbcl patients with standard chop-r therapy. Cost-model parameters are also provided for economic modelling of dlbcl interventions.
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Affiliation(s)
- S Costa
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Cancer Control Research, BC Cancer, Vancouver, BC
| | - D W Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - C Steidl
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Cancer Control Research, BC Cancer, Vancouver, BC.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Cancer Control Research, BC Cancer, Vancouver, BC.,School of Population and Public Health, University of British Columbia, Vancouver, BC
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18
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McTaggart-Cowan H, King MT, Norman R, Costa DSJ, Pickard AS, Regier DA, Viney R, Peacock SJ. The EORTC QLU-C10D: The Canadian Valuation Study and Algorithm to Derive Cancer-Specific Utilities From the EORTC QLQ-C30. MDM Policy Pract 2019; 4:2381468319842532. [PMID: 31245606 PMCID: PMC6580722 DOI: 10.1177/2381468319842532] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 02/18/2019] [Indexed: 01/22/2023] Open
Abstract
Objective. The EORTC QLQ-C30 is widely used for assessing quality of life in cancer. However, QLQ-C30 responses cannot be incorporated in cost-utility analysis because they are not based on general population's preferences, or utilities. To overcome this limitation, the QLU-C10D, a cancer-specific utility algorithm, was derived from the QLQ-C30. The aim of this study was to obtain Canadian population utility weights for the QLU-C10D. Methods. Respondents from a Canadian research panel expressed their preferences for 16 choice sets in an online discrete choice experiment. Each choice set consisted of two health states described by the 10 QLU-C10D domains plus an attribute representing duration of survival. Using a conditional logit model, responses were converted into utility decrements by evaluating the marginal rate of substitution between each QLU-C10D domain level with respect to duration. Results. A total of 3,363 individuals were recruited. A total of 2,345 completed at least one choice set and 2,271 completed all choice sets. The largest utility decrements were associated with the worse levels of Physical Functioning (-0.24), Pain (-0.18), Role Functioning (-0.15), Emotional Functioning (-0.12), and Nausea (-0.12). The remaining domains and levels had decrements of -0.05 to -0.09. The utility of the worst possible health state was -0.15. Conclusion. Respondents from the general population were most concerned with generic health domains, but Nausea and Bowel Problems also had an impact on the individual's utility. It is unclear as to whether cancer-specific domains will affect cost-utility analysis when evaluating cancer treatments; this will be tested in the next phase of the study.
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Affiliation(s)
- Helen McTaggart-Cowan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Madeleine T King
- Faculties of Science and Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Daniel S J Costa
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Illinois, USA
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Stuart J Peacock
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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19
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Bentley C, Costa S, Burgess MM, Regier D, McTaggart-Cowan H, Peacock SJ. Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada. BMC Health Serv Res 2018; 18:339. [PMID: 29739463 PMCID: PMC5941483 DOI: 10.1186/s12913-018-3117-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens. METHODS In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. The aim of the study was to gain citizens' input on the topic and have them generate recommendations that could inform cancer drug funding decisions in BC. A market research company was engaged to recruit members of the BC general public to deliberate over two weekends (four days) on how best to allocate resources for expensive cancer treatments. Participants were stratified based on the 2006 census data for BC. Participants were asked to discuss disinvestment, intravenous versus oral chemotherapy delivery, and decision governance. All sessions were audio recorded and transcribed. Transcripts were analyzed using NVivo 11 software. RESULTS Twenty-four individuals participated in the event and generated 30 recommendations. Participants accepted the principle of resource scarcity and the need of governments to make difficult trade-offs when allocating health-care resources. They supported the view that cost-benefit thresholds must be set for high-cost drugs. They also expected reasonable health benefits in return for large expenditures, and supported the view that some drugs do not merit funding. Participants also wanted drug funding decisions to be made in a non-partisan and transparent way. CONCLUSION The recommendations from the Vancouver deliberation can provide guidance to policy makers in BC and may be useful in challenging pricing by pharmaceutical companies.
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Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Sarah Costa
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Michael M Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, Southern Medical Program, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Dean Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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20
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Tammemagi MC, Schmidt H, Martel S, McWilliams A, Goffin JR, Johnston MR, Nicholas G, Tremblay A, Bhatia R, Liu G, Soghrati K, Yasufuku K, Hwang DM, Laberge F, Gingras M, Pasian S, Couture C, Mayo JR, Nasute Fauerbach PV, Atkar-Khattra S, Peacock SJ, Cressman S, Ionescu D, English JC, Finley RJ, Yee J, Puksa S, Stewart L, Tsai S, Haider E, Boylan C, Cutz JC, Manos D, Xu Z, Goss GD, Seely JM, Amjadi K, Sekhon HS, Burrowes P, MacEachern P, Urbanski S, Sin DD, Tan WC, Leighl NB, Shepherd FA, Evans WK, Tsao MS, Lam S. Participant selection for lung cancer screening by risk modelling (the Pan-Canadian Early Detection of Lung Cancer [PanCan] study): a single-arm, prospective study. Lancet Oncol 2017; 18:1523-1531. [PMID: 29055736 DOI: 10.1016/s1470-2045(17)30597-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Results from retrospective studies indicate that selecting individuals for low-dose CT lung cancer screening on the basis of a highly predictive risk model is superior to using criteria similar to those used in the National Lung Screening Trial (NLST; age, pack-year, and smoking quit-time). We designed the Pan-Canadian Early Detection of Lung Cancer (PanCan) study to assess the efficacy of a risk prediction model to select candidates for lung cancer screening, with the aim of determining whether this approach could better detect patients with early, potentially curable, lung cancer. METHODS We did this single-arm, prospective study in eight centres across Canada. We recruited participants aged 50-75 years, who had smoked at some point in their life (ever-smokers), and who did not have a self-reported history of lung cancer. Participants had at least a 2% 6-year risk of lung cancer as estimated by the PanCan model, a precursor to the validated PLCOm2012 model. Risk variables in the model were age, smoking duration, pack-years, family history of lung cancer, education level, body-mass index, chest x-ray in the past 3 years, and history of chronic obstructive pulmonary disease. Individuals were screened with low-dose CT at baseline (T0), and at 1 (T1) and 4 (T4) years post-baseline. The primary outcome of the study was incidence of lung cancer. This study is registered with ClinicalTrials.gov, number NCT00751660. FINDINGS 7059 queries came into the study coordinating centre and were screened for PanCan risk. 15 were duplicates, so 7044 participants were considered for enrolment. Between Sept 24, 2008, and Dec 17, 2010, we recruited and enrolled 2537 eligible ever-smokers. After a median follow-up of 5·5 years (IQR 3·2-6·1), 172 lung cancers were diagnosed in 164 individuals (cumulative incidence 0·065 [95% CI 0·055-0·075], incidence rate 138·1 per 10 000 person-years [117·8-160·9]). There were ten interval lung cancers (6% of lung cancers and 6% of individuals with cancer): one diagnosed between T0 and T1, and nine between T1 and T4. Cumulative incidence was significantly higher than that observed in NLST (4·0%; p<0·0001). Compared with 593 (57%) of 1040 lung cancers observed in NLST, 133 (77%) of 172 lung cancers in the PanCan Study were early stage (I or II; p<0·0001). INTERPRETATION The PanCan model was effective in identifying individuals who were subsequently diagnosed with early, potentially curable, lung cancer. The incidence of cancers detected and the proportion of early stage cancers in the screened population was higher than observed in previous studies. This approach should be considered for adoption in lung cancer screening programmes. FUNDING Terry Fox Research Institute and Canadian Partnership Against Cancer.
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Affiliation(s)
- Martin C Tammemagi
- Department of Health Sciences, Brock University, St Catharines, ON, Canada
| | | | - Simon Martel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - Annette McWilliams
- Fionna Stanley Hospital and Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | | | | | | | - Rick Bhatia
- Memorial University, Newfoundland, NL, Canada
| | | | | | | | | | - Francis Laberge
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - Michel Gingras
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - Sergio Pasian
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - Christian Couture
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - John R Mayo
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | | | - Diana Ionescu
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | - John Yee
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Serge Puksa
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Scott Tsai
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Colm Boylan
- St Joseph's Healthcare, Hamilton, ON, Canada
| | | | | | - Zhaolin Xu
- Dalhousie University, Halifax, NS, Canada
| | | | - Jean M Seely
- Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | | | | | | | | | | | - Don D Sin
- St Paul's Hospital, Vancouver, BC, Canada
| | - Wan C Tan
- St Paul's Hospital, Vancouver, BC, Canada
| | | | | | | | | | - Stephen Lam
- Vancouver General Hospital, Vancouver, BC, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada.
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21
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McTaggart-Cowan H, Bentley C, Ogilvie G, Regier DA, Peacock SJ. The Girls-Only HPV Vaccination Program in British Columbia, Canada: A Qualitative Study Exploring Expert Informants' Perspectives of Input From the Public. J Obstet Gynaecol Can 2017; 39:726-727. [PMID: 28511920 DOI: 10.1016/j.jogc.2017.03.116] [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: 12/15/2016] [Accepted: 03/17/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC
| | - Colene Bentley
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC; British Columbia Centre for Disease Control, Vancouver, BC
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
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22
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Cressman S, Peacock SJ, Tammemägi MC, Evans WK, Leighl NB, Goffin JR, Tremblay A, Liu G, Manos D, MacEachern P, Bhatia R, Puksa S, Nicholas G, McWilliams A, Mayo JR, Yee J, English JC, Pataky R, McPherson E, Atkar-Khattra S, Johnston MR, Schmidt H, Shepherd FA, Soghrati K, Amjadi K, Burrowes P, Couture C, Sekhon HS, Yasufuku K, Goss G, Ionescu DN, Hwang DM, Martel S, Sin DD, Tan WC, Urbanski S, Xu Z, Tsao MS, Lam S. The Cost-Effectiveness of High-Risk Lung Cancer Screening and Drivers of Program Efficiency. J Thorac Oncol 2017; 12:1210-1222. [PMID: 28499861 DOI: 10.1016/j.jtho.2017.04.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 03/13/2017] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Lung cancer risk prediction models have the potential to make programs more affordable; however, the economic evidence is limited. METHODS Participants in the National Lung Cancer Screening Trial (NLST) were retrospectively identified with the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The high-risk subgroup was assessed for lung cancer incidence and demographic characteristics compared with those in the low-risk subgroup and the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), which is an observational study that was high-risk-selected in Canada. A comparison of high-risk screening versus standard care was made with a decision-analytic model using data from the NLST with Canadian cost data from screening and treatment in the PanCan study. Probabilistic and deterministic sensitivity analyses were undertaken to assess uncertainty and identify drivers of program efficiency. RESULTS Use of the risk prediction tool developed from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial with a threshold set at 2% over 6 years would have reduced the number of individuals who needed to be screened in the NLST by 81%. High-risk screening participants in the NLST had more adverse demographic characteristics than their counterparts in the PanCan study. High-risk screening would cost $20,724 (in 2015 Canadian dollars) per quality-adjusted life-year gained and would be considered cost-effective at a willingness-to-pay threshold of $100,000 in Canadian dollars per quality-adjusted life-year gained with a probability of 0.62. Cost-effectiveness was driven primarily by non-lung cancer outcomes. Higher noncurative drug costs or current costs for immunotherapy and targeted therapies in the United States would render lung cancer screening a cost-saving intervention. CONCLUSIONS Non-lung cancer outcomes drive screening efficiency in diverse, tobacco-exposed populations. Use of risk selection can reduce the budget impact, and screening may even offer cost savings if noncurative treatment costs continue to rise.
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Affiliation(s)
- Sonya Cressman
- The Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada; The British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
| | - Stuart J Peacock
- The Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada; The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - William K Evans
- Cancer Care Ontario, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Natasha B Leighl
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R Goffin
- McMaster University, Hamilton, Ontario, Canada; The Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - Alain Tremblay
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Geoffrey Liu
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daria Manos
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul MacEachern
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada; Foothills Medical Centre, Calgary, Alberta, Canada
| | - Rick Bhatia
- Memorial University, St. John's, Newfoundland, Canada
| | - Serge Puksa
- McMaster University, Hamilton, Ontario, Canada; The Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada
| | - Garth Nicholas
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Annette McWilliams
- Fiona Stanley Hospital, Perth, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia
| | - John R Mayo
- The University of British Columbia, Vancouver, British Columbia, Canada; The Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - John Yee
- The University of British Columbia, Vancouver, British Columbia, Canada; The Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - John C English
- The University of British Columbia, Vancouver, British Columbia, Canada; The Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Reka Pataky
- The Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada; The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; The University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Michael R Johnston
- Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heidi Schmidt
- Joint Department of Medical Imaging (University Health Network, Sinai Health Systems, Women's College Hospital) Toronto, Ontario, Canada
| | - Frances A Shepherd
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kam Soghrati
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Kayvan Amjadi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | | | - Glenwood Goss
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Diana N Ionescu
- The British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Don D Sin
- Centre for Heart Lung Innovation, Institute for Heart and Lung Health, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Institute for Heart and Lung Health, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Zhaolin Xu
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ming-Sound Tsao
- University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephen Lam
- The British Columbia Cancer Agency, Vancouver, British Columbia, Canada; The University of British Columbia, Vancouver, British Columbia, Canada
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Costa S, Regier DA, Meissner B, Cromwell I, Ben-Neriah S, Chavez E, Hung S, Steidl C, Scott DW, Marra MA, Peacock SJ, Connors JM. A time-and-motion approach to micro-costing of high-throughput genomic assays. ACTA ACUST UNITED AC 2016; 23:304-313. [PMID: 27803594 DOI: 10.3747/co.23.2987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Genomic technologies are increasingly used to guide clinical decision-making in cancer control. Economic evidence about the cost-effectiveness of genomic technologies is limited, in part because of a lack of published comprehensive cost estimates. In the present micro-costing study, we used a time-and-motion approach to derive cost estimates for 3 genomic assays and processes-digital gene expression profiling (gep), fluorescence in situ hybridization (fish), and targeted capture sequencing, including bioinformatics analysis-in the context of lymphoma patient management. METHODS The setting for the study was the Department of Lymphoid Cancer Research laboratory at the BC Cancer Agency in Vancouver, British Columbia. Mean per-case hands-on time and resource measurements were determined from a series of direct observations of each assay. Per-case cost estimates were calculated using a bottom-up costing approach, with labour, capital and equipment, supplies and reagents, and overhead costs included. RESULTS The most labour-intensive assay was found to be fish at 258.2 minutes per case, followed by targeted capture sequencing (124.1 minutes per case) and digital gep (14.9 minutes per case). Based on a historical case throughput of 180 cases annually, the mean per-case cost (2014 Canadian dollars) was estimated to be $1,029.16 for targeted capture sequencing and bioinformatics analysis, $596.60 for fish, and $898.35 for digital gep with an 807-gene code set. CONCLUSIONS With the growing emphasis on personalized approaches to cancer management, the need for economic evaluations of high-throughput genomic assays is increasing. Through economic modelling and budget-impact analyses, the cost estimates presented here can be used to inform priority-setting decisions about the implementation of such assays in clinical practice.
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Affiliation(s)
- S Costa
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - B Meissner
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - S Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - E Chavez
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - S Hung
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - C Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - D W Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
| | - M A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medical Genetics, University of British Columbia, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - J M Connors
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
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Chantratita N, Tandhavanant S, Seal S, Wikraiphat C, Wongsuvan G, Ariyaprasert P, Suntornsut P, Teerawattanasook N, Jutrakul Y, Srisurat N, Chaimanee P, Mahavanakul W, Srisamang P, Phiphitaporn S, Mokchai M, Anukunananchai J, Wongratanacheewin S, Chetchotisakd P, Emond MJ, Peacock SJ, West TE. TLR4 genetic variation is associated with inflammatory responses in Gram-positive sepsis. Clin Microbiol Infect 2016; 23:47.e1-47.e10. [PMID: 27615723 DOI: 10.1016/j.cmi.2016.08.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/06/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify important pathogen recognition receptor (PRR) pathways regulating innate immune responses and outcome in Staphylococcus aureus sepsis. METHODS We analysed whether candidate PRR pathway genetic variants were associated with killed S. aureus-induced cytokine responses ex vivo and performed follow-up in vitro studies. We tested the association of our top-ranked variant with cytokine responses and clinical outcomes in a prospective multicentre cohort of patients with staphylococcal sepsis. RESULTS An intronic TLR4 polymorphism and expression quantitative trait locus, rs1927907, was highly associated with cytokine release induced by stimulation of blood from healthy Thai subjects with S. aureus ex vivo. S. aureus did not induce TLR4-dependent NF-κB activation in transfected HEK293 cells. In monocytes, tumor necrosis factor (TNF)-α release induced by S. aureus was not blunted by a TLR4/MD-2 neutralizing antibody, but in a monocyte cell line, TNF-α was reduced by knockdown of TLR4. In Thai patients with staphylococcal sepsis, rs1927907 was associated with higher interleukin (IL)-6 and IL-8 levels as well as with respiratory failure. S. aureus-induced responses in blood were most highly correlated with responses to Gram-negative stimulants whole blood. CONCLUSIONS A genetic variant in TLR4 is associated with cytokine responses to S. aureus ex vivo and plasma cytokine levels and respiratory failure in staphylococcal sepsis. While S. aureus does not express lipopolysaccharide or activate TLR4 directly, the innate immune response to S. aureus does appear to be modulated by TLR4 and shares significant commonality with that induced by Gram-negative pathogens and lipopolysaccharide.
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Affiliation(s)
- N Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - S Tandhavanant
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - S Seal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - C Wikraiphat
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - G Wongsuvan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - P Ariyaprasert
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - P Suntornsut
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - N Teerawattanasook
- Department of Clinical Pathology, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Y Jutrakul
- Department of Clinical Pathology, Udon Thani Hospital, Udon Thani, Thailand
| | - N Srisurat
- Department of Clinical Pathology, Khon Kaen Hospital, Khon Kaen, Thailand
| | - P Chaimanee
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - W Mahavanakul
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - P Srisamang
- Department of Pediatrics, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - S Phiphitaporn
- Department of Medicine, Udon Thani Hospital, Udon Thani, Thailand
| | - M Mokchai
- Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
| | | | - S Wongratanacheewin
- Department of Microbiology and Melioidosis Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - P Chetchotisakd
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - M J Emond
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - S J Peacock
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T E West
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA; International Respiratory and Severe Illness Center, University of Washington, Seattle, USA
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25
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Cromwell I, Regier DA, Peacock SJ, Poh CF. Cost-Effectiveness Analysis of Using Loss of Heterozygosity to Manage Premalignant Oral Dysplasia in British Columbia, Canada. Oncologist 2016; 21:1099-106. [PMID: 27401887 DOI: 10.1634/theoncologist.2015-0433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/05/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Management of low-grade oral dysplasias (LGDs) is complicated, as only a small percentage of lesions will progress to invasive disease. The current standard of care requires patients to undergo regular monitoring of their lesions, with intervention occurring as a response to meaningful clinical changes. Recent improvements in molecular technologies and understanding of the biology of LGDs may allow clinicians to manage lesions based on their genome-guided risk. METHODS We used a decision-analytic Markov model to estimate the cost-effectiveness of risk-stratified care using a genomic assay. In the experimental arm, patients with LGDs were managed according to their risk profile using the assay, with low- and intermediate-risk patients given longer screening intervals and high-risk patients immediately treated with surgery. Patients in the comparator arm had standard care (biannual follow-up appointments at an oral cancer clinic). Incremental costs and outcomes in life-years gained (LYG) and quality-adjusted life-years (QALY) were calculated based on the results in each arm. RESULTS The mean cost of assay-guided management was $8,123 (95% confidence interval [CI] $2,973 to $23,062 in 2013 Canadian dollars) less than the cost of standard care. This difference was driven largely by reductions in resource use among people who did not develop cancer. Mean incremental effectiveness was 0.18 LYG (95% CI 0.08 to 0.39) or 0.64 QALY (95% CI 0.46 to 0.89). Sensitivity analysis suggests that these findings are robust to both expected and extreme variation in all parameter values. CONCLUSION Use of the assay-guided management strategy costs less and is more effective than standard management of LGDs. IMPLICATIONS FOR PRACTICE The findings of this study strongly suggest that the use of a risk-stratification method such as a genomic assay can result in improved quality-adjusted survival outcomes for patients with low-grade oral dysplasia (LGD). The use of such an assay in this study provides "precision medicine," allowing for a change in follow-up frequency or early intervention as compared with current standard care. As genomic technologies become more common in cancer care, it is hoped that such an assay, once validated, will become part of a new model for the standard management of LGDs in similar health systems.
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Affiliation(s)
- Ian Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Catherine F Poh
- Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada Department of Oral Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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Cromwell I, Gaudet M, Peacock SJ, Aquino-Parsons C. Cost-effectiveness analysis of anal cancer screening in women with cervical neoplasia in British Columbia, Canada. BMC Health Serv Res 2016; 16:206. [PMID: 27349646 PMCID: PMC4924299 DOI: 10.1186/s12913-016-1442-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 05/28/2016] [Indexed: 12/02/2022] Open
Abstract
Background Precursors to anal squamous cell carcinoma may be detectable through screening; however, the literature suggests that population-level testing is not cost-effective. Given that high-grade cervical neoplasia (CIN) is associated with an increased risk of developing anal cancer, and in light of changing guidelines for the follow-up and management of cervical neoplasia, it is worthwhile to examine the costs and effectiveness of an anal cancer screening program delivered to women with previously-detected CIN. Methods A model of anal cancer screening and treatment was constructed, to estimate the cost-effectiveness of a population of CIN II/III+ women who were screened using anal cytology vs. one that received no anal cancer screening. Costs were based on Canadian estimates, and survival was based on estimates taken from the scientific literature. Effectiveness was measured in terms of life years gained (LYG) and quality-adjusted life years (QALYs). The model was run for 50 cycles, with each cycle representing one year. Results Incremental cost (screened vs. unscreened) was $82.17 per woman in the model. Incremental effectiveness was 0.004 LYG, and was equivalent to zero in terms of QALY. An ICER of $20,561/LYG was calculated, while no meaningful incremental cost-effectiveness ratio (ICER) could be calculated for quality-adjusted survival. Conclusion Our analysis suggests that anal cancer screening is cost-effective in terms of overall survival in women with a previous diagnosis of CIN II or CIN III as part of regular follow-up, but may not contribute meaningfully-different quality-adjusted survival due to the adverse effects of screening-related interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1442-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada. .,Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada.
| | - M Gaudet
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada.,Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Canada
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada.,Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - C Aquino-Parsons
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada
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Cressman S, Karsan A, Hogge DE, McPherson E, Bolbocean C, Regier DA, Peacock SJ. Economic impact of genomic diagnostics for intermediate-risk acute myeloid leukaemia. Br J Haematol 2016; 174:526-35. [PMID: 27098559 PMCID: PMC5021117 DOI: 10.1111/bjh.14076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/26/2016] [Indexed: 01/22/2023]
Abstract
Acute Myeloid Leukaemia (AML) is a rare but serious group of diseases that require critical decision-making for curative treatment. Over the past decade, scientific discovery has revealed dozens of prognostic gene mutations for AML while sequencing costs have plummeted. In this study, we compared the cost-effectiveness of multigene integrative analysis (genomic analysis) with the standard molecular testing currently used for diagnosis of intermediate-risk AML. We used a decision analytic model with data for costs and outcomes from British Columbia, Canada, to assess the long-term (10-year) economic impacts. Our results suggest that genomic analysis would result in a 26% increase in the use of first-remission allogeneic stem cell transplantation. The resulting treatment decisions and downstream effects would come at an additional cost of $12 556 [2013 Canadian dollars (CAD)] per person and the incremental cost-effectiveness ratio would be $49 493 per quality-adjusted life-year gained. Cost-effectiveness was dependent on quality of life during the long-term (5-10) years of survival, relapse rates following first-remission chemotherapy and the upfront cost of transplantation. Non-relapse mortality rates, short-term quality of life and the cost of genomic sequencing had only minor impacts. Further research on post-remission outcomes can lead to improvements in the cost-effectiveness of curative treatments for AML.
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Affiliation(s)
- Sonya Cressman
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.,Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Aly Karsan
- Centre for Clinical Genomics, Michael Smith Genome Sciences Centre, Vancouver, BC, Canada.,Cancer Genetics Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donna E Hogge
- Terry Fox Laboratories, British Columbia Cancer Research Centre, Vancouver, BC, Canada.,Leukemia Bone Marrow Transplant Program of BC, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Emily McPherson
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.,Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Corneliu Bolbocean
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.,Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.,Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.,Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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Cromwell I, Ferreira Z, Smith L, van der Hoek K, Ogilvie G, Coldman A, Peacock SJ. Cost and resource utilization in cervical cancer management: a real-world retrospective cost analysis. ACTA ACUST UNITED AC 2016; 23:S14-22. [PMID: 26985142 DOI: 10.3747/co.23.2914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We set out to assess the health care resource utilization and cost of cervical cancer from the perspective of a single-payer health care system. METHODS Retrospective observational data for women diagnosed with cervical cancer in British Columbia between 2004 and 2009 were analyzed to calculate patient-level resource utilization patterns from diagnosis to death or 5-year discharge. Domains of resource use within the scope of this cost analysis were chemotherapy, radiotherapy, and brachytherapy administered by the BC Cancer Agency; resource utilization related to hospitalization and outpatient visits as recorded by the B.C. Ministry of Health; medically required services billed under the B.C. Medical Services Plan; and prescriptions dispensed under British Columbia's health insurance programs. Unit costs were applied to radiotherapy and brachytherapy, producing per-patient costs. RESULTS The mean cost per case of treating cervical cancer in British Columbia was $19,153 (standard error: $3,484). Inpatient hospitalizations, at 35%, represented the largest proportion of the total cost (95% confidence interval: 32.9% to 36.9%). Costs were compared for subgroups of the total cohort. CONCLUSIONS As health care systems change the way they manage, screen for, and prevent cervical cancer, cost-effectiveness evaluations of the overall approach will require up-to-date data for resource utilization and costs. We provide information suitable for such a purpose and also identify factors that influence costs.
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Affiliation(s)
- I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - Z Ferreira
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - L Smith
- Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - K van der Hoek
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - G Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - A Coldman
- Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC;; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC
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29
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Seow H, Pataky R, Lawson B, O'Leary EM, Sutradhar R, Fassbender K, McGrail K, Barbera L, Mpa MD, Burge F, Peacock SJ, Hoch JS. Temporal association between home nursing and hospital costs at end of life in three provinces. ACTA ACUST UNITED AC 2016; 23:S42-51. [PMID: 26985145 DOI: 10.3747/co.23.2971] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has demonstrated that increases in palliative homecare nursing are associated with a reduction in the rate of subsequent hospitalizations. However, little evidence is available about the cost-savings potential of palliative nursing when accounting for both increased nursing costs and potentially reduced hospital costs. METHODS Our retrospective cohort study included cancer decedents from British Columbia, Ontario, and Nova Scotia who received any palliative nursing in the last 6 months of life. A Poisson regression analysis was used to determine the association of increased nursing costs (in 2-week blocks) on the relative average hospital costs in the subsequent 2-week block and on the overall total cost (hospital costs plus nursing costs in the preceding 2-week block). RESULTS The cohort included 58,022 cancer decedents. Results of the analysis for the last month of life showed an association between increased nursing costs and decreased relative hospital costs in comparisons with a reference group (>0 to 1 hour nursing in the block): the maximum decrease was 55% for Ontario, 31% for British Columbia, and 38% for Nova Scotia. Also, increased nursing costs in the last month were almost always associated with lower total costs in comparison with the reference. For example, cost savings per person-block ranged from $376 (>10 nursing hours) to $1,124 (>4 to 6 nursing hours) in British Columbia. CONCLUSIONS In the last month of life, increased palliative nursing costs (compared with costs for >0 to 1 hour of nursing in the block) were associated with lower relative hospital costs and a lower total cost in a subsequent block. Our research suggests a cost-savings potential associated with increased community-based palliative nursing.
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Affiliation(s)
- H Seow
- Department of Oncology, McMaster University, Hamilton, ON
| | - R Pataky
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC
| | - B Lawson
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - E M O'Leary
- Department of Oncology, McMaster University, Hamilton, ON
| | - R Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON;; Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - K Fassbender
- Department of Palliative Care Medicine, University of Alberta, Edmonton, AB
| | - K McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - L Barbera
- Department of Oncology, McMaster University, Hamilton, ON
| | - M D Mpa
- Institute for Clinical Evaluative Sciences, Toronto, ON;; Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - F Burge
- Department of Family Medicine, Dalhousie University, Halifax, NS
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; BC Cancer Agency and University of British Columbia, Vancouver, BC
| | - J S Hoch
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;; Institute for Clinical Evaluative Sciences, Toronto, ON;; Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON;; Pharmacoeconomics Research Unit, Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON
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Lim C, Peacock SJ, Limmathurotsakul D. Association between activities related to routes of infection and clinical manifestations of melioidosis. Clin Microbiol Infect 2015; 22:79.e1-79.e3. [PMID: 26417852 PMCID: PMC4721533 DOI: 10.1016/j.cmi.2015.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/13/2015] [Accepted: 09/15/2015] [Indexed: 01/26/2023]
Abstract
We sought associations between route of infection by Burkholderia pseudomallei and clinical manifestations in 330 cases of melioidosis in northeast Thailand using bivariate multivariable logistic regression models. Activities related to skin inoculation were negatively associated with bacteraemia, activities related to ingestion were associated with bacteraemia, and activities related to inhalation were associated with pneumonia. Our study suggests that route of infection is one of the factors related to clinical manifestations of melioidosis.
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Affiliation(s)
- C Lim
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - S J Peacock
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - D Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Abstract
There is growing recognition that critical decisions concerning investments in new health care technologies and services should incorporate society’s values along with the scientific evidence. From a normative perspective, public engagement can help realize the democratic ideals of legitimacy, transparency, and accountability. On a more pragmatic level, public engagement can help stakeholders understand the degree of popular support for policy options, and may enhance public trust in decision-making processes. To better understand public attitudes and values relating to priority setting in health care, researchers and decision-makers will have to employ a range of quantitative and qualitative approaches, drawing on different disciplines and methodological traditions.
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Affiliation(s)
- Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia Cancer Research Centre, 675 West 10th Avenue, Vancouver, V5Z 1L3 Canada ; Cancer Control Research, British Columbia Cancer Agency, University of British Columbia, British Columbia, Canada ; School of Population and Public Health, University of British Columbia, British Colombia, Canada
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Hadjirin NF, Lay EM, Paterson GK, Harrison EM, Peacock SJ, Parkhill J, Zadoks RN, Holmes MA. Detection of livestock-associated meticillin-resistant Staphylococcus aureus CC398 in retail pork, United Kingdom, February 2015. Euro Surveill 2015; 20:21156. [PMID: 26111237 PMCID: PMC4841384 DOI: 10.2807/1560-7917.es2015.20.24.21156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/20/2022] Open
Abstract
Livestock-associated meticillin-resistant Staphylococcus aureus belonging to clonal complex 398 (LA-MRSA CC398) is an important cause of zoonotic infections in many countries. Here, we describe the isolation of LA-MRSA CC398 from retail meat samples of United Kingdom (UK) farm origin. Our findings indicate that this lineage is probably established in UK pig farms and demonstrate a potential pathway for the transmission of LA-MRSA CC398 from livestock to humans in the UK.
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Affiliation(s)
- N F Hadjirin
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - E M Lay
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - G K Paterson
- School of Biological, Biomedical and Environmental Sciences, University of Hull, Hull, United Kingdom
| | - E M Harrison
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - S J Peacock
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- The Wellcome Trust Sanger Institute, Wellcome Trust, Cambridge, United Kingdom
| | - J Parkhill
- The Wellcome Trust Sanger Institute, Wellcome Trust, Cambridge, United Kingdom
| | - R N Zadoks
- Moredun Research Institute, Penicuik, United Kingdom
- University of Glasgow, Institute of Biodiversity, Animal Health and Comparative Medicine, Glasgow, United Kingdom
| | - M A Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Abstract
BACKGROUND Scientific advances have led to the discovery of novel treatments with high prices. The cost to publicly fund high-cost drugs may threaten the sustainability of drug budgets in different health care systems. In oncology, there are concerns that health-benefit gains are diminishing over time and that the economic evidence to support funding decisions is too limited. METHODS To assess the additional costs and benefits gained from oncology drugs over time, we used treatment protocols and efficacy results from U.S. Food and Drug Administration records to calculate cost-effectiveness ratios for drugs approved to treat first- and second-line metastatic or advanced breast, colorectal, and non-small cell lung cancer during the years 1994-2013. We assessed reimbursement recommendations reached by health technology assessment agencies in the U.K., Australia, and Canada. RESULTS Cost-effectiveness ratios were calculated for 50 drugs approved by the U.S. regulator. The more recent approvals were often based on surrogate efficacy outcomes and had extremely high costs, often triple the costs of drugs approved in previous years. Over time, the effectiveness gains have increased for some cancer indications; however, for other indications (non-small cell lung and second-line colorectal cancer), the magnitude of gains in effectiveness decreased. Reimbursement recommendations for drugs with the highest cost-effectiveness ratios were the most inconsistent. CONCLUSION Evaluation of the clinical benefits that oncology drugs offer as a function of their cost has become highly complex, and for some clinical indications, health benefits are diminishing over time. There is an urgent need for better economic evidence from oncology drug trials and systematic processes to inform funding decisions. IMPLICATIONS FOR PRACTICE High-cost oncology drugs may threaten the ability of health care systems to provide access to promising new drugs for patients. In order to make better drug-funding decisions and enable equitable access to breakthrough treatments, discussions in the oncology community should include economic evidence. This study summarizes the extra benefits and costs of newly approved drugs from pivotal trials during the postgenomic era of drug discovery. The reader will gain an appreciation of the need for economic evidence to make better drug-reimbursement decisions and the dynamics at play in today's oncology drug market.
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Affiliation(s)
- Sonya Cressman
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada; Vancouver Island Cancer Centre, Victoria, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - George P Browman
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada; Vancouver Island Cancer Centre, Victoria, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Jeffrey S Hoch
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada; Vancouver Island Cancer Centre, Victoria, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Laurel Kovacic
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada; Vancouver Island Cancer Centre, Victoria, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada; Vancouver Island Cancer Centre, Victoria, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, British Columbia, Canada
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Saunderson RB, Gouliouris T, Nickerson EK, Cartwright EJP, Kidney A, Aliyu SH, Brown NM, Limmathurotsakul D, Peacock SJ, Török ME. Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults. Clin Microbiol Infect 2015; 21:779-85. [PMID: 26033668 PMCID: PMC4509716 DOI: 10.1016/j.cmi.2015.05.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/13/2015] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Abstract
Staphylococcus aureus bacteraemia (SAB) is a common, serious infection that is associated with high rates of morbidity and mortality. Evidence suggests that infectious disease consultation (IDC) improves clinical management in patients with SAB. We examined whether the introduction of a routine bedside IDC service for adults with SAB improved clinical management and outcomes compared to telephone consultation. We conducted an observational cohort study of 571 adults with SAB at a teaching hospital in the United Kingdom between July 2006 and December 2012. A telephone consultation was provided on the day of positive blood culture in all cases, but an additional bedside IDC was provided after November 2009 (routine IDC group). Compared to patients in the pre-IDC group, those in the routine IDC group were more likely to have a removable focus of infection identified, echocardiography performed and follow-up blood cultures performed. They also received longer courses of antimicrobial therapy, were more likely to receive combination antimicrobial therapy and were more likely to have SAB recorded in the hospital discharge summary. There was a trend towards lower mortality at 30 days in the routine IDC group compared to the pre-IDC group (12% vs. 22%, p 0.07). Our findings suggest that routine bedside IDC should become the standard of care for adults with SAB.
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Affiliation(s)
- R B Saunderson
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Australia
| | - T Gouliouris
- Department of Medicine, University of Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E K Nickerson
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - A Kidney
- Department of Medicine, University of Cambridge, UK
| | - S H Aliyu
- Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N M Brown
- Clinical Microbiology and Public Health Laboratory, Public Health England, UK
| | - D Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - S J Peacock
- Department of Medicine, University of Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - M E Török
- Department of Medicine, University of Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, UK; Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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Cromwell I, Peacock SJ, Mitton C. 'Real-world' health care priority setting using explicit decision criteria: a systematic review of the literature. BMC Health Serv Res 2015; 15:164. [PMID: 25927636 PMCID: PMC4433097 DOI: 10.1186/s12913-015-0814-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/23/2015] [Indexed: 11/24/2022] Open
Abstract
Background Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in ‘real-world’ health care allocation decisions. Methods A systematic review of the published literature was conducted to find examples of ‘real-world’ priority setting exercises that used explicit criteria to guide decision-making. Results We found thirty-three examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the ‘real-world’ trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen. Conclusions Health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0814-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ian Cromwell
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, Canada. .,Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada.
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, Canada. .,Department of Cancer Control Research, British Columbia Cancer Agency, Vancouver, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada. .,Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, Canada.
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Regier DA, Peacock SJ, Pataky R, van der Hoek K, Jarvik GP, Hoch J, Veenstra D. Societal preferences for the return of incidental findings from clinical genomic sequencing: a discrete-choice experiment. CMAJ 2015; 187:E190-E197. [PMID: 25754703 DOI: 10.1503/cmaj.140697] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/15/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND An important challenge with the application of next-generation sequencing technology is the possibility of uncovering incidental genomic findings. A paucity of evidence on personal utility for incidental findings has hindered clinical guidelines. Our objective was to estimate personal utility for complex information derived from incidental genomic findings. METHODS We used a discrete-choice experiment to evaluate participants' personal utility for the following attributes: disease penetrance, disease treatability, disease severity, carrier status and cost. Study participants were drawn from the Canadian public. We analyzed the data with a mixed logit model. RESULTS In total, 1200 participants completed our questionnaire (available in English and French). Participants valued receiving information about high-penetrance disorders but expressed disutility for receiving information on low-penetrance disorders. The average willingness to pay was $445 (95% confidence interval [CI] $322-$567) to receive incidental findings in a scenario where clinicians returned information about high-penetrance, medically treatable disorders, but only 66% of participants (95% CI 63%-71%) indicated that they would choose to receive information in that scenario. On average, participants placed an important value ($725, 95% CI $600-$850) on having a choice about what type of findings they would receive, including receipt of information about high-penetrance, treatable disorders or receipt of information about high-penetrance disorders with or without available treatment. The predicted uptake of that scenario was 76% (95% CI 72%-79%). INTERPRETATION Most participants valued receiving incidental findings, but personal utility depended on the type of finding, and not all participants wanted to receive incidental results, regardless of the potential health implications. These results indicate that to maximize benefit, participant-level preferences should inform the decision about whether to return incidental findings.
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Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont.
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Reka Pataky
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Kimberly van der Hoek
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Gail P Jarvik
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - Jeffrey Hoch
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
| | - David Veenstra
- Canadian Centre for Applied Research in Cancer Control (Regier, Peacock, Pataky, van der Hoek), Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health (Regier, Peacock, Pataky), University of British Columbia, Vancouver, BC; Department of Medicine (Medical Genetics) (Jarvik), Department of Genome Sciences (Jarvik) and Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy (Veenstra), University of Washington, Seattle, Wash.; Pharmacoeconomics Research Unit (Hoch), Cancer Care Ontario, Toronto, Ont.; Canadian Centre for Applied Research in Cancer Control (Hoch), Toronto, Ont
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Regier DA, Bentley C, Mitton C, Bryan S, Burgess MM, Chesney E, Coldman A, Gibson J, Hoch J, Rahman S, Sabharwal M, Sawka C, Schuckel V, Peacock SJ. Public engagement in priority-setting: Results from a pan-Canadian survey of decision-makers in cancer control. Soc Sci Med 2014; 122:130-9. [DOI: 10.1016/j.socscimed.2014.10.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 10/10/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022]
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Limmathurotsakul D, Paeyao A, Wongratanacheewin S, Saiprom N, Takpho N, Thaipadungpanit J, Chantratita N, Wuthiekanun V, Day NPJ, Peacock SJ. Role of Burkholderia pseudomallei biofilm formation and lipopolysaccharide in relapse of melioidosis. Clin Microbiol Infect 2014; 20:O854-6. [PMID: 24602145 PMCID: PMC4304327 DOI: 10.1111/1469-0691.12614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 11/29/2022]
Abstract
We examined whether quantitative biofilm formation and/or lipopolysaccharide type of Burkholderia pseudomallei was associated with relapsing melioidosis. We devised a 1:4 nested case-control study in which both cases and controls were drawn from a cohort of patients with primary melioidosis. Paired isolates from 80 patients with relapse and single isolates from 184 patients without relapse were tested. Relapse was associated with biofilm formation of the primary infecting isolate (conditional OR 2.03; 95% CI 1.27-3.25; p 0.003), but not with lipopolysaccharide type (p 0.74). This finding highlights the importance of biofilm formation in relapsing melioidosis.
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Affiliation(s)
- D Limmathurotsakul
- Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Gouliouris T, Peacock SJ. The rise and fall of mandatory surveillance for glycopeptide-resistant enterococcal bacteraemia in England. J Infect 2014; 68:401-3. [PMID: 24509143 DOI: 10.1016/j.jinf.2014.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- T Gouliouris
- University of Cambridge, Department of Medicine, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom; Cambridge Public Health England Microbiology and Public Health Laboratory, Box 236, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom.
| | - S J Peacock
- University of Cambridge, Department of Medicine, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom; Cambridge Public Health England Microbiology and Public Health Laboratory, Box 236, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom
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40
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Paterson GK, Morgan FJE, Harrison EM, Cartwright EJP, Török ME, Zadoks RN, Parkhill J, Peacock SJ, Holmes MA. Prevalence and characterization of human mecC methicillin-resistant Staphylococcus aureus isolates in England. J Antimicrob Chemother 2013; 69:907-10. [PMID: 24284779 PMCID: PMC3956372 DOI: 10.1093/jac/dkt462] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives There are limited data available on the epidemiology and prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the human population that encode the recently described mecA homologue, mecC. To address this knowledge gap we undertook a prospective prevalence study in England to determine the prevalence of mecC among MRSA isolates. Patients and methods Three hundred and thirty-five sequential MRSA isolates from individual patients were collected from each of six clinical microbiology laboratories in England during 2011–12. These were tested by PCR or genome sequencing to differentiate those encoding mecA and mecC. mecC-positive isolates were further characterized by multilocus sequence typing, spa typing, antimicrobial susceptibility profile and detection of PBP2a using commercially available kits. Results Nine out of the 2010 MRSA isolates tested were mecC positive, indicating a prevalence among MRSA in England of 0.45% (95% CI 0.24%–0.85%). The remainder were mecA positive. Eight out of these nine mecC MRSA isolates belonged to clonal complex 130, the other being sequence type 425. Resistance to non-β-lactam antibiotics was rare among these mecC MRSA isolates and all were phenotypically identified as MRSA using oxacillin and cefoxitin according to BSAC disc diffusion methodology. However, all nine mecC isolates gave a negative result using three different commercial PBP2a detection assays. Conclusions mecC MRSA are currently rare among MRSA isolated from humans in England and this study provides an important baseline prevalence rate to monitor future changes, which may be important given the increasing prevalence of mecC MRSA reported in Denmark.
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Affiliation(s)
- G K Paterson
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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41
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Najafzadeh M, Johnston KM, Peacock SJ, Connors JM, Marra MA, Lynd LD, Marra CA. Genomic testing to determine drug response: measuring preferences of the public and patients using Discrete Choice Experiment (DCE). BMC Health Serv Res 2013; 13:454. [PMID: 24176050 PMCID: PMC3827922 DOI: 10.1186/1472-6963-13-454] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 09/24/2012] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background The extent to which a genomic test will be used in practice is affected by factors such as ability of the test to correctly predict response to treatment (i.e. sensitivity and specificity of the test), invasiveness of the testing procedure, test cost, and the probability and severity of side effects associated with treatment. Methods Using discrete choice experimentation (DCE), we elicited preferences of the public (Sample 1, N = 533 and Sample 2, N = 525) and cancer patients (Sample 3, N = 38) for different attributes of a hypothetical genomic test for guiding cancer treatment. Samples 1 and 3 considered the test/treatment in the context of an aggressive curable cancer (scenario A) while the scenario for sample 2 was based on a non-aggressive incurable cancer (scenario B). Results In aggressive curable cancer (scenario A), everything else being equal, the odds ratio (OR) of choosing a test with 95% sensitivity was 1.41 (versus a test with 50% sensitivity) and willingness to pay (WTP) was $1331, on average, for this amount of improvement in test sensitivity. In this scenario, the OR of choosing a test with 95% specificity was 1.24 times that of a test with 50% specificity (WTP = $827). In non-aggressive incurable cancer (scenario B), the OR of choosing a test with 95% sensitivity was 1.65 (WTP = $1344), and the OR of choosing a test with 95% specificity was 1.50 (WTP = $1080). Reducing severity of treatment side effects from severe to mild was associated with large ORs in both scenarios (OR = 2.10 and 2.24 in scenario A and B, respectively). In contrast, patients had a very large preference for 95% sensitivity of the test (OR = 5.23). Conclusion The type and prognosis of cancer affected preferences for genomically-guided treatment. In aggressive curable cancer, individuals emphasized more on the sensitivity rather than the specificity of the test. In contrast, for a non-aggressive incurable cancer, individuals put similar emphasis on sensitivity and specificity of the test. While the public expressed strong preference toward lowering severity of side effects, improving sensitivity of the test had by far the largest influence on patients’ decision to use genomic testing.
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Affiliation(s)
| | | | | | | | | | | | - Carlo A Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
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Paterson GK, Morgan FJE, Harrison EM, Peacock SJ, Parkhill J, Zadoks RN, Holmes MA. Prevalence and properties of mecC methicillin-resistant Staphylococcus aureus (MRSA) in bovine bulk tank milk in Great Britain. J Antimicrob Chemother 2013; 69:598-602. [PMID: 24155057 PMCID: PMC3922150 DOI: 10.1093/jac/dkt417] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES mecC methicillin-resistant Staphylococcus aureus (MRSA) represent a newly recognized form of MRSA, distinguished by the possession of a divergent mecA homologue, mecC. The first isolate to be identified came from bovine milk, but there are few data on the prevalence of mecC MRSA among dairy cattle. The aim of this study was to conduct a prevalence study of mecC MRSA among dairy farms in Great Britain. METHODS Test farms were randomly selected by random order generation and bulk tank samples were tested for the presence of mecC MRSA by broth enrichment and plating onto chromogenic agar. All MRSA isolated were screened by PCR for mecA and mecC, and mecC MRSA were further characterized by multilocus sequence typing, spa typing and antimicrobial susceptibility testing. RESULTS mecC MRSA were detected on 10 of 465 dairy farms sampled in England and Wales (prevalence 2.15%, 95% CI 1.17%-3.91%), but not from 625 farms sampled in Scotland (95% CI of prevalence 0%-0.61%). Seven isolates belonged to sequence type (ST) 425, while the other three belonged to clonal complex 130. Resistance to non-β-lactam antibiotics was uncommon. All 10 isolates produced a negative result by slide agglutination for penicillin-binding protein 2a. mecA MRSA ST398 was detected on one farm in England. CONCLUSIONS mecC MRSA is widely distributed among dairy farms in Great Britain, but this distribution is not uniform across the whole country. These results provide an important baseline dataset to monitor the epidemiology of this emerging form of MRSA.
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Affiliation(s)
- G K Paterson
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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Regier DA, van der Hoek K, Ogilvie G, Smith L, Henwood E, Miller DM, McTaggart-Cowan H, Peacock SJ. Exploring colposcopists' attitudes towards use of HPV testing as a primary screening tool for cervical cancer in British Columbia. J Obstet Gynaecol Can 2013; 35:657-63. [PMID: 23876645 DOI: 10.1016/s1701-2163(15)30889-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine colposcopists' attitudes regarding human papillomavirus (HPV) DNA testing as a primary screening tool for cervical cancer. METHODS Questionnaires administered in 2010 and 2011 during workshops in British Columbia elicited colposcopists' attitudes using a series of five-point Likert-style scales (strongly disagree to strongly agree) and binary (yes/no) response questions. The frequency of "agree" or "strongly agree" was used to characterize attitudes. Regression analyses examined statistically significant changes in attitudes after the 2010 workshop. RESULTS Responses generally indicated positive changes in attitudes toward HPV testing. Statistically significant changes after the 2010 workshop were observed for the items relating to strong agreement that HPV is a necessary cause of cervical cancer (39% increase; P < 0.001) and the likelihood of openly advocating for HPV testing (19% increase; P < 0.04). In 2010, 40% of colposcopists stated that four years between HPV tests is too long, and in 2011, 53% did so. CONCLUSION Colposcopists are viewed as opinion leaders and will have a critical role in implementing HPV testing in BC; our study obtained responses from 73% (2010) and 84% (2011) of BC-registered colposcopists. Colposcopists were in favour of HPV testing for primary screening for cervical cancer but did not support an extended interval for HPV testing, which suggests future knowledge translation workshops are crucial. We found that knowledge translation workshops can be an effective approach for translating evidence on screening and screening practices.
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Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada
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Paterson GK, Larsen J, Harrison EM, Larsen AR, Morgan FJ, Peacock SJ, Parkhill J, Zadoks RN, Holmes MA. First detection of livestock-associated meticillin-resistant Staphylococcus aureus CC398 in bulk tank milk in the United Kingdom, January to July 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.50.20337-en] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Livestock-associated meticillin-resistant Staphylococcus aureus belonging to clonal complex 398 (LA-MRSA CC398) is an important cause of zoonotic infections in several countries, but there is only a single published report of this lineage from the United Kingdom (UK). Here, we describe the isolation of LA-MRSA CC398 from bulk tank milk from five geographically dispersed farms in the UK. Our findings suggest that LA-MRSA CC398 is established in livestock in the UK. Awareness of the potential occupational risks and surveillance in other food-producing animal species should be promoted.
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Affiliation(s)
- G K Paterson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - J Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - E M Harrison
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - A R Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - F J Morgan
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - S J Peacock
- The Wellcome Trust Sanger Institute, Wellcome Trust, Cambridge, United Kingdom
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - J Parkhill
- The Wellcome Trust Sanger Institute, Wellcome Trust, Cambridge, United Kingdom
| | - R N Zadoks
- Moredun Research Institute, Penicuik, United Kingdom
| | - M A Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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45
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Paterson GK, Larsen J, Harrison EM, Larsen AR, Morgan FJ, Peacock SJ, Parkhill J, Zadoks RN, Holmes MA. First detection of livestock-associated meticillin-resistant Staphylococcus aureus CC398 in bulk tank milk in the United Kingdom, January to July 2012. Euro Surveill 2012; 17:20337. [PMID: 23241232 PMCID: PMC3867000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Livestock-associated meticillin-resistant Staphylococcus aureus belonging to clonal complex 398 (LA-MRSA CC398) is an important cause of zoonotic infections in several countries, but there is only a single published report of this lineage from the United Kingdom (UK). Here, we describe the isolation of LA-MRSA CC398 from bulk tank milk from five geographically dispersed farms in the UK. Our findings suggest that LA-MRSA CC398 is established in livestock in the UK. Awareness of the potential occupational risks and surveillance in other food-producing animal species should be promoted.
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Affiliation(s)
- G K Paterson
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Paterson GK, Larsen AR, Robb A, Edwards GE, Pennycott TW, Foster G, Mot D, Hermans K, Baert K, Peacock SJ, Parkhill J, Zadoks RN, Holmes MA. The newly described mecA homologue, mecALGA251, is present in methicillin-resistant Staphylococcus aureus isolates from a diverse range of host species. J Antimicrob Chemother 2012; 67:2809-13. [PMID: 22941897 DOI: 10.1093/jac/dks329] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES A previously unidentified mecA homologue, mecA(LGA251), has recently been described in methicillin-resistant Staphylococcus aureus (MRSA) from humans and dairy cattle. The origin and epidemiology of this novel homologue are unclear. The objective of this study was to provide basic descriptive information of MRSA isolates harbouring mecA(LGA251) from a range of host animal species. METHODS A number of S. aureus isolates from historical animal isolate collections were chosen for investigation based on their similarity to known mecA(LGA251) MRSA isolates. The presence of mecA(LGA251) was determined using a multiplex PCR and antimicrobial susceptibility testing performed by disc diffusion. RESULTS MRSA harbouring mecA(LGA251) were found in isolates from a domestic dog, brown rats, a rabbit, a common seal, sheep and a chaffinch. All of the isolates were phenotypically MRSA, although this depended on which test was used; some isolates would be considered susceptible with certain assays. All isolates were susceptible to linezolid, rifampicin, kanamycin, norfloxacin, erythromycin, clindamycin, fusidic acid, tetracycline, trimethoprim/sulfamethoxazole and mupirocin. Five multilocus sequence types were represented (2273, 130, 425, 1764 and 1245) and six spa types (t208, t6293, t742, t6594, t7914 and t843). CONCLUSIONS The discovery of MRSA isolates possessing mecA(LGA251) from a diverse range of host species, including different taxonomic classes, has important implications for the diagnosis of MRSA in these species and our understanding of the epidemiology of this novel mecA homologue.
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Affiliation(s)
- G K Paterson
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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Török ME, Peacock SJ. Rapid whole-genome sequencing of bacterial pathogens in the clinical microbiology laboratory--pipe dream or reality? J Antimicrob Chemother 2012; 67:2307-8. [PMID: 22729921 DOI: 10.1093/jac/dks247] [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: 11/14/2022] Open
Abstract
The ability to perform rapid, high-throughput whole-genome sequencing using bench-top platforms represents a step-change in capabilities for diagnostic and public health microbiology laboratories. As the cost of sequencing continues to decline, the challenge will be to define when and where to apply this technology. This article reviews its potential applications in the clinical microbiology laboratory and discusses the current barriers to implementation.
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Affiliation(s)
- M E Török
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
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Richardson JRJ, Peacock SJ, Hawthorne G, Iezzi A, Elsworth G, Day NA. Construction of the descriptive system for the Assessment of Quality of Life AQoL-6D utility instrument. Health Qual Life Outcomes 2012; 10:38. [PMID: 22507254 PMCID: PMC3349491 DOI: 10.1186/1477-7525-10-38] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 04/17/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument. METHODS The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements. RESULTS AND DISCUSSION The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model. CONCLUSIONS The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.
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Affiliation(s)
- Jeffrey RJ Richardson
- Centre for Health Economics, Monash University, Wellington Road, Clayton, VIC 3800, Australia
- Prof Jeff Richardson, Foundation Director, Centre for Health Economics, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada
- School of Population and Public Health, University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Graeme Hawthorne
- Department of Psychiatry, University of Melbourne, Level 1 North Main Block, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Angelo Iezzi
- Centre for Health Economics, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Gerald Elsworth
- Public Health Innovation, Deakin Population Health Strategic Research Centre, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Neil A Day
- Centre for Program Evaluation, University of Melbourne, 100 Leicester Street, Parkville, VIC 3052, Australia
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Koh GCKW, Peacock SJ, van der Poll T, Wiersinga WJ. The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis 2011; 31:379-88. [PMID: 21805196 PMCID: PMC3303037 DOI: 10.1007/s10096-011-1337-4] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [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: 04/04/2011] [Accepted: 06/21/2011] [Indexed: 02/06/2023]
Abstract
Diabetes is associated with an increased susceptibility to infection and sepsis. Conflicting data exist on whether the mortality of patients with sepsis is influenced by the presence of diabetes, fuelling the ongoing debate on the benefit of tight glucose regulation in patients with sepsis. The main reason for which diabetes predisposes to infection appears to be abnormalities of the host response, particularly in neutrophil chemotaxis, adhesion and intracellular killing, defects that have been attributed to the effect of hyperglycaemia. There is also evidence for defects in humoral immunity, and this may play a larger role than previously recognised. We review the literature on the immune response in diabetes and its potential contribution to the pathogenesis of sepsis. In addition, the effect of diabetes treatment on the immune response is discussed, with specific reference to insulin, metformin, sulphonylureas and thiazolidinediones.
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Affiliation(s)
- G C K W Koh
- The Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.
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50
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Richardson JRJ, McKie J, Peacock SJ, Iezzi A. Severity as an independent determinant of the social value of a health service. Eur J Health Econ 2011; 12:163-174. [PMID: 20455072 DOI: 10.1007/s10198-010-0249-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 04/15/2010] [Indexed: 05/29/2023]
Abstract
This paper has two objectives, first to review the relevant literature concerning the social importance of severity of pre-treatment condition, and second to present the results of a new analysis of the relationship between social value, individual assessment of health improvement and the severity of illness. The present study differs methodologically from others reported in the literature. The underlying hypothesis is that members of the public have an aversion to patients being in a severe health state irrespective of the reason for their being there, and that this aversion will affect the social valuation of a health program after taking account of the magnitude of the health improvement. This effect will be observable in a program which (compared to another) takes a person out of a severe health state--the usual case discussed in the literature--or in a program which (compared to another) leaves a person in a severe health state. The present study tests this second implication of the hypothesis. We present data consistent with the view that after taking account of health improvement, health programs are preferred which do not leave people in severe health states. Alternative explanations are considered and particularly the possibility that data reflect a social preference for individuals achieving their health potential. Both explanations imply the need to reconsider the rules for prioritizing programs. In this analysis, Person Trade-Off (PTO) scores are used to measure social preferences ('value' or 'social utility') and Time Trade-Off (TTO) scores are used to measure individual assessments of health improvement and initial severity. Econometric results suggest that severity is highly significant and may more than double the index of social value of a health service.
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Affiliation(s)
- Jeff R J Richardson
- Centre for Health Economics, Monash University, Clayton, VIC, 3800, Australia.
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