1
|
Caballero J, Jacobs RJ, Ownby RL. Development of a computerized intervention to improve health literacy in older Hispanics with type 2 diabetes using a pharmacist supervised comprehensive medication management. PLoS One 2022; 17:e0263264. [PMID: 35139107 PMCID: PMC8827421 DOI: 10.1371/journal.pone.0263264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The primary objective was to develop a computerized culturally adapted health literacy intervention for older Hispanics with type 2 diabetes (T2D). Secondary objectives were to assess the usability and acceptability of the intervention by older Hispanics with T2D and clinical pharmacists providing comprehensive medication management (CMM).
Materials and methods
The study occurred in three phases. During phase I, an integration approach (i.e., quantitative assessments, qualitative interviews) was used to develop the intervention and ensure cultural suitability. In phase II, the intervention was translated to Spanish and modified based on data obtained in phase I. During phase III, the intervention was tested for usability/acceptability.
Results
Thirty participants (25 older Hispanics with T2D, 5 clinical pharmacists) were included in the study. Five major themes emerged from qualitative interviews and were included in the intervention: 1) financial considerations, 2) polypharmacy, 3) social/family support, 4) access to medication/information, and 5) loneliness/sadness. Participants felt the computerized intervention developed was easy to use, culturally appropriate, and relevant to their needs. Pharmacists agreed the computerized intervention streamlined patient counseling, offered a tailored approach when conducting CMM, and could save them time.
Conclusion
The ability to offer individualized patient counseling based on information gathered from the computerized intervention allows for precision counseling. Future studies are needed to determine the effectiveness of the developed computerized intervention on adherence and health outcomes.
Collapse
Affiliation(s)
- Joshua Caballero
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia, United States of America
- * E-mail:
| | - Robin J. Jacobs
- Departments of Health Informatics, Nutrition, Medical Education & Research, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Raymond L. Ownby
- Department of Psychiatry and Behavioral Medicine, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| |
Collapse
|
2
|
Huang D, Lairson DR, Chung TH, Monahan PO, Rawl SM, Champion VL. Economic Evaluation of Web- versus Telephone-based Interventions to Simultaneously Increase Colorectal and Breast Cancer Screening Among Women. Cancer Prev Res (Phila) 2021; 14:905-916. [PMID: 34244154 DOI: 10.1158/1940-6207.capr-21-0009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
Screening for colorectal and breast cancer is considered cost effective, but limited evidence exists on cost-effectiveness of screening promotion interventions that simultaneously target both cancers. Increasing Colorectal and Breast Cancer Screening (Project COBRA), a randomized controlled trial conducted in the community, examined the cost-effectiveness of an innovative tailored web-based intervention compared with tailored telephone counseling and usual care. Screening status at 6 months was obtained by participant surveys plus medical record reviews. Cost was prospectively measured from the patient and provider perspectives using time logs and project invoices. Relative efficiency of the interventions was quantified by the incremental cost-effectiveness ratios. Nonparametric bootstrapping and net benefit regression analysis were used to assess statistical uncertainty of the results. The average cost per participant to implement the Phone counseling, Web-based, and Web + Phone counseling interventions were $277, $314, and $337, respectively. Comparing Phone counseling with usual care resulted in an additional cost of $300 (95% confidence interval [CI]: $283-$320) per cancer screening test and $421 (95% CI: $400-$441) per additional person screened in the target population. Phone counseling alone was more cost-effective than the Web + Phone intervention. Web-based intervention alone was more costly but less effective than the Phone counseling. When simultaneously promoting screening for both colorectal and breast cancer the Web-based intervention was less cost-effective compared with Phone and Web + Phone strategies. The results suggest that targeting multiple cancer screening may improve the cost-effectiveness of cancer screening interventions. PREVENTION RELEVANCE: This study informs researchers, decision makers, healthcare providers, and payers about the improved cost-effectiveness of targeting multiple cancer screenings for cancer early detection programs.
Collapse
Affiliation(s)
- Danmeng Huang
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - David R Lairson
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
| | - Tong H Chung
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Patrick O Monahan
- Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis, Indiana
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, Indiana
| | - Victoria L Champion
- School of Nursing, Indiana University, Indianapolis, Indiana
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, Indiana
| |
Collapse
|
3
|
Quispe Flores MA, Concepción Zavaleta MJ, Plasencia Dueñas EA, Kcomt Lam M. The COVID-19 pandemic in developing countries: A new opportunity to improve the monitoring of patients with diabetes mellitus. Diabetes Metab Syndr 2020; 14:1871-1872. [PMID: 32998093 PMCID: PMC7505769 DOI: 10.1016/j.dsx.2020.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | - Mikaela Kcomt Lam
- Universidad Privada Antenor Orrego, Facultad de Medicina Humana; COVID-19 Unit, Hospital de Alta Complejidad Virgen de la Puerta, Trujillo, Peru Trujillo, Peru.
| |
Collapse
|
4
|
Wang X, Zhao W, Ke J, Zhao D. Comparison and analyses of therapeutic effects between metabolic management center (MMC) and conventional management modes. Acta Diabetol 2020; 57:1049-1056. [PMID: 32248347 DOI: 10.1007/s00592-020-01518-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
AIMS The past 3 decades witnessed the rapid growth of diabetes in China. To better serve large numbers of patients, the Chinese Medical Doctor Association launched metabolic management center (MMC) program which is featured with a one-stop and comprehensive diabetes management mode in 2016. It is worth exploring whether MMC model is better than conventional models in management. METHODS In this study, 228 patients with type 2 diabetes were recruited, and 193 patients completed the study. Therapeutic effects and health care costs were analyzed. RESULTS AND CONCLUSIONS Our results showed that decreases in HbA1C and TG/HDL-C values were significantly greater in the MMC group than in the control group. The increase in HDL-C was significantly higher in the MMC group than in the control group. The percentage of patients whose HbA1C lower than 7% was significantly higher in the MMC group. The results of the UKPDS model simulation showed that within 30 years, with the slight increases in treatment costs, the average life expectancy and total QALE of the MMC group are higher than those of the control group by 0.61 and 0.51 year, respectively. Further study showed that the drug intervention in the MMC group was significantly stronger. In addition, the questionnaires revealed that MMC group performed better in diabetes knowledge tests and have higher patient satisfaction rates of medical services. More patients in the MMC group adopted a more favorable diet strategy. These advantages enable MMC to achieve more short-term and long-term benefits in diabetes treatment than conventional mode.
Collapse
Affiliation(s)
- Xiaojing Wang
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China
| | - Wenying Zhao
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China
| | - Jing Ke
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China
| | - Dong Zhao
- Beijing Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, 113 Xinhua South Road, Tongzhou District, Beijing City, 101100, China.
| |
Collapse
|
5
|
Anopa Y, Macpherson L, McIntosh E. Systematic Review of Economic Evaluations of Primary Caries Prevention in 2- to 5-Year-Old Preschool Children. Value Health 2020; 23:1109-1118. [PMID: 32828224 DOI: 10.1016/j.jval.2020.04.1823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/01/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To describe and summarize evidence on economic evaluations (EEs) of primary caries prevention in preschool children aged 2 to 5 years and to evaluate the reporting quality of full EE studies using a quality assessment tool. METHODS A systematic literature search was conducted in several databases. Full and partial EEs were included. The reporting quality of full EE studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS A total of 808 studies were identified, and 39 were included in the review. Most papers were published between 2000 and 2017 and originated in the United States and the United Kingdom. The most common type of intervention investigated was a complex multicomponent intervention, followed by water fluoridation. Cost analysis and cost-effectiveness analysis were the most frequently used types of EE. One study employed cost-utility analysis. The proportion of full EEs increased over time. The parameters not reported well included study perspective, baseline year, sensitivity analysis, and discount rate. The CHEERS items that were most often unmet were characterizing uncertainty, study perspective, study parameters, and estimating resources and costs. CONCLUSIONS Within the past 2 decades, there has been an increase in the number of EEs of caries prevention interventions in preschool children. There was inconsistency in how EEs were conducted and reported. Lack of preference-based health-related quality-of-life measure utilization in the field was identified. The use of appropriate study methodologies and greater attention to recommended EE design are required to further improve quality.
Collapse
Affiliation(s)
- Yulia Anopa
- Dental School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK; Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.
| | - Lorna Macpherson
- Dental School, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| |
Collapse
|
6
|
Noble AJ, Snape D, Nevitt S, Holmes EA, Morgan M, Tudur-Smith C, Hughes DA, Buchanan M, McVicar J, MacCallum E, Goodacre S, Ridsdale L, Marson AG. Seizure First Aid Training For people with Epilepsy (SAFE) frequently attending emergency departments and their significant others: results of a UK multi-centre randomised controlled pilot trial. BMJ Open 2020; 10:e035516. [PMID: 32303515 PMCID: PMC7201300 DOI: 10.1136/bmjopen-2019-035516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To determine the feasibility and optimal design of a randomised controlled trial (RCT) of Seizure First Aid Training For Epilepsy (SAFE). DESIGN Pilot RCT with embedded microcosting. SETTING Three English hospital emergency departments (EDs). PARTICIPANTS Patients aged ≥16 with established epilepsy reporting ≥2 ED visits in the prior 12 months and their significant others (SOs). INTERVENTIONS Patients (and their SOs) were randomly allocated (1:1) to SAFE plus treatment-as-usual (TAU) or TAU alone. SAFE is a 4-hour group course. MAIN OUTCOME MEASURES Two criteria evaluated a definitive RCT's feasibility: (1) ≥20% of eligible patients needed to be consented into the pilot trial; (2) routine data on use of ED over the 12 months postrandomisation needed securing for ≥75%. Other measures included eligibility, ease of obtaining routine data, availability of self-report ED data and comparability, SAFE's effect and intervention cost. RESULTS Of ED attendees with a suspected seizure, 424 (10.6%) patients were eligible; 53 (12.5%) patients and 38 SOs consented. Fifty-one patients (and 37 SOs) were randomised. Routine data on ED use at 12 months were secured for 94.1% patients. Self-report ED data were available for 66.7% patients. Patients reported more visits compared with routine data. Most (76.9%) patients randomised to SAFE received it and no related serious adverse events occurred. ED use at 12 months was lower in the SAFE+TAU arm compared with TAU alone, but not significantly (rate ratio=0.62, 95% CI 0.33 to 1.17). A definitive trial would need ~674 patient participants and ~39 recruitment sites. Obtaining routine data was challenging, taking ~8.5 months. CONCLUSIONS In satisfying only one predetermined 'stop/go' criterion, a definitive RCT is not feasible. The low consent rate in the pilot trial raises concerns about a definitive trial's finding's external validity and means it would be expensive to conduct. Research is required into how to optimise recruitment from the target population. TRIAL REGISTRATION NUMBER ISRCTN13871327.
Collapse
Affiliation(s)
- Adam J Noble
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Dee Snape
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Emily A Holmes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Mark Buchanan
- Emergency Department, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Jane McVicar
- MacKinnon Memorial Hospital / Broadford Hospital, NHS Highland, Broadford, Isle of Skye, UK
| | - Elizabeth MacCallum
- Emergency Department, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| |
Collapse
|
7
|
Patel MR, Heisler M, Piette JD, Resnicow K, Song PXK, Choe HM, Shi X, Tobi J, Smith A. Study protocol: CareAvenue program to improve unmet social risk factors and diabetes outcomes- A randomized controlled trial. Contemp Clin Trials 2020; 89:105933. [PMID: 31923472 PMCID: PMC7242130 DOI: 10.1016/j.cct.2020.105933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/23/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
Despite the burdens costs can place on adults with diabetes, few evidence-based, scalable interventions have been identified that address prevalent health-related financial burdens and unmet social risk factors that serve as major obstacles to effective diabetes management. In this study, we will test the effectiveness of CareAvenue - an automated e-health tool that screens for unmet social risk factors and informs and activates individuals to take steps to connect to resources and engage in self-care. We will determine the effectiveness of CareAvenue relative to standard care with respect to improving glycemic control and patient-centered outcomes such as cost-related non-adherence (CRN) behaviors and perceived financial burden. We will also examine the role of patient risk factors (moderators) and behavioral factors (mediators) on the effectiveness of CareAvenue in improving outcomes. We will recruit 720 patients in a large health system with uncontrolled Type 1 diabetes mellitus (T1DM) or Type 2 diabetes mellitus (T2DM) who engage in CRN or perceive financial burden. Participants will be randomized to one of two arms: 1) receipt of a 15-20 min web-based program with routine follow-up (CareAvenue); or 2) receipt of contact information for existing health system assistance services. Outcomes will be assessed at baseline and 6- and 12-month follow-up. Clinical Trial Registration: ClinicalTrials.gov ID NCT03950973, May 2019.
Collapse
Affiliation(s)
- Minal R Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America.
| | - Michele Heisler
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America; Department of Internal Medicine, Michigan Medicine, United States of America; U.S. Department of Veterans Affairs VA, Ann Arbor Healthcare System, United States of America
| | - John D Piette
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America; U.S. Department of Veterans Affairs VA, Ann Arbor Healthcare System, United States of America
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America
| | - Peter X K Song
- Department of Biostatistics, University of Michigan School of Public Health, United States of America
| | - Hae Mi Choe
- College of Pharmacy, University of Michigan, United States of America; University of Michigan Medical Group, United States of America
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, United States of America
| | - Julie Tobi
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America
| | - Alyssa Smith
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, United States of America
| |
Collapse
|
8
|
Shumway M, Fisher L, Hessler D, Bowyer V, Polonsky WH, Masharani U. Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial. J Diabetes Complications 2019; 33:107416. [PMID: 31473079 PMCID: PMC6823162 DOI: 10.1016/j.jdiacomp.2019.107416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
AIMS This study evaluated the implementation costs of two group interventions, one focused on diabetes education (KnowIt) and one focused directly on diabetes distress (OnTrack), that reduced diabetes distress and HbA1C in adults with poorly controlled type 1 diabetes (T1DM) in the T1-REDEEM trial. METHODS Resources used to provide interventions were enumerated using activity-based micro-costing methods. Costs were assigned to resources in 2017 US dollars. US median wage and benefit rates were used to calculate costs of staff time. Cost per unit change was calculated for diabetes distress and HbA1C. RESULTS For both interventions, per participant implementation costs were approximately $250 and cost per 1.0 percentage point (11 mmol/mol) change in HbA1C was $1400. Cost per unit change in diabetes distress was $364 for KnowIt and $335 for OnTrack. No statistically significant differences in costs were observed. CONCLUSIONS This is the first study to examine the costs of implementing interventions targeting diabetes distress in the context of T1DM. Both interventions had per participant implementation costs in the lower end of the range of previously examined diabetes self-management interventions ($219 to $5390). These inventions and their costs merit further attention because reducing diabetes distress may impact long term T1DM outcomes. CLINICAL TRIALS REGISTRATION ClinicalTrials.govNCT02175732.
Collapse
MESH Headings
- Adult
- Anxiety/economics
- Anxiety/etiology
- Anxiety/therapy
- Cost-Benefit Analysis
- Depression/economics
- Depression/etiology
- Depression/therapy
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Group Processes
- Health Care Costs
- Humans
- Implementation Science
- Middle Aged
- Patient Acceptance of Health Care/statistics & numerical data
- Patient Education as Topic/economics
- Patient Education as Topic/methods
- Psychological Distress
- Psychotherapy, Group/economics
- Psychotherapy, Group/methods
- Self Care/economics
- Self Care/methods
- Stress, Psychological/economics
- Stress, Psychological/epidemiology
- Stress, Psychological/etiology
- Stress, Psychological/therapy
Collapse
Affiliation(s)
- Martha Shumway
- Department of Psychiatry, University of California, San Francisco, Box 0884, San Francisco, CA 94143-0884, USA.
| | - Lawrence Fisher
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA
| | - Vicky Bowyer
- Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, 5405 Oberlin Drive #100, San Diego, CA 92121, USA
| | - Umesh Masharani
- Department of Medicine, University of California, San Francisco, Box 1222, San Francisco, CA 94143-1222, USA
| |
Collapse
|
9
|
Perry A, Waterman MG, House A, Wright-Hughes A, Greenhalgh J, Farrin A, Richardson G, Hopton AK, Wright N. Problem-solving training: assessing the feasibility and acceptability of delivering and evaluating a problem-solving training model for front-line prison staff and prisoners who self-harm. BMJ Open 2019; 9:e026095. [PMID: 31585968 PMCID: PMC6797432 DOI: 10.1136/bmjopen-2018-026095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/24/2019] [Accepted: 06/13/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Problem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study. DESIGN AND SETTING A mixed-methods design used routinely collected data, individual outcome measures, an economic protocol and qualitative interviews at four prisons in Yorkshire and Humber, UK. PARTICIPANTS (i) Front-line prison staff, (ii) male and female prisoners with an episode of self-harm in the previous 2 weeks. INTERVENTION The intervention comprised a 1 hour staff training session and a 30 min prisoner session using adapted workbooks and case studies. OUTCOMES We assessed the study processes-coverage of training; recruitment and retention rates and adequacy of intervention delivery-and available data (completeness of outcome data, integrity of routinely collected data and access to the National Health Service (NHS) resource information). Prisoner outcomes assessed incidence of self-harm, quality of life and depression at baseline and at follow-up. Qualitative findings are presented elsewhere. RESULTS Recruitment was higher than anticipated for staff n=280, but lower for prisoners, n=48. Retention was good with 43/48 (89%) prisoners completing the intervention, at follow-up we collected individual outcome data for 34/48 (71%) of prisoners. Access to routinely collected data was inconsistent. Prisoners were frequent users of NHS healthcare. The additional cost of training and intervention delivery was deemed minimal in comparison to 'treatment as usual'. Outcome measures of self-harm, quality of life and depression were found to be acceptable. CONCLUSIONS The intervention proved feasible to adapt. Staff training was delivered but on the whole it was not deemed feasible for staff to deliver the intervention. A large-scale study is warranted, but modifications to the implementation of the intervention are required.
Collapse
Affiliation(s)
| | | | - Allan House
- Academic Unit of Psychiatry, University of Leeds, Leeds, UK
| | | | | | - Amanda Farrin
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | | | - Nat Wright
- Spectrum Community Health CIC, Wakefield, UK
| |
Collapse
|
10
|
de Ruijter D, Hoving C, Evers S, Hudales R, de Vries H, Smit E. An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses. Patient Educ Couns 2019; 102:1802-1811. [PMID: 31395391 DOI: 10.1016/j.pec.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/25/2019] [Accepted: 07/13/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To conduct an economic evaluation of a tailored e-learning program, which successfully improved practice nurses' smoking cessation guideline adherence. METHODS The economic evaluation was embedded in a randomized controlled trial, in which 269 practice nurses recruited 388 smoking patients. Cost-effectiveness was assessed using guideline adherence as effect measure on practice nurse level, and continued smoking abstinence on patient level. Cost-utility was assessed on patient level, using patients' Quality Adjusted Life Years (QALYs) as effect measure. RESULTS The e-learning program was likely to be cost-effective on practice nurse level, as adherence to an additional guideline step cost €1,586. On patient level, cost-effectiveness was slightly likely after six months (cost per additional quitter: €7,126), but not after twelve months. The cost-utility analysis revealed slight cost-effectiveness (cost per QALY gained: €18,431) on patient level. CONCLUSION Providing practice nurses with a tailored e-learning program is cost-effective to improve their smoking cessation counseling. Though, cost-effectiveness on patient level was not found after twelve months, potentially resulting from smoking relapse. PRACTICE IMPLICATIONS Widespread implementation of the e-learning program can improve the quality of smoking cessation care in general practice. Strategies to prevent patients' smoking relapse should be further explored to improve patients' long-term abstinence.
Collapse
Affiliation(s)
- Dennis de Ruijter
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands; Centre of Economic Evaluation, Trimbos Institute, National Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS, Utrecht, the Netherlands
| | - Raesita Hudales
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - Eline Smit
- Department of Communication Science, University of Amsterdam, P.O. Box 15791, 1001 NG Amsterdam, the Netherlands
| |
Collapse
|
11
|
Dieng M, Khanna N, Kasparian NA, Costa DSJ, Butow PN, Menzies SW, Mann GJ, Cust AE, Morton RL. Cost-Effectiveness of a Psycho-Educational Intervention Targeting Fear of Cancer Recurrence in People Treated for Early-Stage Melanoma. Appl Health Econ Health Policy 2019; 17:669-681. [PMID: 31228015 DOI: 10.1007/s40258-019-00483-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the cost effectiveness of a newly developed psycho-educational intervention to reduce fear of cancer recurrence (FCR) in early-stage melanoma patients. METHODS A within-trial cost-effectiveness and cost-utility analysis was conducted from the Australian health system perspective using data from linked Medicare records. Outcomes included FCR, measured with the severity subscale of the FCR Inventory; quality-adjusted life years (QALYs) measured using the preference-based instrument, Assessment of Quality of Life-8 Dimensions (AQoL-8D) and 12-month survival. An incremental cost-effectiveness ratio (ICER) was calculated for two economic outcomes: (1) cost per additional case of 'high' FCR avoided and (2) cost per QALY gained. Means and 95% CIs around the ICER were generated from non-parametric bootstrapping with 1000 replications. RESULTS A total of 151 trial participants were included in the economic evaluation. The mean cost of the psycho-educational intervention was AU$1614 per participant, including intervention development costs. The ICER per case of high FCR avoided was AU$12,903. The cost-effectiveness acceptability curve demonstrated a 78% probability of the intervention being cost effective relative to the control at a threshold of AU$50,000 per extra person avoiding FCR. The ICER per QALY gained was AU$116,126 and the probability of the intervention being cost effective for this outcome was 36% at a willingness to pay of AU$50,000 per QALY. CONCLUSION The psycho-educational intervention reduced FCR at 12 months for people at high risk of developing another melanoma and may represent good value for money. For the QALY outcome, the psycho-educational intervention is unlikely to be cost effective at standard government willingness-to-pay levels. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (CTRN12613000304730).
Collapse
Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building, Level 6, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia.
| | - Nikita Khanna
- NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building, Level 6, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Nadine A Kasparian
- School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Phyllis N Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia
| | - Graham J Mann
- Melanoma Institute Australia, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research and Melanoma Institute Australia, Sydney School of Public Health, The University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre and Melanoma Institute Australia, The University of Sydney, Camperdown, Sydney, NSW, Australia
| |
Collapse
|
12
|
Caballol Angelats R, Gonçalves AQ, Aguilar Martín C, Sancho Sol MC, González Serra G, Casajuana M, Carrasco-Querol N, Fernández-Sáez J, Dalmau Llorca MR, Abellana R, Berenguera A. Effectiveness, cost-utility, and benefits of a multicomponent therapy to improve the quality of life of patients with fibromyalgia in primary care: A mixed methods study protocol. Medicine (Baltimore) 2019; 98:e17289. [PMID: 31593081 PMCID: PMC6799432 DOI: 10.1097/md.0000000000017289] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l'Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. ANALYSIS the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION Clinical-Trials.gov: NCT04049006.
Collapse
Affiliation(s)
- Rosa Caballol Angelats
- Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L‘Ebre, Institut Català de la Salut
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut
| | - Maria Cinta Sancho Sol
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona
- Fundació Pere Mata Terres de l’Ebre
| | - Gemma González Serra
- Unitat d’Expertesa en Sindromes de Sensibilització Central Terres de l’Ebre, Institut Català de la Salut, Tortosa, Tarragona
- Servei de Rehabilitació i Medicina Física, Hospital de Tortosa Verge de la Cinta, Institut Català de la Salut, Tortosa
| | - Marc Casajuana
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)
| | - José Fernández-Sáez
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)
| | - Maria Rosa Dalmau Llorca
- Equip d’Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol)
| | - Rosa Abellana
- Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès
| |
Collapse
|
13
|
Heald A, Davies M, Stedman M, Livingston M, Lunt M, Fryer A, Gadsby R. Analysis of English general practice level data linking medication levels, service activity and demography to levels of glycaemic control being achieved in type 2 diabetes to improve clinical practice and patient outcomes. BMJ Open 2019; 9:e028278. [PMID: 31494602 PMCID: PMC6731821 DOI: 10.1136/bmjopen-2018-028278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Evaluate relative clinical effectiveness of treatment options for type 2 diabetes mellitus (T2DM) using a statistical model of real-world evidence within UK general practitioner practices (GPP), to quantify the opportunities for diabetes care performance improvement. METHOD From the National Diabetes Audit in 2015-2016 and 2016-2017, GPP target glycaemic control (TGC-%HbA1c ≤58 mmol/mol) and higher glycaemic risk (HGR -%HbA1c results >86 mmol/mol) outcomes were linked using multivariate linear regression to prescribing, demographics and practice service indicators. This was carried out both cross-sectionally (XS) (within year) and longitudinally (Lo) (across years) on 35 indicators. Standardised β coefficients were used to show relative level of impact of each factor. Improvement opportunity was calculated as impact on TGC & HGR numbers. RESULTS Values from 6525 GPP with 2.7 million T2DM individuals were included. The cross-sectional model accounted for up to 28% TGC variance and 35% HGR variance, and the longitudinal model accounted for up to 9% TGC and 17% HGR variance. Practice service indicators including % achieving routine checks/blood pressure/cholesterol control targets were positively correlated, while demographic indicators including % younger age/social deprivation/white ethnicity were negatively correlated. The β values for selected molecules are shown as (increased TGC; decreased HGR), canagliflozin (XS 0.07;0.145/Lo 0.04;0.07), metformin (XS 0.12;0.04/Lo -;-), sitagliptin (XS 0.06;0.02/Lo 0.10;0.06), empagliflozin (XS-;0.07/Lo 0.09;0.07), dapagliflozin (XS -;0.04/Lo -;0.4), sulphonylurea (XS -0.18;-0.12/Lo-;-) and insulin (XS-0.14;0.02/ Lo-0.09;-). Moving all GPP prescribing and interventions to the equivalent of the top performing decile of GPP could result in total patients in TGC increasing from 1.90 million to 2.14 million, and total HGR falling from 191 000 to 123 000. CONCLUSIONS GPP using more legacy therapies such as sulphonylurea/insulin demonstrate poorer outcomes, while those applying holistic patient management/use of newer molecules demonstrate improved glycaemic outcomes. If all GPP moved service levels/prescribing to those of the top decile, both TGC/HGR could be substantially improved.
Collapse
Affiliation(s)
- Adrian Heald
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | | | | | - Mark Livingston
- Clinical Biochemistry, Walsall Healthcare NHS Trust, Walsall, UK
| | - Mark Lunt
- The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Anthony Fryer
- Clinical Biochemistry, University Hospitals of North Midlands, Stoke on Trent, Staffordshire, UK
| | - Roger Gadsby
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
14
|
Egüés Olazabal N, Delfrade Osinaga I, Dominguez Pascual S, Pérez Jarauta MJ, Nuin Villanueva M, López Andrés A, Indurain Orduna S, Echauri Ozcoidi M, Agudo Pascual C, Cambra Contín K. [Assistance program in quitting tobacco use in Navarra. 25 years on stage]. Rev Esp Salud Publica 2019; 93:e201907039. [PMID: 31273187 PMCID: PMC10308824] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/14/2019] [Indexed: 06/09/2023] Open
Abstract
In Navarre, the Smoking Cessation Program (PAF) was launched in 1994, result of the collaboration between Public Health and Primary Care. In 2001 it was integrated into the Tobacco Regional Action Plan, together with the other two lines of action: prevention of smoking initiation and promotion of smoke-free spaces. PAF includes two levels of intervention, a basic and an intensive one, with programmed educational support, individual and group. Medications for smoking cessation have been intermittently subsidized by the Health Department of Navarre. In December 2017, funding of medications for smoking cessation was reintroduced, in the same conditions of any other medication. Treatments are limited to one per patient and year, always including educational support. In 2018, 6139 people benefited from this funding, 50% women and 60% with yearly income lower than 18000 euros. We carried out a preliminary evaluation through a telephone survey. Overall, 35% of participants reported to keep abstinent after one year, 40% among those who also received intensive educational support.
Collapse
Affiliation(s)
- Nerea Egüés Olazabal
- Instituto de Salud Pública y Laboral de Navarra (ISPLN). Pamplona. España.Spain
| | | | | | | | - Marian Nuin Villanueva
- Gerencia de Atención Primaria. Servicio Navarro de Salud - Osasunbidea. Pamplona. España.Servicio Navarro de Salud-OsasunbideaSpain
| | - Antonio López Andrés
- Subdirección de Farmacia. Servicio Navarro de Salud - Osasunbidea. Pamplona. España. Servicio Navarro de Salud-OsasunbideaSpain
| | - Santos Indurain Orduna
- Gerencia de Atención Primaria. Servicio Navarro de Salud - Osasunbidea. Pamplona. España.Servicio Navarro de Salud-OsasunbideaSpain
| | | | - Cristina Agudo Pascual
- Subdirección de Farmacia. Servicio Navarro de Salud - Osasunbidea. Pamplona. España. Servicio Navarro de Salud-OsasunbideaSpain
| | - Koldo Cambra Contín
- Instituto de Salud Pública y Laboral de Navarra (ISPLN). Pamplona. España.Spain
| |
Collapse
|
15
|
Carey ME, Agarwal S, Horne R, Davies M, Slevin M, Coates V. Exploring organizational support for the provision of structured self-management education for people with Type 2 diabetes: findings from a qualitative study. Diabet Med 2019; 36:761-770. [PMID: 30868654 DOI: 10.1111/dme.13946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2019] [Indexed: 01/27/2023]
Abstract
AIM To explore the organizational context in which Type 2 diabetes structured group education is provided. METHODS Four Clinical Commissioning Groups in England providing Type 2 diabetes structured self-management education participated in a qualitative study exploring the context for provision of that education. Using UK National Diabetes Audit returns, two Clinical Commissioning Groups were selected that had non-attendance rates of ≤25%, and two that had non-attendance rates of ≥50%. Between May 2016 and August 2017, 20 interviews were conducted with Clinical Commissioning Group staff including: commissioners, healthcare professionals, managers, general practitioners and diabetes educators. Data gathering was prolonged as it proved challenging to engage with healthcare staff as a result of frequent local restructuring and service disruption. RESULTS Local audits revealed discrepancies in basic data such as referral and attendance numbers compared with national audit data. There was a commonality in the themes identified from interviews: diabetes education was rarely embedded in service structure; where education uptake was poor, a lack of central support to delivery teams was noticeable; and where education uptake was positive, delivery teams were actively engaged, sometimes relying on enthusiastic individuals. Both situations put the local sustainability of diabetes education at risk. CONCLUSIONS There appears to be a link between attendance rates and organizational issues, therefore, when considering how to increase attendance rates, the state of the diabetes education infrastructure should be reviewed. Good uptake of diabetes education can be too reliant on the enthusiastic commitment of small teams or individuals delivering the education.
Collapse
Affiliation(s)
- M E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - S Agarwal
- College of Life Sciences, University of Leicester, Leicester, UK
| | - R Horne
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Davies
- Belfast Health and Social Care Trust, Belfast, UK
| | - M Slevin
- School of Nursing, Ulster University, Coleraine, UK
| | - V Coates
- School of Nursing, Ulster University, Coleraine, UK
- Western Health and Social Care Trust, Londonderry, UK
| |
Collapse
|
16
|
Abstract
INTRODUCTION Living donor kidney transplantation (LDKT) is the optimal treatment for most patients with end-stage renal disease (ESRD). However, there are numerous patients who cannot find a living kidney donor. Randomised controlled trials have shown that home-based education for patients with ESRD and their family/friends leads to four times more LDKTs. This educational intervention is currently being implemented in eight hospitals in the Netherlands. Supervision and quality assessment are being employed to maintain the quality of the intervention. In this study, we aim to: (1) conduct a cost-effectiveness analysis of the educational programme and its quality assurance system; (2) investigate the relationship between the quality of the implementation of the intervention and the outcomes knowledge, communication and LDKT activities; and (3) investigate policy implications. METHODS AND DESIGN Patients with ESRD who do not have a living kidney donor are eligible to receive the home-based educational intervention. This is carried out by allied health transplantation professionals and psychologists across eight hospitals in the Netherlands. The cost-effectiveness analysis will be conducted with a Markov model. Cost data will be obtained from the literature. We will obtain the quality of life data from the patients who participate in the educational programme. Questionnaires on knowledge and communication will be used to measure the outcomes of the programme. Data on LDKT activities will be obtained from medical records up to 24 months after the education. A protocol adherence measure will be assessed by a third party by means of a telephone interview with the patients and the invitees. ETHICS AND DISSEMINATION Ethical approval was obtained through all participating hospitals. Results will be disseminated through peer-reviewed publications and scientific presentations. Results of the cost-effectiveness of the educational programme will also be disseminated to the Dutch National Health Care Institute. TRIAL REGISTRATION NUMBER NL6529.
Collapse
Affiliation(s)
- Steef Redeker
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Mark Oppe
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Martijn Visser
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Jan J V Busschbach
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Emma Massey
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sohal Ismail
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
17
|
Gountas I, Sypsa V, Papatheodoridis G, Souliotis K, Athanasakis K, Razavi H, Hatzakis A. Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals. World J Gastroenterol 2019; 25:1327-1340. [PMID: 30918426 PMCID: PMC6429341 DOI: 10.3748/wjg.v25.i11.1327] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral (DAA) treatment coverage, to compute the total costs (including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece.
AIM To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece.
METHODS A previously validated mathematical model was adapted to the Greek HCV-infected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs (direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios.
RESULTS Without the implementation of awareness or screening campaigns, approximately 20000 patients would be diagnosed and treated with DAAs by 2030. This strategy would result in a 19.6% increase in HCV-related mortality in 2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by 78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros (€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very cost-effective. Furthermore, HCV elimination strategy would save €560-895 million by 2035.
CONCLUSION Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.
Collapse
Affiliation(s)
- Ilias Gountas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
- Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens 11527, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - George Papatheodoridis
- Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 11527, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Korinthos 20100, Greece
| | - Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens 11521, Greece
| | - Homie Razavi
- Center for Disease Analysis, Lafayette, CO 80026, United States
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
- Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases, Athens 11527, Greece
| |
Collapse
|
18
|
Crossman S, Ohde A. A case study exploring the effectiveness of an innovative "5Q Care Test" to determine whether patients with complex needs require health or social care. Health Soc Care Community 2019; 27:409-414. [PMID: 30203574 DOI: 10.1111/hsc.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Abstract
A case study was conducted in 2016 to evaluate the effectiveness of an innovation to enable people with "complex" care requirements to be discharged from hospital to an appropriate service for their care, without using the NHS England Continuing Health Care (CHC) assessment. The setting was a rural district general hospital in England, where the quality outcomes and cost-effectiveness of the CHC assessment being conducted in hospital were giving cause for concern. The NHS CHC Framework advocates conducting these assessments in the community where a more accurate indication of long-term care can be determined. The "5Q Care Test" was collaboratively developed with health and social care partners, care providers, and CHC interest groups, including users of the services. It was implemented as a tool to support moving the CHC assessment into the community, as it enabled practitioners to swiftly determine patients' appropriate initial care pathway out of hospital. A full economic impact analysis was conducted 7 months after the tool was introduced. The results showed significant improvement in the quality and cost-effectiveness of the "5Q Care Test," with a reduction in the hospital length of stay, which is known to be associated with improved outcomes for patients and financial savings.
Collapse
Affiliation(s)
| | - Ana Ohde
- Arden and Greater East Midlands Commissioning Support Unit, Leicester, UK
| |
Collapse
|
19
|
Meyer-Rath G, van Rensburg C, Chiu C, Leuner R, Jamieson L, Cohen S. The per-patient costs of HIV services in South Africa: Systematic review and application in the South African HIV Investment Case. PLoS One 2019; 14:e0210497. [PMID: 30807573 PMCID: PMC6391029 DOI: 10.1371/journal.pone.0210497] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/23/2018] [Indexed: 12/29/2022] Open
Abstract
Background In economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Few analyses however use locally relevant cost data. We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country’s HIV programme. Methods We systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. Where no data was found in the literature, we constructed unit costs either based on available information regarding ingredients and relevant public-sector prices, or based on expenditure records. Results Only 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. Other papers detailed the costs of HCT, MMC, palliative and inpatient care; no papers were found on the costs of PrEP, social and behaviour change communication, and PMTCT. The results informed unit costs for 5 of 11 intervention categories included in the Investment Case, with the remainder costed based on ingredients (35%) and expenditure data (10%). Conclusions A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. More primary cost analyses of non-ART interventions are needed.
Collapse
Affiliation(s)
- Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Center for Global Health and Development, Boston University, Boston, Massachusetts, United States of America
- * E-mail:
| | - Craig van Rensburg
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Calvin Chiu
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rahma Leuner
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Steve Cohen
- Strategic Development Consultants, Pietermaritzburg, South Africa
| |
Collapse
|
20
|
McCreight MS, Lambert-Kerzner A, O'Donnell CI, Grunwald GK, Hebert P, Gillette M, Jneid H, Parashar A, Grossman PM, Helfrich C, Mavromatis K, Saket G, Ho PM. Improving anti-platelet therapy adherence in the Veterans Health Administration: A randomized multi-site hybrid effectiveness-implementation study protocol. Contemp Clin Trials 2019; 77:104-110. [PMID: 30576842 DOI: 10.1016/j.cct.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/22/2018] [Accepted: 12/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND P2Y12 inhibitors are critical following percutaneous coronary intervention (PCI) with stent placement; they reduce the risk of stent thrombosis and myocardial infarction. Despite the importance of the therapy, non-adherence is common among Veterans. METHODS AND RESULTS Our main objective is to conduct a multi-site randomized stepped wedge trial to test the effectiveness of a multi-faceted intervention to improve adherence to P2Y12 inhibitors and PCI outcomes as well as formatively evaluate and refine the intervention implementation process. The primary outcomes of the study are the proportion of patients whose P2Y12 inhibitor prescription was filled at the time of hospital discharge following PCI with stent placement as well as the proportion of patients who were adherent based on the pharmacy refill data in the year after PCI hospital discharge. We will also assess the secondary outcomes such as bleeding, myocardial infarction, stroke, and mortality among these patients, and the cost-effectiveness of the intervention. The study was conducted at Veterans Health Administration (VA) PCI sites. At each site, we enrolled patients over a 6-month period and followed them for 12 months after PCI. Additionally, we collected qualitative data to identify contextual factors and to assess barriers and facilitators to the implementation and maintenance of the intervention. CONCLUSIONS The study will add to the current state of knowledge on improving medication adherence in patients receiving PCI with stent implantation. Moreover, the study includes an extensive examination of the implementation process and will contribute to the field of implementation science. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01609842 https://clinicaltrials.gov/ct2/show/NCT01609842?term=clopidogrel+adherence&cntry1=NA%3AUS&rank=1.
Collapse
Affiliation(s)
| | | | | | - Gary K Grunwald
- Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, CO, United States
| | - Paul Hebert
- VHA Puget Sound Health Care System, Seattle, WA, United States
| | - Michael Gillette
- Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Hani Jneid
- Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | | | | | | | | | | | - P Michael Ho
- VHA Eastern Colorado Health Care System, Denver, CO, United States
| |
Collapse
|
21
|
Augustovski F, Chaparro M, Palacios A, Shi L, Beratarrechea A, Irazola V, Rubinstein A, Mills K, He J, Pichon Riviere A. Cost-Effectiveness of a Comprehensive Approach for Hypertension Control in Low-Income Settings in Argentina: Trial-Based Analysis of the Hypertension Control Program in Argentina. Value Health 2018; 21:1357-1364. [PMID: 30502778 PMCID: PMC6457112 DOI: 10.1016/j.jval.2018.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina. OBJECTIVES To assess the cost-effectiveness of this intervention. METHODS A total of 1432 hypertensive participants were recruited from 18 primary health care centers. The intervention included home visits led by community health workers, physician education, and text messaging. Resource use and quality of life data using the three-level EuroQol five-dimensional questionnaire were prospectively collected. The study perspective was that of the public health care system, and the time horizon was 18 months. Intention-to-treat analysis was used to analyze cost and health outcomes (systolic blood pressure [SBP] change and quality-adjusted life-years [QALYs]). A 1 time gross domestic product per capita per QALY was used as the cost-effectiveness threshold (US $14,062). RESULTS Baseline characteristics were similar in the two arms. QALYs significantly increased by 0.06 (95% confidence interval [CI] 0.04-0.09) in the intervention group, and SBP net difference favored the intervention group: 5.3 mm Hg (95% CI 0.27-10.34). Mean total costs per participant were higher in the intervention arm: US $304 in the intervention group and US $154 in the control group (adjusted difference of US $140.18; 95% CI US $75.41-US $204.94). The incremental cost-effectiveness ratio was $3299 per QALY (95% credible interval 1635-6099) and US $26 per mm Hg of SBP (95% credible interval 13-46). Subgroup analysis showed that the intervention was cost-effective in all prespecified subgroups (age, sex, cardiovascular risk, and body mass index). CONCLUSIONS The multicomponent intervention was cost-effective for blood pressure control among low-income hypertensive patients.
Collapse
Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina.
| | - Martín Chaparro
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Alfredo Palacios
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
| | - Katherine Mills
- Department of Epidemiology and Tulane University Translational Science Institute, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology and Tulane University Translational Science Institute, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Andrés Pichon Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
22
|
Stenberg U, Vågan A, Flink M, Lynggaard V, Fredriksen K, Westermann KF, Gallefoss F. Health economic evaluations of patient education interventions a scoping review of the literature. Patient Educ Couns 2018; 101:1006-1035. [PMID: 29402571 DOI: 10.1016/j.pec.2018.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To provide a comprehensive overview of health economic evaluations of patient education interventions for people living with chronic illness. METHODS Relevant literature published between 2000 and 2016 has been comprehensively reviewed, with attention paid to variations in study, intervention, and patient characteristics. RESULTS Of the 4693 titles identified, 56 articles met the inclusion criteria and were included in this scoping review. Of the studies reviewed, 46 concluded that patient education interventions were beneficial in terms of decreased hospitalization, visits to Emergency Departments or General Practitioners, provide benefits in terms of quality-adjusted life years, and reduce loss of production. Eight studies found no health economic impact of the interventions. CONCLUSIONS The results of this review strongly suggest that patient education interventions, regardless of study design and time horizon, are an effective tool to cut costs. This is a relatively new area of research, and there is a great need of more research within this field. PRACTICE IMPLICATIONS In bringing this evidence together, our hope is that healthcare providers and managers can use this information within a broad decision-making process, as guidance in discussions of care quality and of how to provide appropriate, cost-effective patient education interventions.
Collapse
Affiliation(s)
- Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
| | - Andre Vågan
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
| | - Maria Flink
- Medical Management Centre, LIME and Department of Social Work, Karolinska University Hospital, Stockholm, Sweden.
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Kari Fredriksen
- Learning and Mastery Center, Stavanger University Hospital, Stavanger, Norway.
| | - Karl Fredrik Westermann
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
| | - Frode Gallefoss
- Department of Pulmonary Medicine, Sorlandet Hospital, Kristiansand S, Norway.
| |
Collapse
|
23
|
de Wit M, Rondags SMPA, van Tulder MW, Snoek FJ, Bosmans JE. Cost-effectiveness of the psycho-educational blended (group and online) intervention HypoAware compared with usual care for people with Type 1 and insulin-treated Type 2 diabetes with problematic hypoglycaemia: analyses of a cluster-randomized controlled trial. Diabet Med 2018; 35:214-222. [PMID: 29150861 DOI: 10.1111/dme.13548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate the cost-effectiveness of HypoAware, a blended (group and online) psycho-educational intervention based on the evidence-based Blood Glucose Awareness Training, in comparison with usual care in people with Type 1 and Type 2 diabetes with a high risk of severe hypoglycaemia. METHODS We performed an economic evaluation, from a societal and healthcare perspective, that used data from a 6-month, multicentre, cluster-randomized controlled trial (n = 137). RESULTS The proportion of people with at least one severe hypoglycaemic event per 6 months was 0.22 lower (95% CI -0.39 to -0.06) and the proportion of people with impaired hypoglycaemia awareness was 0.16 lower (95% CI -0.34 to 0.02) in the HypoAware group. There was no difference in quality-adjusted life-years (-0.0; 95% CI -0.05 to 0.05). The mean total societal costs in the HypoAware group were EUR708 higher than in the usual care group (95% CI -951 to 2298). The mean incremental cost per severe hypoglycaemic event prevented was EUR2,233. At a willingness-to-pay threshold of EUR20,000 per event prevented, the probability that HypoAware was cost-effective in comparison with usual care was 54% from a societal perspective and 55% from a healthcare perspective. For quality-adjusted life-years the incremental cost-effectiveness ratio was EUR119,360/quality-adjusted life-year gained and the probability of cost-effectiveness was low at all ceiling ratios. CONCLUSIONS Based on the present study, we conclude that HypoAware is not cost-effective compared to usual care. Further research in less well-resourced settings and more severely affected patients is warranted. (Clinical Trials Registry no: Dutch Trial Register NTR4538.).
Collapse
Affiliation(s)
- M de Wit
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - S M P A Rondags
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - M W van Tulder
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam, Amsterdam, The Netherlands
| | - F J Snoek
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - J E Bosmans
- Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Heald AH, Livingston M, Malipatil N, Becher M, Craig J, Stedman M, Fryer AA. Improving type 2 diabetes mellitus glycaemic outcomes is possible without spending more on medication: Lessons from the UK National Diabetes Audit. Diabetes Obes Metab 2018; 20:185-194. [PMID: 28730750 DOI: 10.1111/dom.13067] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
AIMS To determine the factors at general practice level that relate to glycaemic control outcomes in people with type 2 diabetes (T2DM). METHODS Data were accessed from 4050 general practices (50% of total) covering 1.6 million patients with T2DM in the UK National Diabetes Audit 2013 to 2014 and 2014 to 2015. This audit reported characteristics, services and outcomes in the T2DM population, including percentage of patients who had total glycaemic control (TGC), defined as glycated haemoglobin (HbA1c) ≤7.5% (58 mmol/mol), and the percentage who were at higher glycaemic risk (HGR), defined as HbA1c >10% (86 mmol/mol); the respective figures were 67.2% and 6.2%. The medication data were examined in terms of annual defined daily doses (DDDs). Multivariate linear regression analysis was used to identify associations between DDD and patient and practice characteristics. RESULTS Over the period 2012/2013 to 2015/2016, patient numbers grew 4% annually and annual medication expenditure by 8%, but glycaemic control outcomes did not improve. The main findings were that practices with better outcomes: had a higher percentage of patients aged >65 years; provided more effective diabetes services (including case identification, care checks, patient education, percentage of patients with blood pressure and cholesterol under control and more patients with type 1 diabetes achieving target HbA1c levels); spent less overall on prescribing per patient with T2DM; and on average, prescribed fewer sulphonylureas, less insulin (for patients with T2DM), fewer glucagon-like peptide-1 agonists, more metformin, more dipeptidyl peptidase-4 inhibitors, and more blood glucose monitoring strips. Ethnicity and social disadvantage and levels of thiazolidinedione (glitazone) prescribing had no significant impact on outcomes. Sodium-glucose co-transporter-2 inhibitor use was too low for an effect to be observed in the period examined. CONCLUSIONS If all practices brought their service and medication to the level of the top decile practices, they could achieve 74.7% compared with the median of 67.3% of patients achieving TGC, showing an increase of 213 000 in patients achieving TGC, while reducing the number at HGR to 3.8% compared with 6.1%, benefiting 62 000 patients. This could have a major impact on the overall consequent healthcare costs of managing diabetes complications with their attendant mortality risks.
Collapse
Affiliation(s)
- Adrian H Heald
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Nagaraj Malipatil
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Michal Becher
- Robotics and Control Systems, Technical University of Wroclaw, Wroclaw, Poland
| | | | | | - Anthony A Fryer
- Keele University School of Medicine, Newcastle-under-Lyme, UK
- Department of Clinical Biochemistry, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| |
Collapse
|
25
|
Gc VS, Suhrcke M, Hardeman W, Sutton S, Wilson ECF. Cost-Effectiveness and Value of Information Analysis of Brief Interventions to Promote Physical Activity in Primary Care. Value Health 2018; 21:18-26. [PMID: 29304936 DOI: 10.1016/j.jval.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 07/10/2017] [Accepted: 07/16/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Brief interventions (BIs) delivered in primary care have shown potential to increase physical activity levels and may be cost-effective, at least in the short-term, when compared with usual care. Nevertheless, there is limited evidence on their longer term costs and health benefits. OBJECTIVES To estimate the cost-effectiveness of BIs to promote physical activity in primary care and to guide future research priorities using value of information analysis. METHODS A decision model was used to compare the cost-effectiveness of three classes of BIs that have been used, or could be used, to promote physical activity in primary care: 1) pedometer interventions, 2) advice/counseling on physical activity, and (3) action planning interventions. Published risk equations and data from the available literature or routine data sources were used to inform model parameters. Uncertainty was investigated with probabilistic sensitivity analysis, and value of information analysis was conducted to estimate the value of undertaking further research. RESULTS In the base-case, pedometer interventions yielded the highest expected net benefit at a willingness to pay of £20,000 per quality-adjusted life-year. There was, however, a great deal of decision uncertainty: the expected value of perfect information surrounding the decision problem for the National Health Service Health Check population was estimated at £1.85 billion. CONCLUSIONS Our analysis suggests that the use of pedometer BIs is the most cost-effective strategy to promote physical activity in primary care, and that there is potential value in further research into the cost-effectiveness of brief (i.e., <30 minutes) and very brief (i.e., <5 minutes) pedometer interventions in this setting.
Collapse
Affiliation(s)
- Vijay Singh Gc
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Marc Suhrcke
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; UKCRC Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Cambridge, UK; Centre for Health Economics, University of York, York, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Edward C F Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK; Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK; Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
26
|
Abstract
CONTEXT Effective community-based interventions are available to control hypertension. It is important to determine the economics of these interventions. EVIDENCE ACQUISITION Peer-reviewed studies from January 1995 through December 2015 were screened. Interventions were categorized into educational interventions, self-monitoring interventions, and screening interventions. Incremental cost-effectiveness ratios were summarized by types of interventions. The review was conducted in 2016. EVIDENCE SYNTHESIS Thirty-four articles were included in the review (16 from the U.S., 18 from other countries), including 25 on educational interventions, three on self-monitoring interventions, and six on screening interventions. In the U.S., five (31.3%) studies on educational interventions were cost saving. Among the studies that found the interventions cost effective, the median incremental costs were $62 (range, $40-$114) for 1-mmHg reduction in systolic blood pressure (SBP) and $13,986 (range, $6,683-$58,610) for 1 life-year gained. Outside the U.S., educational interventions cost from $0.62 (China) to $29 (Pakistan) for 1-mmHg reduction in SBP. Self-monitoring interventions, evaluated in the U.S. only, cost $727 for 1-mmHg reduction in SBP and $41,927 for 1 life-year gained. For 1 quality-adjusted life-year, screening interventions cost from $21,734 to $56,750 in the U.S., $613 to $5,637 in Australia, and $7,000 to $18,000 in China. Intervention costs to reduce 1 mmHg blood pressure or 1 quality-adjusted life-year were higher in the U.S. than in other countries. CONCLUSIONS Most studies found that the three types of interventions were either cost effective or cost saving. Quality of economic studies should be improved to confirm the findings.
Collapse
Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia.
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heesoo Joo
- Division of Global Migration and Quarantine, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
27
|
Morris J, Nikolopoulos H, Berry T, Jain V, Vallis M, Piccinini-Vallis H, Bell RC. Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study. BMJ Open 2017; 7:e018527. [PMID: 29138209 PMCID: PMC5695303 DOI: 10.1136/bmjopen-2017-018527] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes. DESIGN Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews. PARTICIPANTS Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings. RESULTS Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (β=0.71, P<0.001) and discussing physical activity and food requirements (β=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care. CONCLUSIONS Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.
Collapse
Affiliation(s)
- Jill Morris
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Hara Nikolopoulos
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya Berry
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Venu Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Vallis
- Department of Family Medicine, Behaviour Change Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Rhonda C Bell
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
28
|
Wolinsky FD, Hall SF, Lou Y, Edmonds SW, Saag KG, Roblin DW, Wright NC, Jones MP, Cram P, Curtis JR, Morgan SL, Schlechte JA, Williams JH, Zelman DJ. The cost of a patient activation intervention for achieving successful outcomes: results from the PAADRN randomized controlled trial. Osteoporos Int 2017. [PMID: 28620779 PMCID: PMC5670012 DOI: 10.1007/s00198-017-4113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
UNLABELLED In a large, pragmatic clinical trial, we calculated the costs of achieving four successful patient-centered outcomes using a tailored patient activation DXA result letter accompanied by a bone health brochure. The cost to achieve one successful outcome (e.g., a 0.5 standard deviation improvement in care satisfaction) ranged from $127.41 to $222.75. INTRODUCTION Pragmatic randomized controlled trials (RCTs) should focus on patient-centered outcomes and report the costs for achieving those outcomes. We calculated per person incremental intervention costs, the number-needed-to-treat (NNT), and incremental per patient costs (cost per NNT) for four patient-centered outcomes in a direct-to-patient bone healthcare intervention. METHODS The Patient Activation after DXA Result Notification (PAADRN) pragmatic RCT enrolled 7749 patients presenting for DXA at three health centers between February 2012 and August 2014. Interviews occurred at baseline and 52 weeks post-DXA. Intervention subjects received an individually tailored DXA result letter accompanied by an educational bone health brochure 4 weeks post-DXA, while the usual care subjects did not. Outcomes focused on patients (a) correctly identifying their results, (b) contacting their providers, (c) discussing their results with their providers, and (d) satisfaction with their bone healthcare. NNTs were determined using intention-to-treat linear probability models, per person incremental intervention costs were calculated, and costs per NNT were computed. RESULTS Mean age was 66.6 years old, 83.8% were women, and 75.3% were non-Hispanic whites. The incremental per patient cost (costs per NNT) to increase the ability of a patient to (a) correctly identify their DXA result was $171.07; (b) contact their provider about their DXA result was $222.75; (c) discuss their DXA result with their provider was $193.55; and (d) achieve a 0.5 SD improvement in satisfaction with their bone healthcare was $127.41. CONCLUSION An individually tailored DXA result letter accompanied by an educational brochure can improve four patient-centered outcomes at a modest cost. TRIAL REGISTRATION clinicaltrials.gov identifier NCT01507662.
Collapse
Affiliation(s)
- F D Wolinsky
- Department of Health Management and Policy, University of Iowa, 145 North Riverside Drive, CPHB N211, Iowa City, IA, 52242, USA.
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
- College of Nursing, University of Iowa, Iowa City, IA, USA.
| | - S F Hall
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Y Lou
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - S W Edmonds
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- College of Nursing, University of Iowa, Iowa City, IA, USA
- CADRE, Iowa City VA Healthcare System, Iowa City, IA, USA
| | - K G Saag
- Department of Internal Medicine, University of Alabama, Birmingham, AL, USA
| | - D W Roblin
- Kaiser Permanente, Atlanta, GA, USA
- Department of Health Management and Policy, Georgia State University, Atlanta, GA, USA
| | - N C Wright
- Department of Internal Medicine, University of Alabama, Birmingham, AL, USA
- Department of Epidemiology, University of Alabama, Birmingham, AL, USA
| | - M P Jones
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - P Cram
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine and Geriatrics, Mt. Sinai/UHN Hospitals, Toronto, Canada
| | | | | | | | | | | | | |
Collapse
|
29
|
Rizk R, Hiligsmann M, Karavetian M, Evers SMAA. Cost-effectiveness of dedicated dietitians for hyperphosphatemia management among hemodialysis patients in Lebanon: results from the Nutrition Education for Management of Osteodystrophy trial. J Med Econ 2017; 20:1024-1038. [PMID: 28657451 DOI: 10.1080/13696998.2017.1347877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM To assess the cost-effectiveness of nutrition education by dedicated dietitians (DD) for hyperphosphatemia management among hemodialysis patients. MATERIALS AND METHODS This was a trial-based economic evaluation in 12 Lebanese hospital-based units. In total, 545 prevalent patients were cluster randomized to DD, trained hospital dietitian (THD), and existing practice (EP) groups. During Phase I (6 months), DD (n = 116) received intensive education by DD trained on renal nutrition, THD (n = 299) received care from trained hospital dietitians, and EP (n = 130) received usual care from untrained hospital dietitians. Patients were followed-up during Phase II (6 months). RESULTS At baseline, EP had the lowest weekly hemodialysis time, and DD had the highest serum phosphorus and malnutrition-inflammation score. The additional costs of the intervention were low compared with the societal costs (DD: $76.7, $21,007.7; EP: $4.6, $18,675.4; THD: $17.4, $20,078.6, respectively). Between Phases I and II, DD showed the greatest decline in services use and societal costs (DD: -$2,364.0; EP: -$1,727.7; THD: -$1,105.7). At endline, DD experienced the highest decrease in adjusted serum phosphorus (DD: -0.32; EP: +0.16; THD: +0.04 mg/dL), no difference in quality-adjusted life-years (QALY), and the highest societal costs. DD had a cost-effectiveness ratio of $7,853.6 per 1 mg decrease in phosphorus, compared with EP; and was dominated by THD. Regarding QALY, DD was dominated by EP and THD. The results were sensitive to changes in key parameters. LIMITATIONS The analysis depended on numerous assumptions. Interpreting the results is limited by the significant baseline differences in key parameters, suggestive of higher baseline societal costs in DD. CONCLUSIONS DD yielded the greatest effectiveness and decrease in societal costs, but did not affect QALY. Regarding serum phosphorus, DD was likely to be cost-effective compared with EP, but had a low cost-effectiveness probability compared with THD. Regarding QALY, DD was not likely to be cost-effective. Assessing the long-term cost-effectiveness of DD, on similar groups, is recommended.
Collapse
Affiliation(s)
- Rana Rizk
- a Department of Health Services Research , CAPHRI, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Mickaël Hiligsmann
- a Department of Health Services Research , CAPHRI, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| | - Mirey Karavetian
- b Department of Health Sciences, College of Natural and Health Sciences , Zayed University , Dubai , United Arab Emirates
| | - Silvia M A A Evers
- a Department of Health Services Research , CAPHRI, Care and Public Health Research Institute, Maastricht University , Maastricht , The Netherlands
| |
Collapse
|
30
|
Meltzer LR, Simmons VN, Sutton SK, Drobes DJ, Quinn GP, Meade CD, Unrod M, Brandon KO, Harrell PT, Eissenberg T, Bullen CR, Brandon TH. A randomized controlled trial of a smoking cessation self-help intervention for dual users of tobacco cigarettes and E-cigarettes: Intervention development and research design. Contemp Clin Trials 2017; 60:56-62. [PMID: 28648969 PMCID: PMC5559662 DOI: 10.1016/j.cct.2017.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/29/2022]
Abstract
Electronic Nicotine Delivery Systems, also called electronic cigarettes or e-cigarettes, have been available for over a decade and use has been increasing dramatically. The primary reported reasons for use are to aid smoking cessation or reduction, yet a significant proportion appear to be long-term users of both products ("dual users"). Dual users may be motivated to quit smoking and might benefit from a behavioral intervention for smoking cessation. This paper describes the intervention development, as well as the design, methods, and data analysis plans for an ongoing randomized controlled trial (RCT). Formative research and learner verification were conducted to create a usable, understandable, and acceptable self-help intervention targeting dual users. The efficacy is being tested in an RCT with current dual users (N=2900) recruited nationally and randomized to one of three conditions. The Assessment Only (ASSESS) group only completes assessments. The Generic Self-Help (GENERIC) group receives non-targeted smoking cessation booklets and supplemental materials sent monthly over 18months. The e-cigarette Targeted Self-Help (eTARGET) group receives the newly developed intervention (targeted booklets and supplemental materials) sent over the same period. All participants complete self-report surveys every 3months over 2years. The primary study outcome is self-reported 7-day point prevalence abstinence. Cost-effectiveness metrics for the GENERIC and eTARGET interventions will also be calculated.
Collapse
Affiliation(s)
- Lauren R Meltzer
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Vani N Simmons
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - David J Drobes
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Gwendolyn P Quinn
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| | - Marina Unrod
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Karen O Brandon
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States.
| | - Paul T Harrell
- Eastern Virginia Medical School, 700 W Olney Rd, Norfolk, VA 23507, United States
| | - Thomas Eissenberg
- Virginia Commonwealth University, Box 980205, Richmond, VA 23298, United States.
| | | | - Thomas H Brandon
- H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, United States; University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States.
| |
Collapse
|
31
|
Lian J, McGhee SM, So C, Chau J, Wong CKH, Wong WCW, Lam CLK. Five-year cost-effectiveness of the Patient Empowerment Programme (PEP) for type 2 diabetes mellitus in primary care. Diabetes Obes Metab 2017; 19:1312-1316. [PMID: 28230312 DOI: 10.1111/dom.12919] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/13/2017] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Abstract
This study evaluated the short-term cost-effectiveness of the Patient Empowerment Programme (PEP) for diabetes mellitus (DM) in Hong Kong. Propensity score matching was used to select a matched group of PEP and non-PEP subjects. A societal perspective was adopted to estimate the cost of PEP. Outcome measures were the cumulative incidence of all-cause mortality and diabetic complication over a 5-year follow-up period and the number needed to treat (NNT) to avoid 1 event. The incremental cost-effectiveness ratio (ICER) of cost per event avoided was calculated using the PEP cost per subject multiplied by the NNT. The PEP cost per subject from the societal perspective was US$247. There was a significantly lower cumulative incidence of all-cause mortality (2.9% vs 4.6%, P < .001), any DM complication (9.5% vs 10.8%, P = .001) and CVD events (6.8% vs 7.6%, P = .018), in the PEP group. The costs per death from any cause, DM complication or case of CVD avoided were US$14 465, US$19 617 and US$30 796, respectively. The extra amount allocated to managing PEP was small and it appears cost-effective in the short-term as an addition to RAMP.
Collapse
Affiliation(s)
- Jinxiao Lian
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Sarah M McGhee
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ching So
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - June Chau
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - William C W Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
32
|
Shimmin C, Wittmeier KDM, Lavoie JG, Wicklund ED, Sibley KM. Moving towards a more inclusive patient and public involvement in health research paradigm: the incorporation of a trauma-informed intersectional analysis. BMC Health Serv Res 2017; 17:539. [PMID: 28784138 PMCID: PMC5547533 DOI: 10.1186/s12913-017-2463-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of patient engagement in health research has received growing international recognition over recent years. Yet despite some critical advancements, we argue that the concept remains problematic as it negates the very real complexities and context of people's lives. Though patient engagement conceptually begins to disrupt the identity of "researcher," and complicate our assumptions and understandings around expertise and knowledge, it continues to essentialize the identity of "patient" as a homogenous group, denying the reality that individuals' economic, political, cultural, subjective and experiential lives intersect in intricate and multifarious ways. DISCUSSION Patient engagement approaches that do not consider the simultaneous interactions between different social categories (e.g. race, ethnicity, Indigeneity, gender, class, sexuality, geography, age, ability, immigration status, religion) that make up social identity, as well as the impact of systems and processes of oppression and domination (e.g. racism, colonialism, classism, sexism, ableism, homophobia) exclude the involvement of individuals who often carry the greatest burden of illness - the very voices traditionally less heard in health research. We contend that in order to be a more inclusive and meaningful approach that does not simply reiterate existing health inequities, it is important to reconceptualize patient engagement through a health equity and social justice lens by incorporating a trauma-informed intersectional analysis. This article provides key concepts to the incorporation of a trauma-informed intersectional analysis and important questions to consider when developing a patient engagement strategy in health research training, practice and evaluation. In redefining the identity of both "patient" and "researcher," spaces and opportunities to resist and renegotiate power within the intersubjective relations can be recognized and addressed, in turn helping to build trust, transparency and resiliency - integral to the advancement of the science of patient engagement in health research.
Collapse
Affiliation(s)
- Carolyn Shimmin
- Centre for Healthcare Innovation, 753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Kristy D. M. Wittmeier
- Department of Pediatrics, University of Manitoba, 375-753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Josée G. Lavoie
- University of Manitoba, Faculty of Community Health Sciences, 379-753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
- Ongomiizwin- Research, Indigenous Institute of Health and Healing, 715 John Buhler Research Centre-727 McDermot Ave, Winnipeg, MB R3E 3P5 Canada
| | - Evan D. Wicklund
- Department of Disability Studies, University of Winnipeg, 515 Portage Avenue, Winnipeg, MB R3B 2E9 Canada
- Canadian Centre on Disability Studies, 226 Osborne Street North, Winnipeg, MB R3J 1T2 Canada
| | - Kathryn M. Sibley
- Centre for Healthcare Innovation, 753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
- University of Manitoba, Faculty of Community Health Sciences, 379-753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| |
Collapse
|
33
|
Teljeur C, Moran PS, Walshe S, Smith SM, Cianci F, Murphy L, Harrington P, Ryan M. Economic evaluation of chronic disease self-management for people with diabetes: a systematic review. Diabet Med 2017; 34:1040-1049. [PMID: 27770591 DOI: 10.1111/dme.13281] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/17/2022]
Abstract
AIMS To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. BACKGROUND Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. METHODS Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. RESULTS A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. CONCLUSIONS Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.
Collapse
Affiliation(s)
- C Teljeur
- Health Information and Quality Authority, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - P S Moran
- Health Information and Quality Authority, Dublin, Ireland
| | - S Walshe
- Health Information and Quality Authority, Dublin, Ireland
| | - S M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Cianci
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - L Murphy
- Health Information and Quality Authority, Dublin, Ireland
| | - P Harrington
- Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Information and Quality Authority, Dublin, Ireland
| |
Collapse
|
34
|
Abstract
BACKGROUND Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. METHODS Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. RESULTS GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. CONCLUSIONS We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point.
Collapse
Affiliation(s)
- Martin Ridderstråle
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Martin Ridderstråle, MD, Department of Clinical Sciences, Lund University, Malmö S-205 02, Sweden.
| |
Collapse
|
35
|
Phelan S, Hagobian T, Brannen A, Hatley KE, Schaffner A, Muñoz-Christian K, Tate DF. Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial. JAMA 2017; 317. [PMID: 28632867 PMCID: PMC5815021 DOI: 10.1001/jama.2017.7119] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women. OBJECTIVE To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months. DESIGN, SETTING, AND PARTICIPANTS A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016. INTERVENTIONS Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics. MAIN OUTCOMES AND MEASURES The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet. RESULTS Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23.5]). The intervention group and standard care group did not significantly differ in 12-month changes in physical activity (mean [95% CI]: -7.8 min/d [-16.1 to 0.4] in the intervention group vs -7.2 min/d [-14.6 to 0.3] in the standard care group; difference, -0.7 min/d [95% CI, -42.0 to 10.6], P = .76), calorie intake (mean [95% CI]: -298 kcal/d [-423 to -174] in the intervention group vs -144 kcal/d [-257 to -32] in the standard care group; difference, -154 kcal/d [-325 to 17], P = .06), or incidences of injury (16 in the intervention group vs 16 in the standard care group) or low breastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group). CONCLUSIONS AND RELEVANCE Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01408147.
Collapse
Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | - Todd Hagobian
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | - Anna Brannen
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | - Karen E. Hatley
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Andrew Schaffner
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | | | - Deborah F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
36
|
Jafar TH, Jehan I, de Silva HA, Naheed A, Gandhi M, Assam P, Finkelstein EA, Quigley HL, Bilger M, Khan AH, Clemens JD, Ebrahim S, Turner EL, Kasturiratne A. Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial. Trials 2017; 18:272. [PMID: 28606184 PMCID: PMC5469065 DOI: 10.1186/s13063-017-2018-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/08/2017] [Accepted: 05/25/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. METHODS/DESIGN This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed. DISCUSSION The study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries. TRIAL REGISTRATION ClinicalTrials.gov, NCT02657746 . Registered on 14 January 2016.
Collapse
Affiliation(s)
- Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Imtiaz Jehan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Aliya Naheed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, 138669, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, 16957, Singapore
| | - Pryseley Assam
- Biostatistics, Singapore Clinical Research Institute, Singapore, 138669, Singapore
| | - Eric A Finkelstein
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Helena Legido Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Marcel Bilger
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | | | | | - Shah Ebrahim
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Anuradhani Kasturiratne
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| |
Collapse
|
37
|
Crowley MJ, Edelman D, Voils CI, Maciejewski ML, Coffman CJ, Jeffreys AS, Turner MJ, Gaillard LA, Hinton TA, Strawbridge E, Zervakis J, Barton AB, Yancy WS. Jump starting shared medical appointments for diabetes with weight management: Rationale and design of a randomized controlled trial. Contemp Clin Trials 2017; 58:1-12. [PMID: 28445783 DOI: 10.1016/j.cct.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Rates of glycemic control remain suboptimal nationwide. Medication intensification for diabetes can have undesirable side effects (weight gain, hypoglycemia), which offset the benefits of glycemic control. A Shared Medical Appointment (SMA) intervention for diabetes that emphasizes weight management could improve glycemic outcomes and reduce weight while simultaneously lowering diabetes medication needs, resulting in less hypoglycemia and better quality of life. We describe the rationale and design for a study evaluating a novel SMA intervention for diabetes that primarily emphasizes low-carbohydrate diet-focused weight management. METHODS Jump Starting Shared Medical Appointments for Diabetes with Weight Management (Jump Start) is a randomized, controlled trial that is allocating overweight Veterans (body mass index≥27kg/m2) with type 2 diabetes into two arms: 1) a traditional SMA group focusing on medication management and self-management counseling; or 2) an SMA group that combines low-carbohydrate diet-focused weight management (WM/SMA) with medication management. Hemoglobin A1c reduction at 48weeks is the primary outcome. Secondary outcomes include hypoglycemic events, diabetes medication use, weight, medication adherence, diabetes-related quality of life, and cost-effectiveness. We hypothesize that WM/SMA will be non-inferior to standard SMA for glycemic control, and will reduce hypoglycemia, diabetes medication use, and weight relative to standard SMA, while also improving quality of life and costs. CONCLUSIONS Jump Start targets two common problems that are closely related but infrequently managed together: diabetes and obesity. By focusing on diet and weight loss as the primary means to control diabetes, this intervention may improve several meaningful patient-centered outcomes related to diabetes.
Collapse
Affiliation(s)
- Matthew J Crowley
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, United States.
| | - David Edelman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Cynthia J Coffman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Amy S Jeffreys
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Marsha J Turner
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Leslie A Gaillard
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Teresa A Hinton
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Elizabeth Strawbridge
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Jennifer Zervakis
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Anna Beth Barton
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, United States
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States; Duke Diet and Fitness Center, Durham, NC, United States
| |
Collapse
|
38
|
Andronis L, Kinghorn P, Qiao S, Whitehurst DGT, Durrell S, McLeod H. Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy 2017; 15:173-201. [PMID: 27550240 DOI: 10.1007/s40258-016-0268-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Low back pain (LBP) is a major health problem, having a substantial effect on peoples' quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear. OBJECTIVES To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP. METHODS Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), 'similar article' searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms. RESULTS Thirty-three studies were identified. Study interventions were categorised as: (1) combined physical exercise and psychological therapy, (2) physical exercise therapy only, (3) information and education, and (4) manual therapy. Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective. CONCLUSIONS The identified evidence suggests that combined physical and psychological treatments, medical yoga, information and education programmes, spinal manipulation and acupuncture are likely to be cost-effective options for LBP.
Collapse
Affiliation(s)
- Lazaros Andronis
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Philip Kinghorn
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
| | - Suyin Qiao
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Susie Durrell
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucester, UK
| | - Hugh McLeod
- Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
39
|
Gordon LG, Brynes J, Baade PD, Neale RE, Whiteman DC, Youl PH, Aitken JF, Janda M. Cost-Effectiveness Analysis of a Skin Awareness Intervention for Early Detection of Skin Cancer Targeting Men Older Than 50 Years. Value Health 2017; 20:593-601. [PMID: 28408001 DOI: 10.1016/j.jval.2016.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 10/07/2016] [Accepted: 12/18/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of an educational intervention encouraging self-skin examinations for early detection of skin cancers among men older than 50 years. METHODS A lifetime Markov model was constructed to combine data from the Skin Awareness Trial and other published sources. The model incorporated a health system perspective and the cost and health outcomes for melanoma, squamous and basal cell carcinomas, and benign skin lesions. Key model outcomes included Australian costs (2015), quality-adjusted life-years (QALYs), life-years, and counts of skin cancers. Univariate and probabilistic sensitivity analyses were undertaken to address parameter uncertainty. RESULTS The mean cost of the intervention was A$5,298 compared with A$4,684 for usual care, whereas mean QALYs were 7.58 for the intervention group and 7.77 for the usual care group. The intervention was thus inferior to usual care. When only survival gain is considered, the model predicted the intervention would cost A$1,059 per life-year saved. The likelihood that the intervention was cost-effective up to A$50,000 per QALY gained was 43.9%. The model was stable to most data estimates; nevertheless, it relies on the specificity of clinical diagnosis of skin cancers and is subject to limited health utility data for people with skin lesions. CONCLUSIONS Although the intervention improved skin checking behaviors and encouraged men to seek medical advice about suspicious lesions, the overall costs and effects from also detecting more squamous and basal cell carcinomas and benign lesions outweighed the positive health gains from detecting more thin melanomas.
Collapse
MESH Headings
- Age Factors
- Aged
- Australia
- Awareness
- Carcinoma, Basal Cell/diagnosis
- Carcinoma, Basal Cell/economics
- Carcinoma, Basal Cell/mortality
- Carcinoma, Basal Cell/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/economics
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Cost Savings
- Cost-Benefit Analysis
- Decision Support Techniques
- Early Detection of Cancer/economics
- Early Detection of Cancer/methods
- Health Care Costs
- Health Knowledge, Attitudes, Practice
- Humans
- Male
- Markov Chains
- Melanoma/diagnosis
- Melanoma/economics
- Melanoma/mortality
- Melanoma/therapy
- Men's Health/economics
- Middle Aged
- Models, Economic
- Patient Education as Topic/economics
- Predictive Value of Tests
- Prognosis
- Quality-Adjusted Life Years
- Reproducibility of Results
- Risk Factors
- Self-Examination/economics
- Sex Factors
- Skin Neoplasms/diagnosis
- Skin Neoplasms/economics
- Skin Neoplasms/mortality
- Skin Neoplasms/therapy
- Time Factors
- Video Recording/economics
Collapse
Affiliation(s)
- Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
| | - Joshua Brynes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Peter D Baade
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Philippa H Youl
- NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Joanne F Aitken
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia
| | - Monika Janda
- NHMRC Centre for Research Excellence in Sun and Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia; School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| |
Collapse
|
40
|
Krauth C, Bartling T. [Is rehabilitation worth it? : Review of economic evaluations of rehabilitation in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:394-401. [PMID: 28224185 DOI: 10.1007/s00103-017-2514-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Because of demographic change, the rehabilitation sector in Germany is going to face increasing demands in the future. Limited budgets make the optimal allocation of resources a top priority. To support decisions about the optimal scope and design of rehabilitation, studies on health economics are of utmost importance. The aim of this article is to provide an overview of the evaluation of rehabilitation with regard to health economics in Germany.Based on a comprehensive literature research, 17 studies on the cost-effectiveness of rehabilitation in Germany were identified. The health economics evaluation focuses on four main topics: patient education (5 studies), the comparison of outpatient and inpatient rehabilitation (7 studies), medico-occupational rehabilitation programs (2 studies) and aftercare programs (3 studies). All four topics show that innovative rehabilitation technologies can be cost-effective. Significant potential savings in program costs of 25-35% are demonstrated in outpatient rehabilitation (with comparable effectiveness with inpatient care). Designated patient education programs often lead to significant savings with indirect costs, by reducing periods of unfitness to work and extending the long-term ability to work. This review article also points out that some relevant areas of rehabilitation, such as the flexibilization of rehabilitation programs or the efficient organization of access to rehabilitation, have not been evaluated sufficiently on the basis of health economics. This article ends with the requirement to carry out more economics-based rehabilitation studies.
Collapse
Affiliation(s)
- Christian Krauth
- Center for Health Economics Research Hannover - Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Tim Bartling
- Center for Health Economics Research Hannover - Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
41
|
Pingul MM, Mulvihill EM, Reinert SE, Gopalakrishnan G, Plante WA, Boney CM, Bialo SR, Quintos JB. Pediatric Diabetes Outpatient Center at Rhode Island Hospital: The impact of changing initial diabetes education from inpatient to outpatient. R I Med J (2013) 2017; 100:21-24. [PMID: 28146595] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study compared outcomes and costs for new-onset Type 1 diabetes mellitus (T1DM) patients educated at the outpatient versus inpatient settings. METHODS/DESIGN Retrospective study examining the following variables: 1) hemoglobin A1c (HbA1c), 2) severe hypoglycemia, 3) admissions for diabetic ketoacidosis (DKA) or ER visits, and 4) healthcare cost. RESULTS 152 patients with new-onset T1DM from September 2007-August 2009. There were no differences between outpatient group (OG) and inpatient group (IG) in mean HbA1c levels at 1, 2 and 3 years post-diagnosis (OG 8%, 8.5%, 9.3%; IG 8.3%, 8.9%, 9%, p=0.51). Episodes of severe hypoglycemia, DKA, and ER visits were not different between the two groups. Mean total hospital costs for OG and pure OG were significantly less than IG (OG: $2886 vs. IG: $4925, p<0.001), (pure OG: $1044 vs. IG: $4925, p<0.0001). CONCLUSION Our study demonstrates that outpatient- based pediatric diabetes education lowers healthcare cost without compromising medical outcomes. [Full article available at http://rimed.org/rimedicaljournal-2017-02.asp].
Collapse
Affiliation(s)
- Mia M Pingul
- Pediatric Endocrinologist, Pediatric Specialists of Virginia, Fairfax, VA
| | - Erin M Mulvihill
- Summer Research Intern, College of Human Ecology, Cornell University, Ithaca, NY
| | - Steven E Reinert
- Statistician, Information Services Department, Lifespan Corp., Providence, RI
| | - Geetha Gopalakrishnan
- Department of Internal Medicine, Chief, Division of Adult Endocrinology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Wendy A Plante
- Psychologist, Department of Child and Adolescent Psychiatry, Hasbro Children's Hospital and Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, RI
| | - Charlotte M Boney
- Department of Pediatrics, Division of Pediatric Endocrinology, Baystate Children's Hospital, Springfield, MA
| | - Shara R Bialo
- Department of Pediatrics, Division of Pediatric Endocrinology at Rhode Island Hospital and Hasbro Children's Hospital/The Warren Alpert Medical School of Brown University, Providence, RI
| | - Jose Bernardo Quintos
- Department of Pediatrics, Division of Pediatric Endocrinology at Rhode Island Hospital and Hasbro Children's Hospital/The Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
42
|
Horigan G, Davies M, Findlay-White F, Chaney D, Coates V. Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med 2017; 34:14-26. [PMID: 26996982 DOI: 10.1111/dme.13120] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/29/2022]
Abstract
AIMS To identify the reasons why those offered a place on diabetes education programmes declined the opportunity. BACKGROUND It is well established that diabetes education is critical to optimum diabetes care; it improves metabolic control, prevents complications, improves quality of life and empowers people to make informed choices to manage their condition. Despite the significant clinical and personal rewards offered by diabetes education, programmes are underused, with a significant proportion of patients choosing not to attend. METHODS A systematic search of the following databases was conducted for the period from 2005-2015: Medline; EMBASE; Scopus; CINAHL; and PsycINFO. Studies that met the inclusion criteria focusing on patient-reported reasons for non-attendance at structured diabetes education were selected. RESULTS A total of 12 studies spanning quantitative and qualitative methodologies were included. The selected studies were published in Europe, USA, Pakistan, Canada and India, with a total sample size of 2260 people. Two broad categories of non-attender were identified: 1) those who could not attend for logistical, medical or financial reasons (e.g. timing, costs or existing comorbidities) and 2) those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons (e.g. no perceived problem, denial or negative feelings towards education). Diabetes education was declined for many reasons, and the range of expressed reasons was more diverse and complex than anticipated. CONCLUSION New and innovative methods of delivering diabetes education are required which address the needs of people with diabetes whilst maintaining quality and efficiency.
Collapse
MESH Headings
- Activities of Daily Living
- Adult
- Appointments and Schedules
- Child
- Combined Modality Therapy/economics
- Cost of Illness
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/therapy
- Health Care Costs
- Health Knowledge, Attitudes, Practice
- Humans
- Insurance, Health, Reimbursement
- Patient Acceptance of Health Care
- Patient Education as Topic/economics
- Referral and Consultation/economics
Collapse
Affiliation(s)
- G Horigan
- Institute of Nursing and Health Research, University of Ulster, Magee Campus, Londonderry
| | - M Davies
- Department of Clinical Psychology, Belfast Health and Care Trust, Belfast
| | | | - D Chaney
- Diabetes UK Northern Ireland, Belfast, UK
| | - V Coates
- Institute of Nursing and Health Research, University of Ulster, Magee Campus, Londonderry
| |
Collapse
|
43
|
Ritzwoller DP, Toobert D, Sukhanova A, Glasgow RE. Economic Analysis of the Mediterranean Lifestyle Program for Postmenopausal Women With Diabetes. Diabetes Educ 2016; 32:761-9. [PMID: 16971709 DOI: 10.1177/0145721706291757] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate costs associated with the primary intervention of the Mediterranean Lifestyle Program (MLP), which targeted postmenopausal women with type 2 diabetes at risk for coronary heart disease. METHODS Using retrospective data collected during MLP development and implementation, the authors estimated costs for the first 6 months relative to the usual care condition and incremental costs per behavioral, biologic, and quality-of-life change. Sensitivity analyses were conducted using variations in inflation rates, implementation settings, labor and nonlabor inputs, and market wage rates. RESULTS Of the sample of 279 study participants, 163 were randomized into the MLP condition. Total intervention costs were estimated at $211 061 ($148 022 direct costs) or $1295 per MLP participant relative to usual care ($908 direct costs). This translates to $3808 per average change in coronary heart disease risk as measured by an average 1-point reduction in hemoglobin A1C. Relative to other measured improvements, this corresponds to $2345 per unit reduction in body mass index and $644 per unit improvement in Problem Areas in Diabetes Quality-of-Life Self-care Summary score, and a $196 per-gram reduction in intake of saturated fatty acids as noted by the Food Frequency Questionnaire. A significant portion of the direct costs were related to the resources used during the recruitment phase. CONCLUSIONS Providing a relatively intensive lifestyle self-management program for this high-risk group is associated with modest incremental costs compared with usual care, making the program potentially appealing to policy makers.
Collapse
Affiliation(s)
- Debra P Ritzwoller
- The Clinical Research Unit, Kaiser Permanente Colorado, Boulder (Dr Ritzwoller, Ms Sukhanova, Dr Glasgow)
| | | | - Anna Sukhanova
- The Clinical Research Unit, Kaiser Permanente Colorado, Boulder (Dr Ritzwoller, Ms Sukhanova, Dr Glasgow)
| | - Russell E Glasgow
- The Clinical Research Unit, Kaiser Permanente Colorado, Boulder (Dr Ritzwoller, Ms Sukhanova, Dr Glasgow)
| |
Collapse
|
44
|
|
45
|
Ride J, Lorgelly P, Tran T, Wynter K, Rowe H, Fisher J. Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking. BMJ Open 2016; 6:e012086. [PMID: 27864246 PMCID: PMC5128834 DOI: 10.1136/bmjopen-2016-012086] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Postnatal maternal mental health problems, including depression and anxiety, entail a significant burden globally, and finding cost-effective preventive solutions is a public policy priority. This paper presents a cost-effectiveness analysis of the intervention, What Were We Thinking (WWWT), for the prevention of postnatal maternal mental health problems. DESIGN The economic evaluation, including cost-effectiveness and cost-utility analyses, was conducted alongside a cluster-randomised trial. SETTING 48 Maternal and Child Health Centres in Victoria, Australia. PARTICIPANTS Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres. Full data were collected for 175 participants in the control arm and 184 in the intervention arm. INTERVENTION WWWT is a psychoeducational intervention targeted at the partner relationship, management of infant behaviour and parental fatigue. OUTCOME MEASURES The evaluation considered public sector plus participant out-of-pocket costs, while outcomes were expressed in the 30-day prevalence of depression, anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic, prognostic and clinical characteristics. RESULTS The intervention was estimated to cost $A118.16 per participant. The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY gained and $A152 per percentage-point reduction in 30-day prevalence of depression, anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding the results, with a 55% probability that WWWT would be considered cost-effective at that threshold. CONCLUSIONS The results suggest that, although WWWT shows promise as a preventive intervention for postnatal maternal mental health problems, further research is required to reduce the uncertainty over its cost-effectiveness as there were no statistically significant differences in costs or outcomes. TRIAL REGISTRATION NUMBER ACTRN12613000506796; results.
Collapse
Affiliation(s)
- Jemimah Ride
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Paula Lorgelly
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia
- Office of Health Economics, London, UK
| | - Thach Tran
- Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia
| | - Karen Wynter
- Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia
| | - Heather Rowe
- Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
46
|
Hsu J, Wilhelm N, Lewis L, Herman E. Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions. J Allergy Clin Immunol Pract 2016; 4:1123-1134.e27. [PMID: 27658535 PMCID: PMC5117439 DOI: 10.1016/j.jaip.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/02/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
Abstract
The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (eg, higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments.
Collapse
Affiliation(s)
- Joy Hsu
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga.
| | | | - Lillianne Lewis
- Epidemic Intelligence Service, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Elizabeth Herman
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga
| |
Collapse
|
47
|
Dieng M, Cust AE, Kasparian NA, Butow P, Costa DSJ, Menzies SW, Mann GJ, Morton RL. Protocol for a within-trial economic evaluation of a psychoeducational intervention tailored to people at high risk of developing a second or subsequent melanoma. BMJ Open 2016; 6:e012153. [PMID: 27855094 PMCID: PMC5073649 DOI: 10.1136/bmjopen-2016-012153] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Psychological support programmes are not currently funded for people with a history of melanoma. A major barrier to the implementation of effective psychological interventions in routine clinical care is a lack of cost-effectiveness data. This paper describes the planned economic evaluation alongside a randomised controlled trial of a psychoeducational intervention for people with a history of melanoma who are at high risk of developing new primary disease. METHOD AND ANALYSIS The economic evaluation is a within-trial analysis to evaluate the incremental costs and health outcomes of a psychoeducational intervention compared to usual care from the perspective of the Australian healthcare system. Cost-effectiveness and cost-utility analyses will be conducted, providing estimates of the cost to reduce fear of melanoma recurrence and the cost per quality-adjusted life-year (QALY) gained. Fear of melanoma recurrence will be measured using the Fear of Cancer Recurrence Inventory and preference-based quality of life measured using the Assessment of Quality of Life-8 Dimensions (AQoL-8D) instrument. The AQoL-8D will provide utilities for estimation of QALYs in the cost-utility analysis. Unit costs of health services and medicines will be taken from the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme national databases. Health outcomes, and health service and medication use will be collected at baseline, 6 and 12 months follow-up. The within-trial analysis will be conducted at 12 months, consistent with the end point of the trial. ETHICS AND DISSEMINATION Approval to conduct the study was granted by the Sydney Local Health District (RPAH zone) Ethics Review Committee (X13-0065 and HREC/13/RPAH/86), the Department of Health and Ageing Human Research Ethics Committee (21/2013), the University of Sydney Human Research Ethics Committee (2013/595), and the Australian Institute of Health and Welfare Ethics Committee (EO 2013/4/58). TRIAL REGISTRATION NUMBER ACTRN12613000304730; Pre-results.
Collapse
Affiliation(s)
- M Dieng
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
| | - N A Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - P Butow
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - D S J Costa
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - S W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - G J Mann
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - R L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
48
|
Najafzadeh M, Schnipper JL, Shrank WH, Kymes S, Brennan TA, Choudhry NK. Economic value of pharmacist-led medication reconciliation for reducing medication errors after hospital discharge. Am J Manag Care 2016; 22:654-661. [PMID: 28557517] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Medication discrepancies at the time of hospital discharge are common and can harm patients. Medication reconciliation by pharmacists has been shown to prevent such discrepancies and the adverse drug events (ADEs) that can result from them. Our objective was to estimate the economic value of nontargeted and targeted medication reconciliation conducted by pharmacists and pharmacy technicians at hospital discharge versus usual care. STUDY DESIGN Discrete-event simulation model. METHODS We developed a discrete-event simulation model to prospectively model the incidence of drug-related events from a hospital payer's perspective. The model assumptions were based on data published in the peer-reviewed literature. Incidences of medication discrepancies, preventable ADEs, emergency department visits, rehospitalizations, costs, and net benefit were estimated. RESULTS The expected total cost of preventable ADEs was estimated to be $472 (95% credible interval [CI], $247-$778) per patient with usual care. Under the base-case assumption that medication reconciliation could reduce medication discrepancies by 52%, the cost of preventable ADEs could be reduced to $266 (95% CI, $150-$423), resulting in a net benefit of $206 (95% CI, $73-$373) per patient, after accounting for intervention costs. A medication reconciliation intervention that reduces medication discrepancies by at least 10% could cover the initial cost of intervention. Targeting medication reconciliation to high-risk individuals would achieve a higher net benefit than a nontargeted intervention only if the sensitivity and specificity of a screening tool were at least 90% and 70%, respectively. CONCLUSIONS Our study suggests that implementing a pharmacist-led medication reconciliation intervention at hospital discharge could be cost saving compared with usual care.
Collapse
Affiliation(s)
- Mehdi Najafzadeh
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Ste 3030, Boston, MA 02120. E-mail:
| | | | | | | | | | | |
Collapse
|
49
|
Jansen F, Cnossen IC, Eerenstein SEJ, Coupé VMH, Witte BI, van Uden-Kraan CF, Doornaert P, Braunius WW, De Bree R, Hardillo JAU, Honings J, Halmos GB, Leemans CR, Verdonck-de Leeuw IM. Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy: protocol of a multi-center randomized controlled trial. BMC Cancer 2016; 16:580. [PMID: 27484126 PMCID: PMC4971642 DOI: 10.1186/s12885-016-2613-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application "In Tune without Cords" among patients treated with total laryngectomy. METHODS/DESIGN Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application "In Tune without Cords". Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up. DISCUSSION This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice. TRIAL REGISTRATION NTR5255 Protocol version 4 date September 2015.
Collapse
Affiliation(s)
- Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Ingrid C. Cnossen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Simone E. J. Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Birgit I. Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Cornelia F. van Uden-Kraan
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Weibel W. Braunius
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - José A. U. Hardillo
- Department of Otorhinolaryngology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - György B. Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Irma M. Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| |
Collapse
|
50
|
Khunti K, Chatterjee S, Carey M, Daly H, Batista-Ferrer H, Davies MJ. New drug treatments versus structured education programmes for type 2 diabetes: comparing cost-effectiveness. Lancet Diabetes Endocrinol 2016; 4:557-9. [PMID: 27235133 DOI: 10.1016/s2213-8587(16)30048-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/24/2016] [Accepted: 04/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Sudesna Chatterjee
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK.
| | - Marian Carey
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Heather Daly
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| |
Collapse
|