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Neoh CF, Chen SCA, Kong DCM, Hamilton K, Nguyen QA, Spelman T, Tew M, Harvey EL, Ho SA, Saunders NR, Tennakoon S, Crowe A, Marriott D, Trubiano JA, Slavin MA. Costs associated with invasive Scedosporium and Lomentospora prolificans infections: a case-control study. J Antimicrob Chemother 2024; 79:46-54. [PMID: 37944018 DOI: 10.1093/jac/dkad345] [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: 03/16/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Little is known about the short- and long-term healthcare costs of invasive Scedosporium/Lomentospora prolificans infections, particularly in patient groups without haematological malignancy. This study investigated excess index hospitalization costs and cumulative costs of these infections. The predictors of excess cost and length of stay (LOS) of index hospitalization were determined. These estimates serve as valuable inputs for cost-effectiveness models of novel antifungal agents. METHODS A retrospective case-control study was conducted at six Australian hospitals. Cases of proven/probable invasive Scedosporium/L. prolificans infections between 2011 and 2021 (n = 34) were matched with controls (n = 66) by predefined criteria. Cost data were retrieved from activity-based costing systems and analysis was performed from the Australian public hospital perspective. All costs were presented in 2022 Australian dollars (AUD). Median regression analysis was used to adjust excess costs of index hospitalization whereas cumulative costs up to 1.5 years follow-up were estimated using interval-partitioned survival probabilities. RESULTS Invasive Scedosporium/L. prolificans infections were independently associated with an adjusted median excess cost of AUD36 422 (P = 0.003) and LOS of 16.27 days (P < 0.001) during index hospitalization. Inpatient stay was the major cost driver (42.7%), followed by pharmacy cost, of which antifungal agents comprised 23.8% of the total cost. Allogeneic haematopoietic stem cell transplant increased the excess cost (P = 0.013) and prolonged LOS (P < 0.001) whereas inpatient death within ≤28 days reduced both cost (P = 0.001) and LOS (P < 0.001). The median cumulative cost increased substantially to AUD203 292 over 1.5 years in cases with Scedosporium/L. prolificans infections. CONCLUSIONS The economic burden associated with invasive Scedosporium/L. prolificans infections is substantial.
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Affiliation(s)
- Chin Fen Neoh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- The University of Sydney Institute of Infectious Diseases, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David C M Kong
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Melbourne, Australia
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Grampians Health-Ballarat, Melbourne, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | - Kate Hamilton
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Quoc A Nguyen
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital Sydney, Sydney, Australia
- Kolling Institute, Northern Sydney Local Health District and the Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tim Spelman
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michelle Tew
- Health Economics Unit, Centre for Health Policy Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - Su Ann Ho
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Natalie R Saunders
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Surekha Tennakoon
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amy Crowe
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Debbie Marriott
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital Sydney, Sydney, Australia
| | - Jason A Trubiano
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Infectious Diseases, Austin Hospital, Melbourne, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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Tew M, Douglas AP, Szer J, Bajel A, Harrison SJ, Tio SY, Worth LJ, Hicks RJ, Ritchie D, Slavin MA, Thursky KA, Dalziel K. Evaluating the cost-effectiveness of [ 18F]FDG-PET/CT for investigation of persistent or recurrent neutropenic fever in high-risk haematology patients. Cancer Imaging 2023; 23:119. [PMID: 38102639 PMCID: PMC10724891 DOI: 10.1186/s40644-023-00647-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND A recent randomised trial demonstrated [18F]fluorodeoxyglucose positron-emission tomography in combination with low-dose CT (FDG-PET/CT), compared to standard of care computed tomography (CT) imaging, positively impacted antimicrobial management and outcomes of acute leukaemia and haematopoietic stem cell transplant recipients with persistent and recurrent neutropenic fever. We conducted an economic evaluation from a healthcare perspective alongside the clinical trial. METHODS Unit costs in Australian dollars were applied to all resources used (antimicrobials, diagnostic tests, ICU and hospital bed days). Effectiveness was measured as number of patients with antimicrobial rationalisation, 6-month mortality and quality-adjusted life years (QALYs) derived from patient-reported trial-based health-related quality-of-life. Generalised linear models were used to analyse costs and outcomes. Incremental cost-effectiveness ratios (ICERs) for all outcomes and net monetary benefit (NMB) for QALYs were calculated. We performed bootstrapping with 1000 replications using the recycled predictions method. RESULTS The adjusted healthcare costs were lower for FDG-PET/CT (mean $49,563; 95%CI 36,867, 65,133) compared to CT (mean $57,574; 95% CI 44,837, 73,347). The difference in QALYs between the two groups was small (0.001; 95% CI -0.001, 0.004). When simulated 1000 times, FDG-PET/CT was the dominant strategy as it was cheaper with better outcomes than the standard CT group in 74% of simulations. The estimated NMBs at willingness-to-pay thresholds of $50,000 and $100,000 per QALY were positive, thus FDG-PET/CT remained cost-effective at these thresholds. CONCLUSIONS FDG-PET/CT is cost effective when compared to CT for investigation of persistent/recurrent neutropenic fever in high-risk patients, providing further support for incorporation of FDG-PET/CT into clinical guidelines and funding. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT03429387.
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Affiliation(s)
- Michelle Tew
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Abby P Douglas
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jeff Szer
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ashish Bajel
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Simon J Harrison
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Shio Yen Tio
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Leon J Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Ritchie
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Karin A Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, University of Melbourne, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Larach JT, Flynn J, Tew M, Fernando D, Apte S, Mohan H, Kong J, McCormick JJ, Warrier SK, Heriot AG. Robotic versus laparoscopic proctectomy: a comparative study of short-term economic and clinical outcomes. Int J Colorectal Dis 2023; 38:161. [PMID: 37284889 PMCID: PMC10247549 DOI: 10.1007/s00384-023-04446-1] [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] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform. METHODS Consecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs. RESULTS During the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 ± 83.4 versus 243 ± 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 ± 8235 versus A$15,525 ± 6382; P < 0.001) and overall costs (A$34,350 ± 14,770 versus A$26,083 ± 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA ≥ 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1). CONCLUSION Robotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julie Flynn
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Michelle Tew
- Health Economics, Department of Health Services Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Diharah Fernando
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Sameer Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Helen Mohan
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia.
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Schilling C, Tew M, Bunzli S, Shadbolt C, Lohmander LS, Balogh ZJ, Paolucci F, Choong PF, Dowsey MM, Clarke P. An Economic Model for Estimating Trial Costs with an Application to Placebo Surgery Trials. Appl Health Econ Health Policy 2023; 21:263-273. [PMID: 36575335 PMCID: PMC9931787 DOI: 10.1007/s40258-022-00775-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Waste in clinical trials remains rife. We developed an economic model to predict the cost of trials based on input costs, duration, power, number of sites, recruitment eligibility and consenting rates. METHODS We parameterised the model for three proxy placebo-controlled surgical trials using data from a systematic review, a bespoke cost survey, and from the literature. We used the model to compare target and actual trial performance for (i) a trial that was completed on time but with more sites, (ii) a trial that completed after a time extension, and (iii) an incomplete trial. RESULTS Successful trials more accurately anticipated the true recruitment rate that they achieved and those that overestimated this were most likely to fail. The costs of overestimating recruitment rates were dramatic: all proxy trials had significantly higher costs than planned, with additional funding of at least AUD$600,000 (50% above budget) required for trials that completed after adding more sites or more time, and over AUD$2 million (260% above budget) for incomplete trials. CONCLUSIONS This model shows the trade-offs between time and cost, or both, when recruitment is lower than anticipated. Greater consideration is needed to improve trial planning, reviewing, and funding of these trials to avoid costly overruns and incomplete trials.
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Affiliation(s)
- Chris Schilling
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Michelle Tew
- Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - L. Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, University of Lund, Lund, Sweden
| | - Zsolt J. Balogh
- School of Medicine and Public Health, Department of Traumatology, John Hunter Hospital, The University of Newcastle, Newcastle, Australia
| | - Francesco Paolucci
- College of Human and Social Futures, The Newcastle Business School, University of Newcastle, Newcastle, Australia
- Schools of Economics and Management, University of Bologna, Bologna, Italy
| | - Peter F. Choong
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St. Vincent’s Hospital, Melbourne, Australia
| | - Michelle M. Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St. Vincent’s Hospital, Melbourne, Australia
| | - Philip Clarke
- Melbourne School of Population and Global Health, Centre for Health Policy, University of Melbourne, Melbourne, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Guccione L, Fullerton S, Gough K, Hyatt A, Tew M, Aranda S, Francis J. Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake. Front Oncol 2023; 13:1040589. [PMID: 37188202 PMCID: PMC10175822 DOI: 10.3389/fonc.2023.1040589] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Background Advance care planning (ACP) centres on supporting people to define and discuss their individual goals and preferences for future medical care, and to record and review these as appropriate. Despite recommendations from guidelines, rates of documentation for people with cancer are considerably low. Aim To systematically clarify and consolidate the evidence base of ACP in cancer care by exploring how it is defined; identifying benefits, and known barriers and enablers across patient, clinical and healthcare services levels; as well as interventions that improve advance care planning and are their effectiveness. Methods A systematic overview of reviews was conducted and was prospectively registered on PROSPERO. PubMed, Medline, PsycInfo, CINAHL, and EMBASE were searched for review related to ACP in cancer. Content analysis and narrative synthesis were used for data analysis. The Theoretical Domains Framework (TDF) was used to code barriers and enablers of ACP as well as the implied barriers targeted by each of the interventions. Results Eighteen reviews met the inclusion criteria. Definitions were inconsistent across reviews that defined ACP (n=16). Proposed benefits identified in 15/18 reviews were rarely empirically supported. Interventions reported in seven reviews tended to target the patient, even though more barriers were associated with healthcare providers (n=40 versus n=60, respectively). Conclusion To improve ACP uptake in oncology settings; the definition should include key categories that clarify the utility and benefits. Interventions need to target healthcare providers and empirically identified barriers to be most effective in improving uptake. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42021288825.
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Affiliation(s)
- Lisa Guccione
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Lisa Guccione,
| | - Sonia Fullerton
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Oncology, Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Amelia Hyatt
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Tew
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sanchia Aranda
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jill Francis
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Ottawa Hospital research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
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Shan LL, Yang LS, Tew M, Westcott MJ, Spelman TD, Choong PF, Davies AH. Quality of Life in Chronic Limb Threatening Ischaemia: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 64:666-683. [PMID: 35952907 DOI: 10.1016/j.ejvs.2022.07.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/12/2022] [Accepted: 07/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the comparative effectiveness and temporal changes in quality of life (QoL) outcomes after revascularisation, major lower extremity amputation (MLEA), and conservative management (CM) in chronic limb threatening ischaemia (CLTI). DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science. REVIEW METHODS A systematic review and meta-analysis were performed on QoL measured by any QoL instrument in adult patients with CLTI after open surgery (OS), endovascular intervention (EVI), MLEA, or CM. Randomised controlled trials and prospective observational studies published in any language between 1 January 1990 and 21 May 2021 were included. There was a pre-specified measurement time point of six months. Random effects meta-analysis was conducted on total scores for each QoL instrument. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO registration: CRD42021253953). RESULTS Fifty-five studies with 8 909 patients were included. There was significant heterogeneity in the methods used to measure QoL, and the study characteristics. In particular, 14 different QoL instruments were used with various combinations of disease specific and generic instruments within each study. A narrative summary is therefore presented. Comparative effectiveness data showed there was reasonable certainty that QoL was similar between OS and EVI at six months. Temporal outcomes suggested small to moderate improvements in QOL six months after OS and EVI compared with baseline. Limited data indicated that QoL can be maintained or slightly improved after MLEA or CM. Treatment effects were overestimated owing to small study effects, selective non-reporting, attrition, and survivorship bias. CONCLUSION QoL after OS and EVI appears to be similar. Revascularisation may provide modest QoL benefits, while MLEA or CM can maintain QoL. However, certainty of evidence is generally low or very low, and interpretation is hampered by significant heterogeneity. There is a need for a CLTI specific QoL instrument and methodological standardisation in QoL studies.
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Affiliation(s)
- Leonard L Shan
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Linda S Yang
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Tew
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J Westcott
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Tim D Spelman
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter F Choong
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Shan LL, Wang J, Westcott MJ, Tew M, Davies AH, Choong PF. A Systematic Review of Cost-Utility Analyses in Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2022; 85:9-21. [PMID: 35561892 DOI: 10.1016/j.avsg.2022.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND To review and describe the available literature on cost-utility analysis of revascularization and non-revascularization treatment approaches in chronic limb-threatening ischemia. METHODS A systematic review was performed on cost-utility analysis studies evaluating revascularization (open surgery or endovascular), major lower extremity amputation, or conservative management in adult chronic limb-threatening ischemia patients. Six bibliographic databases and online registries were searched for English language articles up to August 2021. The outcome for cost-utility analysis was quality-adjusted in life years. Procedures were compared using incremental cost-effectiveness ratios which were converted to 2021 United States dollars. Study reporting quality was assessed using the 2022 Consolidated Health Economic Evaluation Reporting Standards statement. The study was registered in International Prospective Register of Systematic Reviews (CRD42021273602). RESULTS Three trial-based and five model-based studies were included for review. Studies met between 14/28 and 20/28 criteria of the Consolidated Health Economic Evaluation Reporting Standards CHEERS statement. Only one study was written according to standardized reporting guidelines. Most studies evaluated infrainguinal disease, and adopted a health care provider perspective. There was a large variation in the incremental cost-effectiveness ratios presented across studies. Open surgical revascularization (incremental cost-effectiveness ratios: $3,678, $58,828, and $72,937), endovascular revascularization (incremental cost-effectiveness ratios: $52,036, $125,329, and $149,123), and mixed open or endovascular revascularization (incremental cost-effectiveness ratio: $8,094) maybe more cost-effective than conservative management. CONCLUSIONS The application of cost-utility analyses in chronic limb-threatening ischemia is in its infancy. Revascularization in infrainguinal disease may be favored over major lower extremity amputation or conservative management. However, data is inadequate to support recommendations for a specific treatment. This review identifies short and long-term considerations to address the current state of evidence. Cost-utility analysis is an important tool in healthcare policy and should be encouraged amongst the vascular surgical community.
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Affiliation(s)
- Leonard L Shan
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Jennifer Wang
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Mark J Westcott
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Michelle Tew
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Peter F Choong
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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Shan LL, Telianidis S, Qureshi MI, Westcott MJ, Tew M, Choong PF, Davies AH. A Review of Illness Perceptions in Chronic Limb-Threatening Ischemia: Current Knowledge Gaps and a Framework for Future Studies. Ann Vasc Surg 2022; 87:321-333. [PMID: 36029950 DOI: 10.1016/j.avsg.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/18/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To review illness perceptions (IP) in chronic limb-threatening ischemia (CLTI) patients undergoing revascularisation (open surgical or endovascular), major lower extremity amputation, or conservative management. METHODS MEDLINE, EMBASE, PsycINFO, CINAHL, WOS, and Scopus databases were searched from inception to August 20th, 2021 for studies evaluating IP in CLTI according to Leventhal's Common-Sense Model (CSM). Since only one study was identified, a post-hoc secondary literature search of MEDLINE was performed for reviews of IP in cardiovascular disease and diabetes to identify potential learning points for future research. All studies underwent narrative synthesis guided by tabulated data. RESULTS One study and seven reviews were included from the primary and secondary literature searches, respectively. Timeline and controllability were the main aspects of IP that predict prosthetic use in CLTI patients, more so at six months than one month. Other reviews in cardiovascular disease and diabetes identified important targets for future research: (i) factors that affect IP and whether IP can be used as an outcome measure, (ii) relationship between IP and clinician-reported and patient-reported outcomes, and (iii) methods to educate and change maladaptive IP. The importance of using valid and reliable measures of IP that encompass all components of Leventhal's' CSM was stressed. CONCLUSIONS Knowledge of IP in CLTI patients is severely limited in contrast to other fields in cardiovascular disease and diabetes. This review helps to close this gap by raising awareness of IP and its importance within the vascular surgical community, and by providing a framework for future studies.
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Affiliation(s)
- Leonard L Shan
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia.
| | - Stacey Telianidis
- Department of Vascular Surgery, St. Vincent's Hospital Melbourne, Australia
| | - Mahim I Qureshi
- Centre for Surgical Research, Bristol Medical School, The University of Bristol, United Kingdom
| | - Mark J Westcott
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia
| | - Michelle Tew
- Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia
| | - Peter F Choong
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Australia
| | - Alun H Davies
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
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9
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Douglas A, Thursky K, Spelman T, Szer J, Bajel A, Harrison S, Tio SY, Bupha-Intr O, Tew M, Worth L, Teh B, Chee L, Ng A, Carney D, Khot A, Haeusler G, Yong M, Trubiano J, Chen S, Hicks R, Ritchie D, Slavin M. [18F]FDG-PET-CT compared with CT for persistent or recurrent neutropenic fever in high-risk patients (PIPPIN): a multicentre, open-label, phase 3, randomised, controlled trial. The Lancet Haematology 2022; 9:e573-e584. [DOI: 10.1016/s2352-3026(22)00166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/15/2022]
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10
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Caxaj S, Tran M, Mayell S, Tew M, McLaughlin J, Rawal S, Vosko LF, Cole D. Migrant agricultural workers' deaths in Ontario from January 2020 to June 2021: a qualitative descriptive study. Int J Equity Health 2022; 21:98. [PMID: 35842656 PMCID: PMC9287708 DOI: 10.1186/s12939-022-01692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nine migrant agricultural workers died in Ontario, Canada, between January 2020 and June 2021. Methods To better understand the factors that contributed to the deaths of these migrant agricultural workers, we used a modified qualitative descriptive approach. A research team of clinical and academic experts reviewed coroner files of the nine deceased workers and undertook an accompanying media scan. A minimum of two reviewers read each file using a standardized data extraction tool. Results We identified four domains of risk, each of which encompassed various factors that likely exacerbated the risk of poor health outcomes: (1) recruitment and travel risks; (2) missed steps and substandard conditions of healthcare monitoring, quarantine, and isolation; (3) barriers to accessing healthcare; and (4) missing information and broader issues of concern. Conclusion Migrant agricultural workers have been disproportionately harmed by the COVID-19 pandemic. Greater attention to the unique needs of this population is required to avoid further preventable deaths.
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Affiliation(s)
| | | | | | - Michelle Tew
- Occupational Health Clinic for Ontario Workers, Hamilton, Canada
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11
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Tew M, Willis M, Asseburg C, Bennett H, Brennan A, Feenstra T, Gahn J, Gray A, Heathcote L, Herman WH, Isaman D, Kuo S, Lamotte M, Leal J, McEwan P, Nilsson A, Palmer AJ, Patel R, Pollard D, Ramos M, Sailer F, Schramm W, Shao H, Shi L, Si L, Smolen HJ, Thomas C, Tran-Duy A, Yang C, Ye W, Yu X, Zhang P, Clarke P. Exploring Structural Uncertainty and Impact of Health State Utility Values on Lifetime Outcomes in Diabetes Economic Simulation Models: Findings from the Ninth Mount Hood Diabetes Quality-of-Life Challenge. Med Decis Making 2022; 42:599-611. [PMID: 34911405 PMCID: PMC9329757 DOI: 10.1177/0272989x211065479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Structural uncertainty can affect model-based economic simulation estimates and study conclusions. Unfortunately, unlike parameter uncertainty, relatively little is known about its magnitude of impact on life-years (LYs) and quality-adjusted life-years (QALYs) in modeling of diabetes. We leveraged the Mount Hood Diabetes Challenge Network, a biennial conference attended by international diabetes modeling groups, to assess structural uncertainty in simulating QALYs in type 2 diabetes simulation models. METHODS Eleven type 2 diabetes simulation modeling groups participated in the 9th Mount Hood Diabetes Challenge. Modeling groups simulated 5 diabetes-related intervention profiles using predefined baseline characteristics and a standard utility value set for diabetes-related complications. LYs and QALYs were reported. Simulations were repeated using lower and upper limits of the 95% confidence intervals of utility inputs. Changes in LYs and QALYs from tested interventions were compared across models. Additional analyses were conducted postchallenge to investigate drivers of cross-model differences. RESULTS Substantial cross-model variability in incremental LYs and QALYs was observed, particularly for HbA1c and body mass index (BMI) intervention profiles. For a 0.5%-point permanent HbA1c reduction, LY gains ranged from 0.050 to 0.750. For a 1-unit permanent BMI reduction, incremental QALYs varied from a small decrease in QALYs (-0.024) to an increase of 0.203. Changes in utility values of health states had a much smaller impact (to the hundredth of a decimal place) on incremental QALYs. Microsimulation models were found to generate a mean of 3.41 more LYs than cohort simulation models (P = 0.049). CONCLUSIONS Variations in utility values contribute to a lesser extent than uncertainty captured as structural uncertainty. These findings reinforce the importance of assessing structural uncertainty thoroughly because the choice of model (or models) can influence study results, which can serve as evidence for resource allocation decisions.HighlightsThe findings indicate substantial cross-model variability in QALY predictions for a standardized set of simulation scenarios and is considerably larger than within model variability to alternative health state utility values (e.g., lower and upper limits of the 95% confidence intervals of utility inputs).There is a need to understand and assess structural uncertainty, as the choice of model to inform resource allocation decisions can matter more than the choice of health state utility values.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia
| | - Michael Willis
- The Swedish Institute for Health Economics,
Lund, Sweden
| | | | | | - Alan Brennan
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - Talitha Feenstra
- Groningen University, Faculty of Science and
Engineering, GRIP, Groningen, The Netherlands,Groningen University, UMCG, Groningen, The
Netherlands,Netherlands Institute for Public Health and the
Environment (RIVM), Bilthoven, The Netherlands
| | - James Gahn
- Medical Decision Modeling Inc., Indianapolis,
IN, USA
| | - Alastair Gray
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Laura Heathcote
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - William H. Herman
- Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
| | - Deanna Isaman
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Shihchen Kuo
- Department of Internal Medicine, University of
Michigan, Ann Arbor, MI, USA
| | - Mark Lamotte
- Global Health Economics and Outcomes Research,
Real World Solutions, IQVIA, Zaventem, Belgium
| | - José Leal
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd,
Cardiff, UK
| | | | - Andrew J. Palmer
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia,Menzies Institute for Medical Research, The
University of Tasmania, Hobart, Tasmania, Australia
| | - Rishi Patel
- Health Economics Research Centre, Nuffield
Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Pollard
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - Mafalda Ramos
- Global Health Economics and Outcomes Research,
Real World Solutions, IQVIA, Porto Salvo, Portugal
| | - Fabian Sailer
- GECKO Institute for Medicine, Informatics and
Economics, Heilbronn University, Heilbronn, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and
Economics, Heilbronn University, Heilbronn, Germany
| | - Hui Shao
- Department of Pharmaceutical Outcomes and
Policy. University of Florida College of Pharmacy. Gainesville, FL,
USA
| | - Lizheng Shi
- Department of Health Policy and Management;
Tulane University School of Public Health and Tropical Medicine
| | - Lei Si
- Menzies Institute for Medical Research, The
University of Tasmania, Hobart, Tasmania, Australia,The George Institute for Global Health, UNSW
Sydney, Kensington, Australia
| | | | - Chloe Thomas
- School of Health and Related Research,
University of Sheffield, Sheffield, UK
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne,
Victoria, Australia
| | - Chunting Yang
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Wen Ye
- Department of Biostatistics, University of
Michigan, Ann Arbor, MI, USA
| | - Xueting Yu
- Medical Decision Modeling Inc., Indianapolis,
IN, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centres for
Disease Control and Prevention, Atlanta, GA, USA
| | - Philip Clarke
- Philip Clarke, Health Economics Research
Centre, Nuffield Department of Population Health, University of Oxford, Oxford,
UK; ()
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12
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Tew M, De Abreu Lourenco R, Gordon JR, Thursky KA, Slavin MA, Babl FA, Orme L, Bryant PA, Teh BW, Dalziel K, Haeusler GM. Cost-effectiveness of home-based care of febrile neutropenia in children with cancer. Pediatr Blood Cancer 2022; 69:e29469. [PMID: 34854550 DOI: 10.1002/pbc.29469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/10/2021] [Accepted: 11/01/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Home-based treatment of febrile neutropenia (FN) in children with cancer with oral or intravenous antibiotics is safe and effective. There are limited data on the economic impact of this model of care. We evaluated the cost-effectiveness of implementing an FN programme, incorporating home-based intravenous antibiotics for carefully selected patients, in a tertiary paediatric hospital. METHODS A decision analytic model was constructed to compare costs and outcomes of the home-based FN programme, with usual in-hospital treatment with intravenous antibiotics. The programme included a clinical decision rule to stratify patients by risk for severe infection and home-based eligibility criteria using disease, chemotherapy and patient-level factors. Health outcomes (quality of life) and probabilities of FN risk classification and home-based eligibility were based on prospectively collected data between 2017 and 2019. Patient-level costs were extracted from hospital administrative records. Cost-effectiveness was expressed as the incremental cost per quality-adjusted life year (QALY). FINDINGS The mean health care cost of home-based FN treatment in low-risk patients was Australian dollars (A$) 7765 per patient compared to A$20,396 for in-hospital treatment (mean difference A$12,632 [95% CI: 12,496-12,767]). Overall, the home-based FN programme was the dominant strategy, being more effective (0.0011 QALY [95% CI: 0.0011-0.0012]) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care programme. CONCLUSION Compared to in-hospital FN care, the home-based FN programme is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the programme.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joshua Robert Gordon
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin A Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Franz A Babl
- Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Benjamin W Teh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabrielle M Haeusler
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
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13
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Tew M, Forster D, Teh BW, Dalziel K. National cost savings from an ambulatory program for low-risk febrile neutropenia patients in Australia. AUST HEALTH REV 2020; 43:549-555. [PMID: 31526466 DOI: 10.1071/ah19061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022]
Abstract
Objective The management of low-risk febrile neutropenia (FN) patients through ambulatory programs has demonstrated comparative safety and effectiveness to in-patient strategies. However, there is limited evidence of benefits of changing practice, particularly on a national scale. The aim of this study was to estimate costs and benefits of the program over a 10-year time horizon. Methods A comparative cost analysis from a health system perspective was performed, comparing costs and length of stay (LOS) of patients enrolled in an ambulatory program to a historical cohort who did not receive the program. Generalised linear models were used for analysis and bootstrapped to account for uncertainty. National data of identified FN admissions were used to inform future projections, with varying proportions of low-risk patients and eligibility for the ambulatory program. Results The overall LOS for patients in ambulatory cohort was 1.9 days shorter (95% confidence interval (CI) 1.0-2.8 days), a 50% reduction in in-patient bed-days. Although patients in the ambulatory cohort incurred additional costs due to care received outside hospital (mean (± s.d.) A$828.03 ± 124.30), the mean total cost incurred remained substantially lower than that of the historical cohort (A$2979 lower; 95% CI A$772-5391). On a national scale, this could translate into A$62.7 million in costs averted and 41347 bed-days saved over 10 years if the low-risk prediction rate and eligibility for ambulatory programs remained at currently observed rates. Conclusions The wider implementation of a safe and effective ambulatory program to manage low-risk FN patients can result in significant return-on-investment for the healthcare system by eliminating avoidable costs due to unnecessary lengthy hospital admissions. What is known about the topic? There is strong evidence demonstrating out-patient treatment of low-risk FN patients to be an effective and cost-effective strategy compared with continued in-patient hospitalisation. What does this paper add? This study demonstrates the sustainability of the ambulatory program in ensuring cost benefits and in-patient beds through real-life implementation data. It also provides evidence of the substantial cost and bed-days potentially averted when the cost savings and difference in LOS are estimated on a national scale over a 10-year time horizon. What are the implications for practitioners? The management of low-risk FN patients through ambulatory or out-patient programs is a safe and effective approach. There is strong evidence demonstrating the likely cost savings and considerable bed-days saved, which can be reallocated to meet other medical demands.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ; ; and National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, 305 Grattan Street, Melbourne, Vic. 3000, Australia. ; and Corresponding author.
| | - Daniel Forster
- Centre for Health Policy, Melbourne School of Population and Global Health, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ;
| | - Benjamin W Teh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, 305 Grattan Street, Melbourne, Vic. 3000, Australia. ; and Department of Infectious Diseases, Peter MacCallum Cancer Institute, 305 Grattan Street, Melbourne, Vic. 3000, Australia; and Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Institute, 305 Grattan Street, Melbourne, Vic. 3000, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, 207 Bouverie Street, Carlton, Vic. 3053, Australia. ;
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Si L, Willis MS, Asseburg C, Nilsson A, Tew M, Clarke PM, Lamotte M, Ramos M, Shao H, Shi L, Zhang P, McEwan P, Ye W, Herman WH, Kuo S, Isaman DJ, Schramm W, Sailer F, Brennan A, Pollard D, Smolen HJ, Leal J, Gray A, Patel R, Feenstra T, Palmer AJ. Evaluating the Ability of Economic Models of Diabetes to Simulate New Cardiovascular Outcomes Trials: A Report on the Ninth Mount Hood Diabetes Challenge. Value Health 2020; 23:1163-1170. [PMID: 32940234 DOI: 10.1016/j.jval.2020.04.1832] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The cardiovascular outcomes challenge examined the predictive accuracy of 10 diabetes models in estimating hard outcomes in 2 recent cardiovascular outcomes trials (CVOTs) and whether recalibration can be used to improve replication. METHODS Participating groups were asked to reproduce the results of the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME) and the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program. Calibration was performed and additional analyses assessed model ability to replicate absolute event rates, hazard ratios (HRs), and the generalizability of calibration across CVOTs within a drug class. RESULTS Ten groups submitted results. Models underestimated treatment effects (ie, HRs) using uncalibrated models for both trials. Calibration to the placebo arm of EMPA-REG OUTCOME greatly improved the prediction of event rates in the placebo, but less so in the active comparator arm. Calibrating to both arms of EMPA-REG OUTCOME individually enabled replication of the observed outcomes. Using EMPA-REG OUTCOME-calibrated models to predict CANVAS Program outcomes was an improvement over uncalibrated models but failed to capture treatment effects adequately. Applying canagliflozin HRs directly provided the best fit. CONCLUSIONS The Ninth Mount Hood Diabetes Challenge demonstrated that commonly used risk equations were generally unable to capture recent CVOT treatment effects but that calibration of the risk equations can improve predictive accuracy. Although calibration serves as a practical approach to improve predictive accuracy for CVOT outcomes, it does not extrapolate generally to other settings, time horizons, and comparators. New methods and/or new risk equations for capturing these CV benefits are needed.
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Affiliation(s)
- Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | | | | | - Michelle Tew
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Philip M Clarke
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Victoria, Australia; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Mark Lamotte
- Global Health Economics and Outcomes Research, IQVIA, Zaventem, Belgium
| | - Mafalda Ramos
- Global Health Economics and Outcomes Research, IQVIA, Lisbon, Portugal
| | - Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Lizheng Shi
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - Wen Ye
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - William H Herman
- Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shihchen Kuo
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Deanna J Isaman
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Wendelin Schramm
- Centre for Health Economics and Outcomes Research, GECKO Institute, Heilbronn University, Heilbronn, Germany
| | - Fabian Sailer
- Centre for Health Economics and Outcomes Research, GECKO Institute, Heilbronn University, Heilbronn, Germany
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Harry J Smolen
- Medical Decision Modeling Inc., Indianapolis, Indiana, USA
| | - José Leal
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Rishi Patel
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Talitha Feenstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; University of Groningen, Faculty of Science and Engineering, Groningen, The Netherlands
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Victoria, Australia.
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15
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Tew M, Dalziel K, Clarke P, Smith A, Choong PF, Dowsey M. Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement? Qual Life Res 2020; 29:3273-3283. [PMID: 32651804 DOI: 10.1007/s11136-020-02577-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE As patient-reported outcome measures (PROMs) are increasingly integrated into clinical practice, there is a need to translate collected data into valuable information to guide and improve the quality and value of patient care. The purpose of this study was to investigate health-related quality-of-life (QoL) trajectories in the 5 years following total knee replacement (TKR) and the patient characteristics associated with these trajectories. The feasibility of translating QoL trajectories into valuable information for guiding patient-centered care was also explored. METHODS Data on patients who underwent TKR between 2006 and 2011 from a single-institution registry were extracted including patient-reported QoL (captured using the Short Form Survey (SF-12) instrument) up to 5 years post-surgery. QoL trajectories were modelled using latent class growth analysis. Quality-adjusted life-years (QALYs) were calculated to illustrate longer term health benefit. Multinomial logistic regression analyses were performed to examine the association between trajectory groups and baseline patient characteristics. RESULTS After exclusions, 1553 patients out of 1892 were included in the analysis. Six unique QoL trajectories were identified; with differing levels at baseline and improvement patterns post-surgery. Only 18.4% of patients were identified to be in the most positive QoL trajectory (low baseline, large sustainable improvement after surgery) associated with the greatest gain in QALY. These patients were likely to be younger, have no co-morbidities and report greater pain at pre-surgery than most in other QoL trajectories. CONCLUSIONS Our findings demonstrate the importance of underlying heterogeneity in QoL trajectories, resulting in variable QALY gains. There is scope in translating routinely collected PROMs to improve shared decision-making allowing for more patient engagement. However, further research is required to identify suitable approaches of its implementation into practice to guide clinical care and maximize patient outcomes.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia.
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia
| | - Michelle Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia
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Tew M, Dalziel K, Dowsey M, Choong PF, Clarke P. Exploring the Impact of Quality of Life on Survival: A Case Study in Total Knee Replacement Surgery. Med Decis Making 2020; 40:302-313. [PMID: 32297839 DOI: 10.1177/0272989x20913266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. There is growing evidence that quality of life (QoL) has a strong association with mortality. However, incorporation of QoL is uncommon in standard survival modeling. Methods. Using data extracted from a registry of patients undergoing total knee replacement (TKR), the impact of incorporating QoL in survival modeling was explored using 4 parametric survival models. QoL was incorporated and tested in 2 forms, which are baseline and change in QoL due to intervention. Life expectancy and quality-adjusted life years (QALYs) were calculated and comparisons made to a reference model (no QoL) to translate the findings in the context of modeled economic evaluations. Results. A total of 2858 TKR cases (2309 patients) who had TKR between 2006 and 2015 were included in this analysis. Increases in baseline and change in QoL were associated with a reduction in mortality. Compared to the reference model, differences of up to 0.32 life years and 0.53 QALYs were observed, and these translated into a 9.5% change in incremental effectiveness. These differences were much larger as the strength of the association between QoL and mortality increased. Conclusions. This work has demonstrated that the inclusion of QoL measures (at baseline and change from baseline) when extrapolating survival does matter. It can influence health outcomes such as life expectancy and QALYs, which are relevant in cost-effectiveness analysis. This is important because neglecting the correlation between QoL and mortality can lead to imprecise extrapolations and thus risk misleading results affecting subsequent decisions made by policy makers.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kent S, Becker F, Feenstra T, Tran-Duy A, Schlackow I, Tew M, Zhang P, Ye W, Lizheng S, Herman W, McEwan P, Schramm W, Gray A, Leal J, Lamotte M, Willis M, Palmer AJ, Clarke P. The Challenge of Transparency and Validation in Health Economic Decision Modelling: A View from Mount Hood. Pharmacoeconomics 2019; 37:1305-1312. [PMID: 31347104 PMCID: PMC6860461 DOI: 10.1007/s40273-019-00825-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Transparency in health economic decision modelling is important for engendering confidence in the models and in the reliability of model-based cost-effectiveness analyses. The Mount Hood Diabetes Challenge Network has taken a lead in promoting transparency through validation with biennial conferences in which diabetes modelling groups meet to compare simulated outcomes of pre-specified scenarios often based on the results of pivotal clinical trials. Model registration is a potential method for promoting transparency, while also reducing the duplication of effort. An important network initiative is the ongoing construction of a diabetes model registry (https://www.mthooddiabeteschallenge.com). Following the 2012 International Society for Pharmacoeconomics and Outcomes Research and the Society of Medical Decision Making (ISPOR-SMDM) guidelines, we recommend that modelling groups provide technical and non-technical documentation sufficient to enable model reproduction, but not necessarily provide the model code. We also request that modelling groups upload documentation on the methods and outcomes of validation efforts, and run reference case simulations so that model outcomes can be compared. In this paper, we discuss conflicting definitions of transparency in health economic modelling, and describe the ongoing development of a registry of economic models for diabetes through the Mount Hood Diabetes Challenge Network, its objectives and potential further developments, and highlight the challenges in its construction and maintenance. The support of key stakeholders such as decision-making bodies and journals is key to ensuring the success of this and other registries. In the absence of public funding, the development of a network of modellers is of huge value in enhancing transparency, whether through registries or other means.
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Affiliation(s)
- Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frauke Becker
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Talitha Feenstra
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services Research, Bilthoven, The Netherlands
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ping Zhang
- Division of Diabetes Translation, Centres for Disease Control and Prevention, Atlanta, USA
| | - Wen Ye
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Shi Lizheng
- Department of Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - William Herman
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Phil McEwan
- Centre for Health Economics, Swansea University, Swansea, UK
| | | | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Michael Willis
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Andrew J Palmer
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Menzies Institute for Medical Research, The University of Tasmania, Hobart, Australia
| | - Philip Clarke
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
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Tew M, Dalziel KM, Petrie DJ, Clarke PM. Growth of linked hospital data use in Australia: a systematic review. AUST HEALTH REV 2019; 41:394-400. [PMID: 27444270 DOI: 10.1071/ah16034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to quantify and understand the utilisation of linked hospital data for research purposes across Australia over the past two decades. Methods A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Medline OVID, PsycINFO, Embase, EconLit and Scopus were searched to identify articles published from 1946 to December 2014. Information on publication year, state(s) involved, type of data linkage, disease area and purpose was extracted. Results The search identified 3314 articles, of which 606 were included; these generated 629 records of hospital data linkage use across all Australian states and territories. The major contributions were from Western Australia (WA; 51%) and New South Wales (NSW; 32%) with the remaining states and territories having significantly fewer publications (total contribution only 17%). WA's contribution resulted from a steady increase from the late 1990s, whereas NSW's contribution is mostly from a rapid increase from 2010. Current data linkage is primarily used in epidemiological research (73%). Conclusion More than 80% of publications were from WA and NSW, whereas other states significantly lag behind. The observable growth in these two states clearly demonstrates the underutilised opportunities for data linkage to add value in health services research in the other states. What is known about the topic? Linking administrative hospital data to other data has the potential to be a cost-effective method to significantly improve health policy. Over the past two decades, Australia has made significant investments in improving its data linkage capabilities. However, several articles have highlighted the many barriers involved in using linked hospital data. What does this paper add? This paper quantitatively evaluates the performance across all Australian states in terms of the use of their administrative hospital data for research purposes. The performance of states varies considerably, with WA and NSW the clear stand-out performers and limited outputs currently seen for the other Australian states and territories. What are the implications for practitioners? Given the significant investments made into data linkage, it is important to continue to evaluate and monitor the performance of the states in terms of translating this investment into outputs. Where the outputs do not match the investment, it is important to identify and overcome those barriers limiting the gains from this investment. More generally, there is a need to think about how we improve the effective and efficient use of data linkage investments in Australia.
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Affiliation(s)
- Michelle Tew
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Kim M Dalziel
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Dennis J Petrie
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Philip M Clarke
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
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Tew M, Clarke P, Thursky K, Dalziel K. Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients. Pharmacoeconomics 2019; 37:931-941. [PMID: 30864067 DOI: 10.1007/s40273-019-00790-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The inclusion of future medical costs in cost-effectiveness analyses remains a controversial issue. The impact of capturing future medical costs is likely to be particularly important in patients with cancer where costly lifelong medical care is necessary. The lack of clear, definitive pharmacoeconomic guidelines can limit comparability and has implications for decision making. OBJECTIVE The aim of this study was to demonstrate the impact of incorporating future medical costs through an applied example using original data from a clinical study evaluating the cost effectiveness of a sepsis intervention in cancer patients. METHODS A decision analytic model was used to capture quality-adjusted life-years (QALYs) and lifetime costs of cancer patients from an Australian healthcare system perspective over a lifetime horizon. The evaluation considered three scenarios: (1) intervention-related costs (no future medical cost), (2) lifetime cancer costs and (3) all future healthcare costs. Inputs to the model included patient-level data from the clinical study, relative risk of death due to sepsis, cancer mortality and future medical costs sourced from published literature. All costs are expressed in 2017 Australian dollars and discounted at 5%. To further assess the impact of future costs on cancer heterogeneity, variation in survival and lifetime costs between cancer types and the implications for cost-effectiveness analysis were explored. RESULTS The inclusion of future medical costs increased incremental cost-effectiveness ratios (ICERs) resulting in a shift from the intervention being a dominant strategy (cheaper and more effective) to an ICER of $7526/QALY. Across different cancer types, longer life expectancies did not necessarily result in greater lifetime healthcare costs. Incremental costs differed across cancers depending on the respective costs of managing cancer and survivorship, thus resulting in variations in ICERs. CONCLUSIONS There is scope for including costs beyond intervention costs in economic evaluations. The inclusion of future medical costs can result in markedly different cost-effectiveness results, leading to higher ICERs in a cancer population, with possible implications for funding decisions.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia.
| | - Philip Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Karin Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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20
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Thursky K, Lingaratnam S, Jayarajan J, Haeusler GM, Teh B, Tew M, Venn G, Hiong A, Brown C, Leung V, Worth LJ, Dalziel K, Slavin MA. Implementation of a whole of hospital sepsis clinical pathway in a cancer hospital: impact on sepsis management, outcomes and costs. BMJ Open Qual 2018; 7:e000355. [PMID: 30019016 PMCID: PMC6045757 DOI: 10.1136/bmjoq-2018-000355] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/09/2018] [Accepted: 06/02/2018] [Indexed: 01/14/2023] Open
Abstract
Infection and sepsis are common problems in cancer management affecting up to 45% of patients and are associated with significant morbidity, mortality and healthcare utilisation. Objective To develop and implement a whole of hospital clinical pathway for the management of sepsis (SP) in a specialised cancer hospital and to measure the impact on patient outcomes and healthcare utilisation. Methods A multidisciplinary sepsis working party was established. Process mapping of practices for recognition and management of sepsis was undertaken across all clinical areas. A clinical pathway document that supported nurse-initiated sepsis care, prompt antibiotic and fluid resuscitation was implemented. Process and outcome measures for patients with sepsis were collected preimplementation (April-December 2012), postimplementation cohorts (April-December 2013), and from January to December 2014. Results 323 patients were evaluated (111 preimplementation, 212 postimplementation). More patients with sepsis had lactate measured (75.0% vs 17.2%) and appropriate first dose antibiotic (90.1% vs 76.1%) (all p<0.05). Time to antibiotics was halved (55 vs 110 min, p<0.05). Patients with sepsis had lower rates of intensive care unit admission (17.1% vs 35.5%), postsepsis length of stay (7.5 vs 9.9 days), and sepsis-related mortality (5.0% vs 16.2%) (all p<0.05). Mean total hospital admission costs were lower in the SP cohort, with a significant difference in admission costs between historical and SP non-surgical groups of $A8363 (95% CI 81.02 to 16645.32, p=0.048) per patient on the pathway. A second cohort of 449 patients with sepsis from January to December 2014 demonstrated sustained improvement. Conclusions The SP was associated with significant improvement in patient outcomes and reduced costs. The SP has been sustained since 2013, and has been successfully implemented in another hospital with further implementations underway in Victoria.
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Affiliation(s)
- Karin Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Senthil Lingaratnam
- Department of Pharmacy, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Jasveer Jayarajan
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gabrielle M Haeusler
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Benjamin Teh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Michelle Tew
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,University of Melbourne, Center for Health Policy, Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Georgina Venn
- Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Alison Hiong
- Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Christine Brown
- Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Vivian Leung
- Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Leon J Worth
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,University of Melbourne, Center for Health Policy, Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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21
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Palmer AJ, Si L, Tew M, Hua X, Willis MS, Asseburg C, McEwan P, Leal J, Gray A, Foos V, Lamotte M, Feenstra T, O'Connor PJ, Brandle M, Smolen HJ, Gahn JC, Valentine WJ, Pollock RF, Breeze P, Brennan A, Pollard D, Ye W, Herman WH, Isaman DJ, Kuo S, Laiteerapong N, Tran-Duy A, Clarke PM. Computer Modeling of Diabetes and Its Transparency: A Report on the Eighth Mount Hood Challenge. Value Health 2018; 21:724-731. [PMID: 29909878 PMCID: PMC6659402 DOI: 10.1016/j.jval.2018.02.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 08/31/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The Eighth Mount Hood Challenge (held in St. Gallen, Switzerland, in September 2016) evaluated the transparency of model input documentation from two published health economics studies and developed guidelines for improving transparency in the reporting of input data underlying model-based economic analyses in diabetes. METHODS Participating modeling groups were asked to reproduce the results of two published studies using the input data described in those articles. Gaps in input data were filled with assumptions reported by the modeling groups. Goodness of fit between the results reported in the target studies and the groups' replicated outputs was evaluated using the slope of linear regression line and the coefficient of determination (R2). After a general discussion of the results, a diabetes-specific checklist for the transparency of model input was developed. RESULTS Seven groups participated in the transparency challenge. The reporting of key model input parameters in the two studies, including the baseline characteristics of simulated patients, treatment effect and treatment intensification threshold assumptions, treatment effect evolution, prediction of complications and costs data, was inadequately transparent (and often missing altogether). Not surprisingly, goodness of fit was better for the study that reported its input data with more transparency. To improve the transparency in diabetes modeling, the Diabetes Modeling Input Checklist listing the minimal input data required for reproducibility in most diabetes modeling applications was developed. CONCLUSIONS Transparency of diabetes model inputs is important to the reproducibility and credibility of simulation results. In the Eighth Mount Hood Challenge, the Diabetes Modeling Input Checklist was developed with the goal of improving the transparency of input data reporting and reproducibility of diabetes simulation model results.
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Affiliation(s)
- Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Xinyang Hua
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Phil McEwan
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Volker Foos
- IQVIA, Real-World Evidence Solutions, Zaventem, Belgium
| | - Mark Lamotte
- IQVIA, Real-World Evidence Solutions, Zaventem, Belgium
| | - Talitha Feenstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Groningen University, University Medical Center Groningen, Groningen, The Netherlands
| | - Patrick J O'Connor
- HealthPartners Institute and HealthPartners Center for Chronic Care Innovation, Minneapolis, MN, USA
| | - Michael Brandle
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - James C Gahn
- Medical Decision Modeling Inc., Indianapolis, IN, USA
| | | | | | - Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Wen Ye
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - William H Herman
- Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Deanna J Isaman
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Shihchen Kuo
- Departments of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Philip M Clarke
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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22
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Tew M, Efron D, Hiscock H, Dalziel K. What Medications are Australian Children Prescribed? Evidence from the Longitudinal Study of Australian Children. J Paediatr Child Health 2018; 54:335-336. [PMID: 29504222 DOI: 10.1111/jpc.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Michelle Tew
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Community Health Services Research Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Dennis AT, Lamb KE, Story D, Tew M, Dalziel K, Clarke P, Lew J, Parker A, Hessian E, Teale G, Simmons S, Casalaz D. Associations between maternal size and health outcomes for women undergoing caesarean section: a multicentre prospective observational study (The MUM SIZE Study). BMJ Open 2017; 7:e015630. [PMID: 28667219 PMCID: PMC5734348 DOI: 10.1136/bmjopen-2016-015630] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To investigate associations between maternal body mass index (BMI) at delivery (using pregnancy-specific BMI cut-off values 5 kg/m2 higher in each of the WHO groups) and clinical, theatre utilisation and health economic outcomes for women undergoing caesarean section (CS). DESIGN A prospective multicentre observational study. SETTING Seven secondary or tertiary referral obstetric hospitals. PARTICIPANTS One thousand and four hundred and fifty-seven women undergoing all categories of CS. DATA COLLECTION Height and weight were recorded at the initial antenatal visit and at delivery. We analysed the associations between delivery BMI (continuous and pregnancy-specific cut-off values) and total theatre time, surgical time, anaesthesia time, maternal and neonatal adverse outcomes, total hospital admission and theatre costs. RESULTS Mean participant characteristics were: age 32 years, gestation at delivery 38.4 weeks and delivery BMI 32.2 kg/m2. Fifty-five per cent of participants were overweight, obese or super-obese using delivery pregnancy-specific BMI cut-off values. As BMI increased, total theatre time, surgical time and anaesthesia time increased. Super-obese participants had approximately 27% (17 min, p<0.001) longer total theatre time, 20% (9 min, p<0.001), longer surgical time and 40% (11 min, p<0.001) longer anaesthesia time when compared with normal BMI participants. Increased BMI at delivery was associated with increased risk of maternal intensive care unit admission (relative risk 1.07, p=0.045), but no increased risk of neonatal admission to higher acuity care. Total hospital admission costs were 15% higher in super-obese women compared with normal BMI women and theatre costs were 27% higher in super-obese women. CONCLUSIONS Increased maternal BMI was associated with increased total theatre time, surgical and anaesthesia time, increased total hospital admission costs and theatre costs. Clinicians and health administrators should consider these clinical risks, time implications and financial costs when managing pregnant women.
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Affiliation(s)
- Alicia Therese Dennis
- Department of Obstetrics and Gynaecology and Department of Pharmacology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Anaesthesia, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Karen Elaine Lamb
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise & Nutrition Science, Deakin University, Burwood, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - David Story
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Tew
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia
| | - Philip Clarke
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Parkville, Victoria, Australia
| | - Jospeh Lew
- Department of Anaesthesia, The Northern Hospital, Epping, Victoria, Australia
| | - Anna Parker
- Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth Hessian
- Departments of Anaesthesia and Pain Medicine, Western Health, Footscray, Victoria, Australia
| | - Gyln Teale
- Women’s and Children’s Services, Sunshine Hospital, Western Health, Albans, Victoria, Australia
| | - Scott Simmons
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Dan Casalaz
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Affiliation(s)
- Xinyang Hua
- School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Natalie Carvalho
- School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Michelle Tew
- School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Elbert S Huang
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Philip Clarke
- School of Population and Global Health, University of Melbourne, Victoria, Australia
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Pysklywec M, McLaughlin J, Tew M, Haines T. Doctors within borders: meeting the health care needs of migrant farm workers in Canada. CMAJ 2011; 183:1039-43. [PMID: 21502349 DOI: 10.1503/cmaj.091404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael Pysklywec
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
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Crooks DL, Whelan TJ, Reyno L, Willan A, Tozer R, Mings D, Miller J, Tew M, Elliott P, Levine M. The Initial Health Assessment: an intervention to identify the supportive care needs of cancer patients. Support Care Cancer 2003; 12:19-24. [PMID: 14505159 DOI: 10.1007/s00520-003-0526-9] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Accepted: 07/23/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The first step in effective supportive care delivery is an assessment of patient needs. The Initial Health Assessment Form (IHA) was developed to aid clinicians in recognition and documentation of a patient's supportive care needs during their first visit to a comprehensive cancer centre. The purpose of this study was to determine the relative effectiveness of this instrument as compared to routine practice. METHODS A before-after study was performed. Charts of consecutive patients with newly diagnosed cancer attending the Hamilton Regional Cancer Centre were selected randomly. Each chart was reviewed to determine the documentation at the initial patient assessment of 22 supportive care items under eight domains of need: physical, psychological, daily living, social, financial, informational, special needs and personal resources. The pre-intervention evaluation (T1) occurred over a 3-month period followed by the introduction of the IHA into clinical practice. Three months after its introduction, the post-intervention (T2) evaluation took place over the ensuing 3 months. RESULTS A total of 306 charts were evaluated (153 each in T1 and T2). Patients from the two time periods were comparable with respect to background demographic variables. Introduction of the IHA increased the mean documentation of supportive care needs and resources from 26% in T1 to 49% in T2 ( p=0.001). Significant improvements were found in all domains of need. Despite improvements, documentation of assessment continued to remain low for daily living, social, financial, and informational needs. CONCLUSIONS The IHA improved documentation of supportive care needs and resources. There is still room for improvement.
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Affiliation(s)
- Dauna L Crooks
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Lo BB, Meymouna M, Boulahi MA, Tew M, Sow A, Ba A, Sow MB. [Prevalence of serum markers of hepatitis B and C virus in blood donors of Nouakchott, Mauritania]. Bull Soc Pathol Exot 1999; 92:83-4. [PMID: 10399594] [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: 02/13/2023]
Abstract
This preliminary survey was intended to collect transversal data to ensure a better understanding of the hepatitis B and C epidemiology in Mauritania. The authors have studied the seroprevalence rate of HBs antigen and HCV antibodies among 349 blood donors. Data of this study showed that anti-HCV antibody was detected in 1.1% and HBs antigen in 20.3% blood donors.
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Affiliation(s)
- B B Lo
- Service des laboratoires et banque de sang du centre hospitalier national, Nouakchott, Mauritanie
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Tew M. A warning about allied health professionals. Tex Med 1998; 94:6. [PMID: 9664813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
BACKGROUND The objective of this study was to examine the physical and emotional health status, self-perceived problems, and needs of newly diagnosed cancer patients to determine and plan supportive care strategies. METHODS A cross-sectional survey of newly diagnosed cancer patients attending a regional cancer center during a 6-month period was performed. Patients with breast, colorectal, head and neck, lung, and prostate carcinoma as well as nonmelanoma of the skin were selected randomly. Patients were interviewed prior to their first appointment at the clinic. Physical health status was assessed using the Symptom Distress Scale, psychologic health status was assessed with the General Health Questionnaire (GHQ), day-to-day functioning with the Rapid Disability Scale, and social support with the modified Sarason's Social Support Scale. Perceived needs were assessed in a number of ways, including identification of patients' specific social concerns and informational needs, and by asking them to list their current problems or concerns. RESULTS Of 156 eligible patients, 134 completed the interview. One hundred and twenty-nine patients (96%) reported current symptoms that included fatigue (66%), worried outlook (61%), difficulty sleeping (48%), and pain (42%). Forty-four patients (33%) were identified as psychologically distressed with a GHQ score of > or = 6. One hundred and fourteen patients (85%) had informational needs, 89 (66%) indicated > or = 1 social concerns, and 55 (41%) reported a need for assistance with day-to-day living. CONCLUSIONS Patients with newly diagnosed cancer commonly report symptoms related to fatigue, pain, and psychologic distress. Other frequently reported issues relate to the need for information and social concerns regarding the patients' ability to take care of their home and maintain family and other relationships. Awareness of these issues is important for planning supportive care interventions for newly diagnosed cancer patients.
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Affiliation(s)
- T J Whelan
- Department of Medicine, McMaster University and the OCTRF Hamilton Regional Cancer Centre, Ontario, Canada
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Browman GP, Czukar D, Mohide EA, Neimanis M, De Pauw S, Tew M, Barrett B. Survey of telephone contacts for a Regional Canadian Cancer Society District. Can J Oncol 1995; 5:420-6. [PMID: 8770458] [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: 02/02/2023]
Abstract
This is a descriptive of a census survey of telephone contacts to six unit offices of the Metro Hamilton District Canadian Cancer Society (CCS). The survey instrument was also designed to address two a priori hypotheses: that first-time contacts would be systematically different from the population of other callers; and, that some telephone contacts might represent a disguised need for emotional support. We also assessed satisfaction of CCS personnel with the outcome of telephone contacts. Over a four-day survey period, there were 946 telephone contacts of which 158 (17%) were patient related. First-time telephone contacts were more likely to be spouses or relatives/friends of patients as opposed to non-first-time contacts which were more likely to be patients (P = 0.01). A need for emotional support during telephone contact was more likely to be related to an underlying stressful prompting event for the call (P = 0.002). CCS telephone receptionist personnel were relatively less satisfied that callers' needs were met where emotional support was needed, as opposed to calls for service or information only. The results have implications for the orientation and continuing education of CCS personnel dealing with telephone contacts related to patients.
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Affiliation(s)
- G P Browman
- Hamilton Regional Cancer Centre, McMaster University, Hamilton, Ontario.
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Abstract
We compared the quality-of-life (QOL) dimensions after laryngectomy in patients with advanced larynx or pharynx cancer that were elicited from 20 consecutive laryngectomy patients and 20 health care professionals working in the Regional Head and Neck Oncology Service. Subjects in both groups were asked to identify important QOL items after recovery from laryngectomy and to rank and rate each on a vertical visual analogue scale. Health care professionals ranked impaired communication and self-image/self-esteem as the two most important QOL dimensions, whereas patients ranked the physical consequences of surgery, e.g., tracheal mucous production, and interference with social activities as the two most important items. The results indicate that the responses of health care professionals do not fully correlate with patient priorities. These findings are relevant to researchers developing treatment-specific QOL measures and to health care professionals when presenting treatment options to patients.
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Affiliation(s)
- E A Mohide
- Department of Clinical Epidemiology and Biostatistics, School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Abstract
Analysis of national perinatal statistics from Holland, 1986, demonstrates that for all births after 32 weeks' gestation mortality is much lower under the non-interventionist care of midwives than under the interventionist management of obstetricians at all levels of predicted risk. This finding confirms with great authority the conclusions of all earlier impartial analyses from Britain and other countries which agree in contradicting the claims on which the organisation of maternity services in most developed countries is now based, namely, that childbirth is made so much safer by the application of high technology that only this option should be provided.
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Drummond MF, Mohide EA, Tew M, Streiner DL, Pringle DM, Gilbert JR. Economic evaluation of a support program for caregivers of demented elderly. Int J Technol Assess Health Care 1991; 7:209-19. [PMID: 1907599 DOI: 10.1017/s0266462300005109] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.
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Abstract
A randomized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario. Thirty caregivers were allocated to receive the experimental intervention consisting of: caregiver-focused health care, education about dementia and caregiving, assistance with problem solving, regularly scheduled in-home respite, and a self-help family caregiver support group. Thirty control subjects received conventional community nursing care. Before completion of the intervention, 18 (30%) were withdrawn, almost equally from each group. The most frequent reason was long-term institutionalization of the demented relative (n = 10). At baseline, caregivers in both groups were suffering from above-average levels of depression and anxiety. After the six-month intervention period, we found neither experimental nor control group improved in these areas. However, the experimental group showed a clinically important improvement in quality of life, experienced a slightly longer mean time to long-term institutionalization, found the caregiver role less problematic, and had greater satisfaction with nursing care than the control group.
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Affiliation(s)
- E A Mohide
- McMaster University, Hamilton, Ontario, Canada
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Abstract
We set up a trial to test whether the KT1000 arthrometer would give consistent measurements of anteroposterior laxity when used by the same and different examiners on the knees of the same subjects on the same day. The results showed substantial inter- and intra-examiner variation in the measurements both of absolute displacement in single knees and of side-to-side differences between pairs of knees. This casts doubt on the reliability of the instrument when used to compare the results of different techniques for reconstructing injured cruciate ligaments.
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Affiliation(s)
- I W Forster
- Queen's Medical Centre, University Hospital, Nottingham, England
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Tew M, Forster IW, Wallace WA. Effect of total knee arthroplasty on maximal flexion. Clin Orthop Relat Res 1989:168-74. [PMID: 2791386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The advantage of potential flexion offered by total knee arthroplasty (TKA) is limited. In this review of 724 replaced knees, only one-third flexed to 105 degrees, while nearly one-half did not flex beyond 90 degrees. Postoperative flexion depended partly on preoperative flexion and partly on the prosthesis used, but these factors could not be the only determinants of results, for flexion in individual knees could increase, decrease, or remain unchanged whatever the preoperative measurement and whatever the design of prosthesis. Little difference in flexion before or after TKA was found between rheumatoid and osteoarthritic knees. Success or failure of the implant, according to the crude definition used, was not associated with degree of flexion. Patients with the lowest levels of function tended to have TKA with the least flexion and vice versa. Nevertheless, the degree of flexion is only one of the factors influencing mobility.
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Affiliation(s)
- M Tew
- Department of Orthopaedic and Accident Surgery, University Hospital, Queens Medical Centre, Nottingham, England
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Tew M. Points: From budgets to babies. West J Med 1988. [DOI: 10.1136/bmj.296.6632.1333-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
One of the objectives of knee replacement is to correct flexion deformity, the frequent consequence of rheumatoid arthritis and osteoarthritis. A review of 697 primary and revision replacements carried out between 1969 and 1985 and followed up from 1 to 16 years found that such deformity was present in 61% of knees before the primary operation. Replacement reduced this to 17% and the improvement was usually maintained. The deformity was present in only 21% of the replacements which required revision and the second operation reduced this to 8%. Flexion contractures affected rheumatoid knees more often and more seriously than osteoarthritic knees, but arthroplasty was more successful in correcting the deformity in the former. All of the 11 types of prosthesis used achieved some degree of correction, but the Walldius hinge and the variants of the Freeman condylar design were the most successful. Surprisingly, the best outcome, in terms of pain and reduced need for revision, was found in the rheumatoid knees most seriously deformed before operation, but this association was absent in the osteoarthritic knees. Postoperative deformity in knees without pain or extreme weakness did not appear to influence the patients' ability to walk or to use stairs or a chair, as measured by unexacting tests in the clinic.
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Tew M. Place of birth and perinatal delivery. J R Coll Gen Pract 1986; 36:84-5. [PMID: 3712340 PMCID: PMC1960390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Tew M. Home births. 'We have the technology'. Nurs Times 1985; 81:22-4. [PMID: 3852280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Tew M, Waugh W, Forster IW. Comparing the results of different types of knee replacement. A method proposed and applied. J Bone Joint Surg Br 1985; 67:775-9. [PMID: 4055880 DOI: 10.1302/0301-620x.67b5.4055880] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many knee replacement prostheses, embodying various principles of design, are now available and there is need for a method by which valid comparisons of results can be made. An important criterion of success is durability, so the length of time the prostheses have been in situ must be taken into account. Such a method is proposed here and is applied to the results of 673 knee replacements, of nine different types, implanted at the same hospital between 1970 and 1983. A prosthesis was considered to have failed if it had been removed or persistently caused severe pain. Two types of prosthesis were found to be significantly less successful than the other seven, between which none consistently showed significant superiority. Results for the seven types were similar despite the facts that they had been used for knees with different degrees of damage, some as secondary implants, and that they were of different design and at different stages of technical development. The more recently introduced types of prosthesis, designed to have theoretical advantages, were found in practice to be no more successful than the models they superseded.
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Abstract
We examine the hypothesis that a knee replacement is most likely to survive successfully if it is stable with a coronal tibiofemoral angle close to 7 degrees of valgus, the accepted normal. The records of 428 knee replacements followed up for one to nine years were analysed. The highest success rate was indeed found in those so aligned at operation and such knees were most likely to remain stable. Nevertheless, half of the failures occurred in knees correctly aligned at operation and two-fifths in knees which had remained stable in this alignment; many failures must have been caused by factors other than malalignment. Some knees, well aligned at operation, deteriorated into severely varus or valgus positions; their failure rate was significantly higher than that for knees which remained normally aligned and higher also than for knees severely varus or valgus from operation onwards. Malalignment, in itself, may not be the most important cause of failure, though it probably does compound failure from other causes.
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Tew M. Their lives in whose hands? Health Soc Serv J 1983; 93:1284-5. [PMID: 10263804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
A method of analysing the results of knee replacement operations, which makes it possible to estimate the annual failure rate and the proportion of implants which will survive successfully for 10 years, is applied to the post-operative data for 365 operations, using Freeman, Sheehan and Manchester prostheses, carried out from 1972 to 1980 at Harlow Wood Orthopaedic Hospital. Two criteria of success are defined. On both, and for all prostheses, the annual failure rate is found to be much lower in the first two than in the later years. Thus, account must be taken of the period since operation if the success of different prostheses is to be validly compared. This is not possible using conventional statistical methods. But significant trends in annual failure rates and significant differences between prostheses can only be identified from samples larger than are usually available in individual series. Hence it will be necessary for many centres to co-operate in pooling results if reliable conclusions are to be reached and valid comparisons made.
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