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Okafor CE, Keramat SA, Comans T, Page AT, Potter K, Hilmer SN, Lindley RI, Mangin D, Naganathan V, Etherton-Beer C. Cost-Consequence Analysis of Deprescribing to Optimize Health Outcomes for Frail Older People: A Within-Trial Analysis. J Am Med Dir Assoc 2024; 25:539-544.e2. [PMID: 38307120 DOI: 10.1016/j.jamda.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES The structured, clinically supervised withdrawal of medicines, known as deprescribing, is one strategy to address inappropriate polypharmacy. This study aimed to evaluate the costs and consequences of deprescribing in frail older people living in residential aged care facilities (RACFs) in Australia. DESIGN A within-trial cost-consequence analysis of a deprescribing intervention-Opti-Med. The Opti-Med double-blind randomized controlled trial of deprescribing included 3 groups: blinded control, blinded intervention, and an open intervention group. SETTING AND PARTICIPANTS Seventeen RACFs in Western Australia and New South Wales. Participants were 303 older people living in participating RACFs from March 2014 to February 2019. METHODS Analysis was conducted from the health sector perspective. Health economic outcomes assessed include cost saved from deprescribed medicines and the incremental quality-adjusted life-years. Costs were presented in 2022 Australian dollars. RESULTS The total cost of the Opti-Med intervention was $239.13 per participant. The costs saved through deprescribed medicines over 12 months after adjusting for mortality within the trial period was $328.90 per participant in the blinded intervention group and $164.00 per participant in the open intervention group. On average, the cost of the intervention was more than offset by the cost saved from deprescribed medicines. Extrapolating these findings to the Australian population suggests a potential net cost saving of about $1 to $16 million per annum for the health system nationally. The incremental quality-adjusted life-years were very similar across the 3 groups within the trial period. CONCLUSIONS AND IMPLICATIONS Deprescribing for frail older people living in RACFs can be a cost-saving intervention without reducing the quality of life. Systemwide implementation of deprescribing across RACFs in Australia has the potential to improve health care delivery through the cost savings, which could be reapplied to further optimize care within RACFs.
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Affiliation(s)
- Charles E Okafor
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Amy T Page
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | | | - Sarah N Hilmer
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Kolling Institute, Northern Sydney Local Health District and The University of Sydney, St Leonards, New South Wales, Australia
| | - Richard I Lindley
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; The George Institute for Global Health, Barangaroo, Sydney, New South Wales, Australia
| | - Dee Mangin
- McMaster University, Hamilton, Ontario, Canada; University of Otago, Christchurch Central City, Christchurch, New Zealand
| | - Vasi Naganathan
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Department of Geriatric Medicine, Centre of Education and Research in Ageing, Concord Repatriation Hospital, New South Wales, Australia
| | - Christopher Etherton-Beer
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
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Hernando-Calvo A, Nguyen P, Bedard PL, Chan KK, Saleh RR, Weymann D, Yu C, Amir E, Regier DA, Gyawali B, Kain D, Wilson B, Earle CC, Mittmann N, Abdul Razak AR, Isaranuwatchai W, Sabatini P, Spreafico A, Stockley TL, Pugh TJ, Williams C, Siu LL, Hanna TP. Impact on costs and outcomes of multi-gene panel testing for advanced solid malignancies: a cost-consequence analysis using linked administrative data. EClinicalMedicine 2024; 69:102443. [PMID: 38380071 PMCID: PMC10876574 DOI: 10.1016/j.eclinm.2024.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
Background To date, economic analyses of tissue-based next generation sequencing genomic profiling (NGS) for advanced solid tumors have typically required models with assumptions, with little real-world evidence on overall survival (OS), clinical trial enrollment or end-of-life quality of care. Methods Cost consequence analysis of NGS testing (555 or 161-gene panels) for advanced solid tumors through the OCTANE clinical trial (NCT02906943). This is a longitudinal, propensity score-matched retrospective cohort study in Ontario, Canada using linked administrative data. Patients enrolled in OCTANE at Princess Margaret Cancer Centre from August 2016 until March 2019 were matched with contemporary patients without large gene panel testing from across Ontario not enrolled in OCTANE. Patients were matched according to 19 patient, disease and treatment variables. Full 2-year follow-up data was available. Sensitivity analyses considered alternative matched cohorts. Main Outcomes were mean per capita costs (2019 Canadian dollars) from a public payer's perspective, OS, clinical trial enrollment and end-of-life quality metrics. Findings There were 782 OCTANE patients with 782 matched controls. Variables were balanced after matching (standardized difference <0.10). There were higher mean health-care costs with OCTANE ($79,702 vs. $59,550), mainly due to outpatient and specialist visits. Publicly funded drug costs were less with OCTANE ($20,015 vs. $24,465). OCTANE enrollment was not associated with improved OS (restricted mean survival time [standard error]: 1.50 (±0.03) vs. 1.44 (±0.03) years, log-rank p = 0.153), varying by tumor type. In five tumor types with ≥35 OCTANE patients, OS was similar in three (breast, colon, uterus, all p > 0.40), and greater in two (ovary, biliary, both p < 0.05). OCTANE was associated with greater clinical trial enrollment (25.4% vs. 9.5%, p < 0.001) and better end-of-life quality due to less death in hospital (10.2% vs. 16.4%, p = 0.003). Results were robust in sensitivity analysis. Interpretation We found an increase in healthcare costs associated with multi-gene panel testing for advanced cancer treatment. The impact on OS was not significant, but varied across tumor types. OCTANE was associated with greater trial enrollment, lower publicly funded drug costs and fewer in-hospital deaths suggesting important considerations in determining the value of NGS panel testing for advanced cancers. Funding T.P H holds a research grant provided by the Ontario Institute for Cancer Research through funding provided by the Government of Ontario (#IA-035 and P.HSR.158) and through funding of the Canadian Network for Learning Healthcare Systems and Cost-Effective 'Omics Innovation (CLEO) via Genome Canada (G05CHS).
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Affiliation(s)
- Alberto Hernando-Calvo
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Nguyen
- ICES Queen's. Queen's University, Kingston, ON, Canada
| | - Philippe L. Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelvin K.W. Chan
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Ramy R. Saleh
- Department of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Celeste Yu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dean A. Regier
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Danielle Kain
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Brooke Wilson
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Craig C. Earle
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nicole Mittmann
- Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Albiruni R. Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- St. Michael's Hospital Centre for Excellence in Economic Analysis Research, University of Toronto, Toronto, ON, Canada
| | - Peter Sabatini
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tracy L. Stockley
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Trevor J. Pugh
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | | | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy P. Hanna
- ICES Queen's. Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
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Bulamu NB, Kaambwa B, Beks H, Versace VL, Clark RA. Health economics in nursing research: what you need to know to include economic evaluation methodology in your research. Eur J Cardiovasc Nurs 2024; 23:99-106. [PMID: 38170820 DOI: 10.1093/eurjcn/zvad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024]
Abstract
Due to limited resources and constant, ever-changing healthcare challenges, health economics is essential to support healthcare decisions while improving health outcomes. Economic evaluation methodology facilitates informed decision-making related to the efficient allocation of resources while positively impacting clinical practice. In this paper, we provide an overview of economic evaluation methods and a real-world example applying one method of economic evaluation (cost-utility analysis) in nursing research.
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Affiliation(s)
- Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
| | - Hannah Beks
- Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - Vincent L Versace
- Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - Robyn A Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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Sworn K, Poku E, Thokala P, Sutton A, Foster S, Siddall I, Reuter H. Effectiveness of iodine-impregnated incise drapes for preventing surgical site infection in patients with clean or clean contaminated wounds: A systematic literature review and cost-consequence analysis. J Perioper Pract 2023; 33:368-379. [PMID: 36705002 PMCID: PMC10693728 DOI: 10.1177/17504589221139603] [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] [Accepted: 10/23/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Surgical site infection is a serious complication associated with significant morbidity, mortality and health care expenditure. AIMS To determine the clinical effectiveness and economic impact of using iodine-impregnated incise drapes for preventing surgical site infection. METHODS MEDLINE, Embase, Cochrane Library and CINAHL databases were systematically searched. Critical appraisal and synthesis of clinical evidence informed a decision analytical cost-consequence model. FINDINGS Nine studies were included in the systematic literature review. Evidence from cardiac surgery patients was considered appropriate to inform the cost analysis. The economic model evaluation estimated cost savings of £549 per patient with the iodophor-impregnated drape in the deterministic analysis and a mean cost saving per patient of £554,172 per 1000 in the probabilistic analysis. CONCLUSION Using iodine-impregnated drapes in cardiac surgery patients may effectively reduce infections and provide cost-savings, but further research is required.
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Affiliation(s)
- Katie Sworn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Edith Poku
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Henning Reuter
- Medical Solutions Division, 3M Deutschland GmbH, Neuss, Germany
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Zambelli A, Cazzaniga M, La Verde N, Munzone E, Antonazzo IC, Mantovani LG, Di Cosimo S, Mancuso A, Generali D, Cortesi PA. A cost-consequence analysis of adding pertuzumab to the neoadjuvant combination therapy in HER2-positive high-risk early breast cancer in Italy. Breast 2023; 71:113-121. [PMID: 37573652 PMCID: PMC10428118 DOI: 10.1016/j.breast.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Clinical trials confirmed the beneficial effects of adding pertuzumab (P) to the combination of trastuzumab-chemotherapy (TC) in the (neo)adjuvant setting of high-risk HER2-positive early breast cancer (HER2+BC). We evaluated the clinical, economic and societal impact of adding pertuzumab to neoadjuvant TC combination (TPC) in Italy. METHODS A cost-consequence analysis comparing TPC vs. TC was performed developing a cohort-based multi-state Markov model to estimate the clinical, societal and economic impact of the neoadjuvant therapy of TPC versus TC in HER2+BC at high-risk of recurrence. The model works on a cycle length of 1 month and 5-years-time horizon. Literature review-based data were used to populate the model. The following clinical and economic outcomes were estimated: cumulative incidence of loco-regional/distant recurrences, life of years and QALY and both direct and indirect costs (€). Finally, sensitivity analyses were performed. RESULTS TPC was associated with a 75,630 € saved of direct costs. Specifically, it was associated with an initial increase of treatment costs (+4.8%) followed by reduction of recurrence management cost (-20.4%). TPC was also associated with an indirect cost reduction of 1.40%, as well as decreased incidence of distant recurrence (-20.14%), days of work lost (-1.53%) and days lived with disability (-0.50%). Furthermore, TPC reported 10,47 QALY gained (+2.77%) compared to TC. The probability to achieve the pathological complete response (pCR) was the parameter that mostly affected the results in the sensitivity analysis. CONCLUSION Our findings suggested that TPC combination could be a cost-saving option in patients with HER2+BC at high-risk of recurrence.
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Affiliation(s)
- Alberto Zambelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marina Cazzaniga
- Phase 1 Research Centre, ASST-Monza (MB), 20900, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Nicla La Verde
- Department of Oncology, Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Serena Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy; Multidisciplinary Unit of Breast Pathology and Translational Research, ASST of Cremona Hospital, 26100, Cremona, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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Scobie S, Jowett S, Lambe T, Patel S, Woolley R, Ives N, Rick C, Smith C, Brady MC, Clarke C, Sackley C. Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: preliminary cost-consequence analysis of the PD COMM pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:154. [PMID: 34372913 PMCID: PMC8351093 DOI: 10.1186/s40814-021-00888-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PD COMM pilot randomised controlled trial compared Lee Silverman Voice Treatment (LSVT® LOUD) with standard NHS speech and language therapy (SLT) and a control arm in people with Parkinson's disease (PwPD) with self-reported problems with voice or speech. This analysis compares costs and quality of life outcomes between the trial arms, and considers the validity of the alternative outcome measures for economic evaluations. METHODS A comparison of costs and outcomes was undertaken alongside the PD COMM pilot trial involving three arms: LSVT® LOUD treatment (n = 30); standard NHS SLT (n = 30); and a control arm (n = 29) excluded from receiving therapy for at least 6 months after randomisation unless deemed medically necessary. For all trial arms, resource use and NHS, social care and patient costs and quality of life were collected prospectively at baseline, 3, 6, and 12 months. Total economic costs and outcomes (EQ-5D-3L, ICECAP-O) were considered over the 12-month follow-up period from an NHS payer perspective. Quality of life measures for economic evaluation of SLT for people with Parkinson's disease were compared. RESULTS Whilst there was no difference between arms in voice or quality of life outcomes at 12 months, there were indications of differences at 3 months in favour of SLT, which need to be confirmed in the main trial. The estimated mean cost of NHS care was £3288 per patient per year for the LSVT® LOUD arm, £2033 for NHS SLT, and £1788 for the control arm. EQ-5D-3L was more strongly correlated to voice impairment than ICECAP-O, and was sensitive to differences in voice impairment between arms. CONCLUSIONS The pilot did not identify an effect of SLT on disease-specific or economic outcomes for PwPD at 12 months; however, there appeared to be improvements at 3 months. In addition to the sample size not powered to detect difference in cost-consequence analysis, many patients in the control arm started SLT during the 12-month period used for economic analysis, in line with the study protocol. The LSVT® LOUD intervention was more intense and therefore more costly. Early indications suggest that the preferred economic outcome measure for the full trial is EQ-5D-3L; however, the ICECAP-O should still be included to capture a broader measure of wellbeing. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. Registered 22 March 2012.
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Affiliation(s)
- Sarah Scobie
- Nuffield, Trust, London, UK.,Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Tosin Lambe
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Smitaa Patel
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Caroline Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Christina Smith
- Psychology and Language Science, University College London, London, UK
| | - Marion C Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Carl Clarke
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK.,Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Cath Sackley
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Jeong S, Ohr SO, Cleasby P, Barrett T, Davey R, Deeming S. A cost-consequence analysis of normalised advance care planning practices among people with chronic diseases in hospital and community settings. BMC Health Serv Res 2021; 21:729. [PMID: 34301254 PMCID: PMC8305493 DOI: 10.1186/s12913-021-06749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of international literature concurs that comprehensive and complex Advance Care Planning (ACP) programs involving specially qualified or trained healthcare professionals are effective in increasing documentation of Advance Care Directives (ACDs), improving compliance with patients' wishes and satisfaction with care, and quality of care for patients and their families. Economic analyses of ACDs and ACP have been more sporadic and inconclusive. This study aimed to contribute to the evidence on resource use associated with implementation of ACP and to inform key decision-makers of the resource implications through the conduct of a cost-consequence analysis of the Normalised Advance Care Planning (NACP) trial. METHODS The outcomes for the economic evaluation included the number of completed "legally binding" ACDs and the number of completed Conversation Cards (CC). The cost analysis assessed the incremental difference in resource utilisation between Usual Practice and the Intervention. Costs have been categorised into: 1) Contract staff costs; 2) Costs associated with the development of the intervention; 3) Implementation costs; 4) Intervention (delivery) costs; and 5) Research costs. RESULTS The cost incurred for each completed ACD was A$13,980 in the hospital setting and A$1248 in the community setting. The cost incurred for each completed Conversation Card was A$7528 in the hospital setting and A$910 in the community setting. CONCLUSIONS The cost-consequence analysis does not support generalisation of the specified intervention within the hospital setting. The trial realised an estimated incremental cost per completed ACD of $1248, within the community setting. This estimate provides an additional benchmark against which decision-makers can assess the value of either 1) this approach towards the realisation of additional completed ACDs; and/or 2) the value of ACP and ACDs more broadly, when this estimate is positioned within the potential health outcomes and downstream health service implications that may arise for people with or without a completed ACD. TRIAL REGISTRATION The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). The URL of the trial registry record.
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Affiliation(s)
- Sarah Jeong
- School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
| | - Se Ok Ohr
- School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
- Hunter New England Nursing and Midwifery Research Centre, Hunter New England Local Health District, James Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW 2300 Australia
| | - Peter Cleasby
- Division of Aged, Subacute and Complex Care, PO Box 6088 Long Jetty, Central Coast Local Health District, NSW 2261 Gosford, Australia
| | - Tomiko Barrett
- Department of Aged Care Services, Wyong Hospital, PO Box 4200, Lakehaven, Central Coast Local Health District, Wyong, NSW 2263 Australia
| | - Ryan Davey
- School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
| | - Simon Deeming
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305 Australia
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Hambleton A, Le Grange D, Miskovic-Wheatley J, Touyz S, Cunich M, Maguire S. Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine. J Eat Disord 2020; 8:50. [PMID: 33052259 PMCID: PMC7544521 DOI: 10.1186/s40337-020-00328-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with Anorexia Nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic, temporal and human factors, rendering it particularly susceptible to inequities and disruption. This has resulted in poorer service provision for rural and regional families, and recently a significant challenge to providing face-to-face services during the COVID-19 global pandemic. The present study examines whether FBT for AN can be successfully translated to a digital delivery platform to address these access issues. METHOD Forty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN, and live in a rural or regional setting, will along with their family be recruited to the study. Trained therapists will provide 18 sessions of FBT over 9 months via telemedicine to the home of the young person and their family. The analysis will examine treatment effectiveness, feasibility, acceptability, and cost-effectiveness. DISCUSSION The study addresses the treatment needs of families not able to attend face-to-face clinical services for evidence-based treatment for eating disorders. This might be due to several barriers, including a lack of local services or long travel distances to services. There has been a recent and unprecedented demand for telemedicine to facilitate the continuity of care during COVID-19 despite geographical circumstances. If delivering treatment in this modality is clinically and economically effective and feasible, it will facilitate access to potentially lifesaving, evidence-based treatments for families formerly unable to access such care and provide evidence for the continuity of services when and where face-to-face treatment is not feasible.
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Affiliation(s)
- A. Hambleton
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - D. Le Grange
- UCSF Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, San Francisco, California USA
| | - J. Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - S. Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - M. Cunich
- The Boden Collaboration for Obesity, Nutrition & Eating Disorders, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW Australia
| | - S. Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, St Leonards, Australia
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Bell K, Corbacho B, Ronaldson S, Richardson G, Hood K, Sanders J, Robling M, Torgerson D. Costs and consequences of the Family Nurse Partnership (FNP) programme in England: evidence from the Building Blocks trial. F1000Res 2019; 8:1640. [PMID: 31632654 PMCID: PMC6784875 DOI: 10.12688/f1000research.20149.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The Family Nurse Partnership (FNP) is a licensed intensive home visiting intervention programme delivered to teenage mothers which was originally introduced in England in 2006 by the Department of Health and is now provided through local commissioning of public health services and supported by a national unit led by a consortium of partners. The Building Blocks (BB) trial aimed to explore the effectiveness and cost-effectiveness of this programme. This paper reports the results of an economic evaluation of the Building Blocks randomised controlled trial (RCT) based on a cost-consequence approach. Methods: A large sample of 1618 families was followed-up at various intervals during pregnancy and for two years after birth. A cost-consequence approach was taken to appraise the full range of costs arising from the intervention including both health and social measures of cost alongside the consequences of the trial, specifically, the primary outcomes. Results: A large number of potential factors were identified that are likely to attract additional costs beyond the implementation costs of the intervention including both health and non-health outcomes. Conclusion: Given the extensive costs and only small beneficial consequences observed within the two year follow-up period, the cost-consequence model suggests that the FNP intervention is unlikely to be worth the substantial costs and policy makers may wish to consider other options for investment. Trial registration:
ISRCTN23019866 (20/04/2009)
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Affiliation(s)
- Kerry Bell
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Belen Corbacho
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Sarah Ronaldson
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, UK, York, North Yorkshire, YO10 5DD, UK
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, CF14 4XN, UK
| | - Michael Robling
- Population Health Trials, Cardiff University, Cardiff, CF14 4ER, UK
| | - David Torgerson
- Health Sciences, University of York, UK, York, North Yorkshire, YO10 5DD, UK
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10
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Haghparast-Bidgoli H, Skordis J, Harris-Fry H, Krishnan S, O'Hearn M, Kumar A, Pradhan R, Mishra NK, Upadhyay A, Pradhan S, Ojha AK, Cunningham S, Rath S, Palmer T, Koniz-Booher P, Kadiyala S. Protocol for the cost-consequence and equity impact analyses of a cluster randomised controlled trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child dietary diversity and nutritional status in rural Odisha, India (UPAVAN trial). Trials 2019; 20:287. [PMID: 31133067 PMCID: PMC6537168 DOI: 10.1186/s13063-019-3388-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background Undernutrition causes around 3.1 million child deaths annually, around 45% of all child deaths. India has one of the highest proportions of maternal and child undernutrition globally. To accelerate reductions in undernutrition, nutrition-specific interventions need to be coupled with nutrition-sensitive programmes that tackle the underlying causes of undernutrition. This paper describes the planned economic evaluation of the UPAVAN trial, a four-arm, cluster randomised controlled trial that tests the nutritional and agricultural impacts of an innovative agriculture extension platform of women’s groups viewing videos on nutrition-sensitive agriculture practices, coupled with a nutrition-specific behaviour-change intervention of videos on nutrition, and a participatory learning and action approach. Methods The economic evaluation of the UPAVAN interventions will be conducted from a societal perspective, taking into account all costs incurred by the implementing agency (programme costs), community and health care providers, and participants and their households, and all measurable outcomes associated with the interventions. All direct and indirect costs, including time costs and donated goods, will be estimated. The economic evaluation will take the form of a cost-consequence analysis, comparing incremental costs and incremental changes in the outcomes of the interventions, compared with the status quo. Robustness of the results will be assessed through a series of sensitivity analyses. In addition, an analysis of the equity impact of the interventions will be conducted. Discussion Evidence on the cost and cost-effectiveness of nutrition-sensitive agriculture interventions is scarce. This limits understanding of the costs of rolling out or scaling up programs. The findings of this economic evaluation will provide useful information for different multisectoral stakeholders involved in the planning and implementation of nutrition-sensitive agriculture programmes. Trial registration ISRCTN65922679. Registered on 21 December 2016 Electronic supplementary material The online version of this article (10.1186/s13063-019-3388-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jolene Skordis
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Harris-Fry
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| | - Sneha Krishnan
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
| | - Meghan O'Hearn
- Tufts University, Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA, 02111, USA
| | - Abhinav Kumar
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Ronali Pradhan
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Naba Kishore Mishra
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Odisha, 754224, India
| | - Avinash Upadhyay
- Digital Green, S-26 to 28, 3rd Floor, Green Park Extension Market, New Delhi, 110016, India
| | - Shibananth Pradhan
- VARRAT (Voluntary Association for Rural Reconstruction and Appropriate Technology), Boulakani Baradang, Mahakalpara Kendrapad, Odisha, 754224, India
| | - Amit Kumar Ojha
- Ekjut, 556 B-Ward No 17-Potka, Chakradharpur, Jharkhand, 833102, India
| | - Sarah Cunningham
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115,, USA
| | - Shibanand Rath
- Ekjut, 556 B-Ward No 17-Potka, Chakradharpur, Jharkhand, 833102, India
| | - Tom Palmer
- University College London, Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Peggy Koniz-Booher
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally, JSI Research and Training Institute, Inc., 1616 Fort Myer Drive 16th Floor, Arlington, VA, 22209, USA
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT,, UK
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11
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Dong P, Hu H, Guan X, Ung COL, Shi L, Han S, Yu S. Cost-consequence analysis of salvianolate injection for the treatment of coronary heart disease. Chin Med 2018; 13:28. [PMID: 29946348 PMCID: PMC6000959 DOI: 10.1186/s13020-018-0185-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/27/2018] [Indexed: 01/07/2023] Open
Abstract
Background Complicated with the impact of aging population and urbanization, coronary heart disease (CHD) incurs more and more disease burdens in China. Salvianolate injection is a Chinese patent drug widely used for treating CHD in China. A series of studies have verified the efficacy of salvianolate injection
, but the high drug cost has raised concerns. It is, therefore, important to conduct cost-consequence analysis to demonstrate whether salvianolate injection is associated with outcome improvement and cost containment. The aim of this study was to retrospectively evaluate the cost-consequence of salvianolate injection for the treatment of coronary heart disease by combining salvianolate injection with conventional treatment from a societal perspective. Methods We retrospectively studied hospitalized patients with CHD from August 2011 to December 2015 by using electronic medical record database. Patients who received salvianolate injection combined with conventional treatment were selected as exposed group, while those who received conventional treatment alone were selected as unexposed group. Propensity score matching (PSM) analysis was used to balance the characteristics of patients. After PSM, we evaluated hospital stay, total nitrates dosage, total medical costs, and subcategories costs. Patients with chronic ischemic heart disease were analyzed as a highly selected subcohort. Results For the overall group, hospital stay was significantly decreased by 2.9 days (P < 0.05) and total nitrates dosage was significantly decreased by 172.4 mg (P < 0.05) in exposed group; cost savings of pharmacy cost, examination cost, laboratory cost, operation cost and treatment was observed as significant (at P < 0.05); and the additional expenditure of Chinese patent drug (1174.9 CNY) was less than the saving of total medical costs (2636.4 CNY). For chronic ischemic heart disease subcohort, compared with unexposed group, significant decreases were also found in hospital stay and total nitrates dosage (P < 0.05); cost savings were significant (P < 0.05) for exposed group in terms of total medical costs (4339.5 CNY) and subcategories costs (including pharmacy cost, examination cost, operation cost and treatment cost); and the additional expenditure of Chinese patent drug (1189.3 CNY) was less than the saving of total medical costs. Conclusion Compared with conventional treatment for the treatment of CHD, combination of salvianolate injection and conventional treatment was associated with a reduction in hospital stay and total nitrates dosage. The acquisition cost of Chinese patent drug (including salvianolate injection) was offset by a higher reduction in total medical costs, especially for chronic ischemic heart disease. Electronic supplementary material The online version of this article (10.1186/s13020-018-0185-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pengxin Dong
- 1School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong China.,2International Research Center of Medical Administration, Peking University, Beijing, China
| | - Hao Hu
- 3State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Xiaodong Guan
- 4School of Pharmaceutical Science, Peking University Health Science Center, Beijing, China
| | - Carolina Oi Lam Ung
- 3State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Luwen Shi
- 2International Research Center of Medical Administration, Peking University, Beijing, China.,4School of Pharmaceutical Science, Peking University Health Science Center, Beijing, China
| | - Sheng Han
- 2International Research Center of Medical Administration, Peking University, Beijing, China
| | - Shuwen Yu
- 1School of Pharmaceutical Sciences, Shandong University, Jinan, Shandong China.,5Shandong University Affiliated Jinan Central Hospital, Jinan, Shandong China
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12
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Lelijveld N, Bailey J, Mayberry A, Trenouth L, N’Diaye DS, Haghparast-Bidgoli H, Puett C. The "ComPAS Trial" combined treatment model for acute malnutrition: study protocol for the economic evaluation. Trials 2018; 19:252. [PMID: 29690899 PMCID: PMC5916722 DOI: 10.1186/s13063-018-2594-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute malnutrition is currently divided into severe (SAM) and moderate (MAM) based on level of wasting. SAM and MAM currently have separate treatment protocols and products, managed by separate international agencies. For SAM, the dose of treatment is allocated by the child's weight. A combined and simplified protocol for SAM and MAM, with a standardised dose of ready-to-use therapeutic food (RUTF), is being trialled for non-inferior recovery rates and may be more cost-effective than the current standard protocols for treating SAM and MAM. METHOD This is the protocol for the economic evaluation of the ComPAS trial, a cluster-randomised controlled, non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current standard protocol in South Sudan and Kenya. We will calculate the total economic costs of both protocols from a societal perspective, using accounting data, interviews and survey questionnaires. The incremental cost of implementing the combined protocol will be estimated, and all costs and outcomes will be presented as a cost-consequence analysis. Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome, if statistically significant. DISCUSSION We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level, reduced length of treatment, especially for MAM, and reduced dosages of RUTF. The findings of this economic evaluation will be important for policymakers, especially given the hypothesised non-inferiority of the main health outcomes. The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis. It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies, especially for MAM, and improve comparability with other studies. TRIAL REGISTRATION ISRCTN 30393230 , date: 16/03/2017.
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Affiliation(s)
- Natasha Lelijveld
- No Wasted Lives, Action Against Hunger UK, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanette Bailey
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- International Rescue Committee, New York, NY USA
| | - Amy Mayberry
- No Wasted Lives, Action Against Hunger UK, London, UK
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13
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Bray N, Burns P, Jones A, Winrow E, Edwards RT. Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis. Int J Public Health 2017; 62:1039-1050. [PMID: 28612100 PMCID: PMC5668333 DOI: 10.1007/s00038-017-0989-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing. Methods An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards. Results Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (−£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p < 0.001; p = 0.009, respectively), main tenant satisfaction with financial situation (p = 0.020), number of rooms left unheated per household (p < 0.001), frequency of household outpatient appointments (p = 0.001), and accident/emergency department attendance (p < 0.012). Conclusions Warmth-related housing improvements may be a cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.
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Affiliation(s)
- Nathan Bray
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Hall, Bangor, Gwynedd, LL57 2PZ, UK.
| | - Paul Burns
- Socially Sustainable Ltd., Sunderland, UK
| | - Alice Jones
- Alice Jones Impact Consulting Ltd., Nottingham, UK
| | - Eira Winrow
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Hall, Bangor, Gwynedd, LL57 2PZ, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Hall, Bangor, Gwynedd, LL57 2PZ, UK
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14
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Weijers L, Baerwald C, Mennini FS, Rodríguez-Heredia JM, Bergman MJ, Choquette D, Herrmann KH, Attinà G, Nappi C, Merino SJ, Patel C, Mtibaa M, Foo J. Cost per response for abatacept versus adalimumab in rheumatoid arthritis by ACPA subgroups in Germany, Italy, Spain, US and Canada. Rheumatol Int 2017; 37:1111-1123. [PMID: 28560470 PMCID: PMC5486786 DOI: 10.1007/s00296-017-3739-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/10/2017] [Indexed: 01/22/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disorder leading to disability and reduced quality of life. Effective treatment with biologic DMARDs poses a significant economic burden. The Abatacept versus Adalimumab Comparison in Biologic-Naïve RA Subjects with Background Methotrexate (AMPLE) trial was a head-to-head, randomized study comparing abatacept in serum anti-citrullinated protein antibody (ACPA)-positive patients, with increasing efficacy across ACPA quartile levels. The aim of this study was to evaluate the cost per response accrued using abatacept versus adalimumab in ACPA-positive and ACPA-negative patients with RA from the health care perspective in Germany, Italy, Spain, the US and Canada. A cost-consequence analysis (CCA) was designed to compare the monthly costs per responding patient/patient in remission. Efficacy, safety and resource use inputs were based on the AMPLE trial. A one-way deterministic sensitivity analysis (OWSA) was also performed to assess the impact of model inputs on the results for total incremental costs. Cost per response in ACPA-positive patients favoured abatacept compared with adalimumab (ACR20, ACR90 and HAQ-DI). Subgroup analysis favoured abatacept with increasing stringency of response criteria and serum ACPA levels. Cost per remission (DAS28-CRP) favoured abatacept in ACPA-negative patients, while cost per CDAI and SDAI favoured abatacept in ACPA-positive patients. Abatacept was consistently favoured in ACPA-Q4 patients across all outcomes and countries. Cost savings were greater with abatacept when more stringent response criteria were applied and also with increasing ACPA levels, which could lead to a lower overall health care budget impact with abatacept compared with adalimumab.
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Affiliation(s)
- Laure Weijers
- Real World Strategy and Analytics, Mapi Group, Houten, The Netherlands.
| | - Christoph Baerwald
- Department of Internal Medicine, Rheumatology Unit, University Hospital, Leipzig, Germany
| | - Francesco S Mennini
- EEHTA-CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Rome Italy and Institute of Leadership and Management in Health, Kingston University, London, UK
| | | | | | - Denis Choquette
- Institut de Rhumatologie de Montréal, University of Montreal, Quebec, Canada
| | | | | | | | | | - Chad Patel
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Jason Foo
- Real World Strategy and Analytics, Mapi Group, Houten, The Netherlands
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15
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Ylijoki-Sørensen S, Boldsen JL, Lalu K, Sajantila A, Baandrup U, Boel LWT, Ehlers LH, Bøggild H. Cost-consequence analysis of cause of death investigation in Finland and in Denmark. Forensic Sci Int 2014; 245:133-42. [PMID: 25447186 DOI: 10.1016/j.forsciint.2014.10.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
The 1990s 12-16% total autopsy rate in Denmark has until now declined to 4%, while in Finland, it has remained between 25 and 30%. The decision to proceed with a forensic autopsy is based on national legislation, but it can be assumed that the financing of autopsies influences the decision process. Only little is known about the possible differences between health economics of Finnish and Danish cause of death investigation systems. The aims of this article were to analyse costs and consequences of Finnish and Danish cause of death investigations, and to develop an alternative autopsy practice in Denmark with another cost profile. Data on cause of death investigation systems and costs were derived from Departments of Forensic Medicine, Departments of Pathology, and the National Police. Finnish and Danish autopsy rates were calculated in unnatural (accident, suicide, homicide and undetermined intent) and natural (disease) deaths, and used to develop an alternative autopsy practice in Denmark. Consequences for society were analysed. The estimated unit cost (€) for one forensic autopsy is 3.2 times lower in Finland than in Denmark (€1400 versus €4420), but in Finland the salaries for forensic pathologists working at the National Institute for Health and Welfare are not included in the unit cost. The unit cost for one medical autopsy is also lower in Finland than in Denmark; €700 versus €1070. In our alternative practice in Denmark, the forensic autopsy rate was increased from 2.2% to 8.5%, and the medical autopsy rate from 2.4% to 5.8%. Costs per 10,000 deaths were estimated to be 50% (±25%) higher than now; i.e. €3,678,724 (2,759,112-4,598,336), but would result in a lower unit cost for forensic autopsies €3,094 (2,320-3,868) and for medical autopsies €749 (562-936). This practice would produce a higher accuracy of national mortality statistics, which, consequently, would entail higher quality in public health, an accurate basis for decision-making in health politics, and better legislative safety in society. The implementation of this alternative practice in Denmark requires that legislation demands that forensic autopsy be performed if causality between unnatural death and cause of death cannot be clarified or if cause of death remains unknown. The Danish Health and Medicines Authority should provide guidelines that request a medical autopsy in natural deaths where more information about disease as a cause of death is needed. Our study results warrant similar health economic analyses of different cause of death investigations in other countries.
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Affiliation(s)
- Seija Ylijoki-Sørensen
- Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
| | - Jesper Lier Boldsen
- ADBOU, Institute of Forensic Medicine, University of Southern Denmark, Lucernemarken 20, 5260 Odense S, Denmark.
| | - Kaisa Lalu
- National Institute for Health and Welfare, Forensic Medicine Unit, Helsinki Kytösuontie 11, 00300 Helsinki, Finland.
| | - Antti Sajantila
- Department of Forensic Medicine, Hjelt Institute, Helsinki University, Kytösuontie 11, 00014 Helsinki, Finland, and Institute of Applied Genetics, Department of Molecular and Medical Genetics, University of North Texas Health Science Center, Ft. Worth, Texas, USA.
| | - Ulrik Baandrup
- Centre for Clinical Research, Vendsyssel Hospital/Faculty of Medicine, Aalborg University, Bispensgade 37, 9800 Hjørring, Denmark.
| | - Lene Warner Thorup Boel
- Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
| | - Lars Holger Ehlers
- Department of Business and Management, Danish Center for Healthcare Improvements, Faculty of Social Sciences, Aalborg University, Fibigerstræde 11, Room 73, 9220 Aalborg, Denmark.
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 3-209, 9220 Aalborg, Denmark.
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16
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Cebrià I Iranzo MDÀ, Tortosa-Chuliá MÁ, Igual-Camacho C, Sancho P, Galiana L, Tomás JM. [ Cost-consequence analysis of respiratory preventive intervention among institutionalized older people: randomized controlled trial]. Rev Esp Geriatr Gerontol 2014; 49:203-209. [PMID: 24417971 DOI: 10.1016/j.regg.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/13/2013] [Accepted: 11/19/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment. MATERIAL AND METHODS A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n=54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective. RESULTS The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to Euro 21,678. CONCLUSIONS This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate.
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Affiliation(s)
- Maria Dels Àngels Cebrià I Iranzo
- Departament de Fisioteràpia, Universitat de València, Valencia, España; Servicio de Rehabilitación, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | | | - Celedonia Igual-Camacho
- Departament de Fisioteràpia, Universitat de València, Valencia, España; Servicio de Rehabilitación, Hospital Clínic Universitari, Valencia, España
| | - Patricia Sancho
- Departament de Metodologia de les Ciències del Comportament, Universitat de València, Valencia, España
| | - Laura Galiana
- Departament de Metodologia de les Ciències del Comportament, Universitat de València, Valencia, España
| | - José Manuel Tomás
- Departament de Metodologia de les Ciències del Comportament, Universitat de València, Valencia, España
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