ORCID Profile
0000-0001-9978-6311
Current Organisations
University of Sydney
,
University of New South Wales
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Publisher: Wiley
Date: 22-04-2020
DOI: 10.1002/OBY.22711
Publisher: Springer Science and Business Media LLC
Date: 21-11-2017
Publisher: Springer Science and Business Media LLC
Date: 23-05-2023
Publisher: Frontiers Media SA
Date: 03-2019
Publisher: Springer Science and Business Media LLC
Date: 16-01-2020
DOI: 10.1038/S41366-020-0529-3
Abstract: Overweight and obesity in children is associated with poor health-related quality of life (HRQoL), but the nuances of this relationship across different age and socio-demographic groups are not well-established. The aim of this study is to examine how the association between weight status and HRQoL changes with age and socioeconomic position (SEP) throughout childhood and adolescence. We used data from the Longitudinal Study of Australian Children (LSAC), a cohort study in which children were interviewed biennially from ages 4 to 17 years over seven waves of data. Measurements of HRQoL (using PedsQL Age was a significant modifier of the association between weight status and HRQoL, with adjustment for known predictors of HRQoL (P 0.05). Our results demonstrate that the relationship between overweight and obesity status and poor HRQoL is strengthened with increasing age through childhood and adolescence, but is not affected by SEP. Paediatricians, researchers and carers of children with obesity should acknowledge HRQoL outcomes, particularly for older children and adolescents.
Publisher: Elsevier BV
Date: 02-2018
Publisher: BMJ
Date: 26-07-2023
DOI: 10.1136/HEARTJNL-2022-322300
Abstract: To determine the cost-effectiveness and cost-utility of a quadpill containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg in comparison with irbesartan 150 mg for people with hypertension who are either untreated or receiving monotherapy. We conducted a within-trial and modelled economic evaluation of the Quadruple UltrA-low-dose tReaTment for hypErTension trial. The analysis was preplanned, and medications and health service use captured during the trial. The main outcomes were incremental cost-effectiveness ratios (ICERs) for cost per mm Hg systolic blood pressure (BP) reduction at 3 months, and modelled cost per quality-adjusted life year (QALY) over a lifetime. The within-trial analysis showed no clear difference in cost per mm Hg BP lowering between randomised treatments at 3 months ($A10 (95% uncertainty interval (UI) $A −18 to $A37) per mm Hg per person) for quadpill versus monotherapy. The modelled cost-utility over a lifetime projected a mean incremental cost of $A265 (95% UI $A166 to $A357) and a mean 0.02 QALYs gained (95% UI 0.01 to 0.03) per person with quadpill therapy compared with monotherapy. Quadpill therapy was cost-effective in the base case (ICER of $A14 006 per QALY), and the result was sensitive to the quadpill cost in one-way sensitivity analysis. Quadpill in comparison with monotherapy is comparably cost-effective for short-term BP lowering. In the long-term, quadpill therapy is likely to be cost-effective. ANZCTRN12616001144404.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-03-2019
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2019
Publisher: Wiley
Date: 12-08-2021
DOI: 10.1002/OSP4.549
Abstract: Many countries report socioeconomic inequalities in childhood obesity, but when they develop is not well‐characterised. Studies rarely isolate BMI growth rates from overall BMI, perhaps overlooking an important precursor to the observed inequalities in obesity. The objective of this study was to determine the age at which inequalities in BMI growth rates develop in children and whether they are similar across the BMI spectrum. Using the Longitudinal Study of Australian Children ( n = 9024), a cohort study, we measured socioeconomic inequalities in annual BMI growth from age 2 to 17 years by age, sex and weight status. We fit a linear model using generalised estimating equations (GEE) to estimate simultaneously the effects of age and weight status on inequalities in BMI growth rate. The slope (SII) and relative (RII) indexes of inequality for annual BMI growth were greatest in middle childhood (age 4–11 years) (SII 0.25, RII 1.83 (boys) 1.78 (girls)) and were moderate during adolescence (age 10–17 years) (SII 0.11, RII 1.16 [boys] 1.15 [girls]). In early childhood, there was little evidence of inequality in annual BMI growth except in children with obesity. In middle childhood and adolescence, inequalities were greater at higher weight status. The GEE indicated that both weight status ( P 0.001) and age period ( P 0.001) affected inequalities in BMI growth rates. Inequalities in annual BMI growth were strongest in middle childhood, and widest in children at the upper end of the BMI spectrum. This could signify a key age bracket to intervene clinically and at a public health level and improve inequalities in childhood obesity.
Publisher: BMJ
Date: 09-2020
DOI: 10.1136/BMJGH-2020-003332
Abstract: Prior studies have revealed the increasing prevalence of obesity and its associated health effects among ageing adults in resource poor countries. However, no study has examined the long-term and economic impact of overweight and obesity in sub-Saharan Africa. Therefore, we quantified the long-term impact of overweight and obesity on life expectancy (LE), quality-adjusted life years (QALYs) and total direct healthcare costs. A Markov simulation model projected health and economic outcomes associated with three categories of body mass index (BMI): healthy weight (18.5≤BMI .0) overweight (25.0≤BMI 30.0) and obese (BMI ≥30.0 kg/m 2 ) in simulated adult cohorts over a 50-year time horizon from age fifty. Costs were estimated from government and patient perspectives, discounted 3% annually and reported in 2017 US$. Mortality rates from Ghanaian lifetables were adjusted by BMI-specific all-cause mortality HRs. Published input data were used from the 2014/2015 Ghana WHO Study on global AGEing and adult health data. Internal and external validity were assessed. From age 50 years, average (95% CI) remaining LE for females were 25.6 (95% CI: 25.4 to 25.8), 23.5 (95% CI: 23.3 to 23.7) and 21.3 (95% CI: 19.6 to 21.8) for healthy weight, overweight and obesity, respectively. In males, remaining LE were healthy weight (23.0 95% CI: 22.8 to 23.2), overweight (20.7 95% CI: 20.5 to 20.9) and obesity (17.6 95% CI: 17.5 to 17.8). In females, QALYs for healthy weight were 23.0 (95% CI: 22.8 to 23.2), overweight, 21.0 (95% CI: 20.8 to 21.2) and obesity, 19.0 (95% CI: 18.8 to 19.7). The discounted total costs per female were US$619 (95% CI: 616 to 622), US$1298 (95% CI: 1290 to 1306) and US$2057 (95% CI: 2043 to 2071) for healthy weight, overweight and obesity, respectively. QALYs and costs were lower in males. Overweight and obesity have substantial health and economic impacts, hence the urgent need for cost-effective preventive strategies in the Ghanaian population.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Springer Science and Business Media LLC
Date: 14-09-2021
DOI: 10.1186/S12939-021-01529-9
Abstract: Women are disadvantaged by ageing: older women are more likely than older men to suffer from ill-health, have less access to health care and suffer discrimination within the health care system. Globally, there is a dearth of health research on gender and ageing with substantial knowledge gaps in low and middle-income country contexts. Part of a wider investigation on health and ageing in Fiji, our objective was to identify and describe gendered differences in healthy ageing in this Pacific Island context. We believe this to be the first such study in the Pacific region. Applying a health systems lens, we used a mixed-methods approach, encompassing analysis of cause of death data focus group discussion to gather community and family attitudes to health services and policy analysis, and then used data triangulation techniques to draw out key themes and insights. We found that gender affects health outcomes among older persons, attitudes towards and experience of healthy ageing, and an older person’s access to and use of health services. We also found that while Fiji’s policy response to ageing has recognised the importance of gender, to-date there has been limited action to address gender differences. Gender (as oppose to sex differences) has direct and indirect implications for the health of older Fijians, while gendered inequalities and patriarchal norms appear to affect both men and women’s experience of ageing and the health system response. Further, gender and age discrimination may be intersecting, intensifying their separate effects. This study demonstrates the feasibility and importance of applying a gender lens to the study of healthy ageing. Our findings from Fiji may be relevant to other island nations in the south Pacific which share similar challenges of population ageing, a constrained health budget and geographically-dispersed populations. The data triangulation methodology may be considered an efficient and insightful way to examine gendered responses to healthy ageing elsewhere.
Publisher: Springer Science and Business Media LLC
Date: 05-04-2016
DOI: 10.1007/S00125-016-3914-7
Abstract: People with type 1 diabetes have reduced life expectancy (LE) compared with the general population. Our aim is to quantify mortality changes from 2002 to 2011 in people with type 1 diabetes in Sweden. This study uses health records from the Swedish National Diabetes Register (NDR) linked with death records. Abridged period life tables for those with type 1 diabetes aged 20 years and older were derived for 2002-06 and 2007-11 using Chiang's method. Cox proportional hazard models were used to assess trends in overall and cause-specific mortality. There were 27,841 persons aged 20 years and older identified in the NDR as living with type 1 diabetes between 2002 and 2011, contributing 194,685 person-years of follow-up and 2,018 deaths. For men with type 1 diabetes, the remaining LE at age 20 increased significantly from 47.7 (95% CI 46.6, 48.9) in 2002-06 to 49.7 years (95% CI 48.9, 50.6) in 2007-11. For women with type 1 diabetes there was no significant change, with an LE at age 20 of 51.7 years (95% CI 50.3, 53.2) in 2002-06 and 51.9 years (95% CI 50.9, 52.9) in 2007-11. Cardiovascular mortality significantly reduced, with a per year HR of 0.947 (95% CI 0.917, 0.978) for men and 0.952 (95% CI 0.916, 0.989) for women. From 2002-06 to 2007-11 the LE at age 20 of Swedes with type 1 diabetes increased by approximately 2 years for men but minimally for women. These recent gains have been driven by reduced cardiovascular mortality.
Publisher: Informa UK Limited
Date: 20-01-2021
DOI: 10.1080/09286586.2021.1875009
Abstract: To project the prevalence, causes, associated factors of vision-related disability and demand for orientation and mobility (O&M) services in Australia from 2020 to 2060. The age-specific prevalence and main causes of vision-related disability were estimated based on primary data of 74,862 participants in 2015 Survey of Disability, Ageing and Carers. Logistic regression analyses were performed to identify associated factors for the outcome variables including vision-related disability, cataract, macular degeneration and glaucoma. Future prevalence of vision-related disability and demand for O&M services were forecasted using the population projections by the Australian Bureau of Statistics through 2060. The main causes of vision-related disability are non-specific sight loss, cataracts, macular degeneration and glaucoma. Health-related associations for vision-related disability are older age, having a history of stroke, having diabetes, depression, heart disease and hearing impairment. The number of Australians with vision-related disability (283,650, 1.10%) and demand for O&M services (123,317, 0.48%) in 2020 will increase to 559,161 (1.38%) and 237,694 (0.59%) respectively in 2060. The number of people with vision-related disability and in need of O&M services in Australia will grow exponentially over the coming decades. General health promotion and specific strategies of early detection and timely treatments of the major eye diseases may ameliorate the trend in vision-related disability.
Publisher: BMJ
Date: 03-2019
DOI: 10.1136/BMJOPEN-2018-026525
Abstract: To develop a model to predict future socioeconomic inequalities in body mass index (BMI) and obesity. Microsimulation modelling using BMI data from adult participants of Australian Health Surveys, and published data on the relative risk of mortality in relation to BMI and socioeconomic position (SEP), based on education. Australia. 74 329 adults, aged 20 and over from Australian Health Surveys, 1995–2015. The primary outcomes were BMI trajectories and obesity prevalence by SEP for four birth cohorts, born 10 years apart, centred on 1940, 1950, 1960 and 1970. Simulations projected persistent or widening socioeconomic inequality in BMI and obesity over the adult life course, for all birth cohorts. Recent birth cohorts were predicted to have greater socioeconomic inequality by middle age, compared with earlier cohorts. For ex le, among men, there was no inequality in obesity prevalence at age 60 for the 1940 birth cohort (low SEP 25% (95% CI 17% to 34%) high SEP 26% (95% CI 19% to 34%)), yet for the 1970 birth cohort, obesity prevalence was projected to be 51% (95% CI 43% to 58%) and 41% (95% CI 36% to 46%) for the low and high SEP groups, respectively. Notably, for more recent birth cohorts, the model predicted the greatest socioeconomic inequality in severe obesity (BMI kg/m 2 ) at age 60. Lower SEP groups and more recent birth cohorts are at higher risk of obesity and severe obesity, and its consequences in middle age. Prevention efforts should focus on these vulnerable population groups in order to avoid future disparities in health outcomes. The model provides a framework for further research to investigate which interventions will be most effective in narrowing the gap in socioeconomic disparities in obesity in adulthood.
Publisher: Public Library of Science (PLoS)
Date: 26-11-2014
Publisher: Wiley
Date: 27-03-2014
DOI: 10.1002/OBY.20747
Abstract: To determine the costs and cost-effectiveness of an early childhood home visiting program delivered to families in socio-economically disadvantaged areas of Sydney, Australia during 2007-2010. Economic evaluation of a randomized controlled trial, the healthy beginnings (HB) trial, from the perspective of the health funder. Intervention resources were determined from local health district records in 2012 $AUD. Health-care resource utilization was determined through patient-level data linkage. The cost of HB intervention in the clinical trial over 2 years was $1309 per child (2012 $AUD). The incremental cost-effectiveness ratio was $4230 per unit BMI avoided and $631 per 0.1 reduction in BMI z-score. It was estimated that the program could be delivered in practice for $709 per child with incremental cost-effectiveness ratios of $2697 per unit BMI avoided and $376 per 0.1 reduction in BMI z-score. We present the first economic evaluation of an effective obesity prevention initiative in early childhood. HB is a moderately priced intervention with demonstrated effectiveness that offers similar or better value for money than existing obesity prevention or treatment interventions targeted at older children.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-048395
Abstract: One in three people aged 65 years and over fall each year. The health, economic and personal impact of falls will grow substantially in the coming years due to population ageing. Developing and implementing cost-effective strategies to prevent falls and mobility problems among older people is therefore an urgent public health challenge. StandingTall is a low-cost, unsupervised, home-based balance exercise programme delivered through a computer or tablet. StandingTall has a simple user-interface that incorporates physical and behavioural elements designed to promote compliance. A large randomised controlled trial in 503 community-dwelling older people has shown that StandingTall is safe, has high adherence rates and is effective in improving balance and reducing falls. The current project targets a major need for older people and will address the final steps needed to scale this innovative technology for widespread use by older people across Australia and internationally. This project will endeavour to recruit 300 participants across three sites in Australia and 100 participants in the UK. The aim of the study is to evaluate the implementation of StandingTall into the community and health service settings in Australia and the UK. The nested process evaluation will use both quantitative and qualitative methods to explore uptake and acceptability of the StandingTall programme and associated resources. The primary outcome is participant adherence to the StandingTall programme over 6 months. Ethical approval has been obtained from the South East Sydney Local Health District Human Research Ethics Committee (HREC reference 18/288) in Australia and the North West- Greater Manchester South Research Ethics Committee (IRAS ID: 268954) in the UK. Dissemination will be via publications, conferences, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers. ACTRN12619001329156.
Publisher: Elsevier BV
Date: 04-2017
Publisher: American Diabetes Association
Date: 10-10-2014
DOI: 10.2337/DC14-0405
Abstract: To examine whether previous severe hypoglycemic events were associated with the risk of all-cause mortality after major cardiovascular events (myocardial infarction [MI] or stroke) in patients with type 1 diabetes. This study is based on data from the Swedish National Diabetes Register linked to patient-level hospital records, prescription data, and death records. We selected patients with type 1 diabetes who visited a clinic during 2002–2010 and experienced a major cardiovascular complication after their clinic visit. We estimated a two-part model for all-cause mortality after a major cardiovascular event: logistic regression for death within the first month and a Cox proportional hazards model conditional on 1-month survival. At age 60 years, 5-year cumulative mortality risk was estimated from the models for patients with and without prior diabetes complications. A total of 1,839 patients experienced major cardiovascular events, of whom 403 had previously experienced severe hypoglycemic events and 703 died within our study period. A prior hypoglycemic event was associated with a significant increase in mortality after a cardiovascular event, with hazard ratios estimated at 1.79 (95% CI 1.37–2.35) within the first month and 1.25 (95% CI 1.02–1.53) after 1 month. Patients with prior hypoglycemia had an estimated 5-year cumulative mortality risk of 52.4% (95% CI 45.3–59.5) and 39.8% (95% CI 33.4–46.3) for MI and stroke, respectively. We have found evidence that patients with type 1 diabetes in Sweden with prior severe hypoglycemic events have increased risk of mortality after a cardiovascular event.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Wiley
Date: 28-12-2018
DOI: 10.1111/JGH.13925
Abstract: The Asia-Pacific region contains more than half of the world's population and is markedly heterogeneous in relation to income levels and the provision of public and private health services. For low-income countries, the major health priorities are child and maternal health. In contrast, priorities for high-income countries include vascular disease, cancer, diabetes, dementia, and mental health disorders as well as chronic inflammatory disorders such as hepatitis B and hepatitis C. Cost-effectiveness analyses are methods for assessing the gains in health relative to the costs of different health interventions. Methods for measuring health outcomes include years of life saved (or lost), quality-adjusted life years, and disability-adjusted life years. The incremental cost-effectiveness ratio measures the cost (usually in US dollars) per life year saved, quality-adjusted life year gained, or disability-adjusted life year averted of one intervention relative to another. In low-income countries, approximately 50% of infant deaths (< 5 years) are caused by gastroenteritis, the major pathogen being rotavirus infection. Rotavirus vaccines appear to be cost-effective but, thus far, have not been widely adopted. In contrast, infant vaccination for hepatitis B is promoted in most countries with a striking reduction in the prevalence of infection in vaccinated in iduals. Cost-effectiveness analyses have also been applied to newer and more expensive drugs for hepatitis B and C and to government-sponsored programs for the early detection of hepatocellular, gastric, and colorectal cancer. Most of these studies reveal that newer drugs and surveillance programs for cancer are only marginally cost-effective in the setting of a high-income country.
Publisher: Frontiers Media SA
Date: 07-03-2022
DOI: 10.3389/FPHAR.2022.834898
Abstract: Objective: To investigate long-term adherence to guideline-recommended cardioprotective medications following hospitalization for an acute myocardial infarction (AMI), and identify characteristics associated with adherence. Methods: An Australian population-based cohort study was used to identify participants who had their first AMI between 2006 and 2014 and were alive after 12 months. Linked routinely collected hospital, and prescription medication claims data was used to study adherence over time. Predictors and rates of adherence to both lipid-lowering medication and renin-angiotensin system blockade at 12 months post-AMI was assessed. Results: 14,200 people (mean age 69.9 years, 38.7% female) were included in our analysis. At 12 months post-AMI, 29.5% (95% CI: 28.8–30.3%) of people were adherent to both classes of medication. In iduals receiving treatment with both lipid-lowering medication and renin-angiotensin system blockade during the 6 months prior to their AMI were over 9 times more likely to be adherent to both medications at 12 months post-AMI (66.2% 95% CI: 64.8–67.5%) compared to those with no prior medication use (treatment naïve) (7.1%, 95% CI: 6.4–7.9%). Prior cardiovascular treatment was the strongest predictor of long-term adherence even after adjusting for age, sex, education and income. Conclusions: Despite efforts to improve long-term medication adherence in patients who have experienced an acute coronary event, considerable gaps remain. Of particular concern are people who are commencing guideline-recommended cardioprotective medication at the time of their AMI. The relationship between prior cardiovascular treatments and post AMI adherence offers insight into the support needs for the patient. Health care intervention strategies, strengthened by enabling policies, are needed to provide support to patients through the initial months following their AMI.
Publisher: Springer Science and Business Media LLC
Date: 22-02-2021
Publisher: Elsevier BV
Date: 12-2020
Publisher: Royal College of General Practitioners
Date: 31-07-2017
Abstract: The 2014 guidelines on cardiovascular risk assessment and lipid modification from the National Institute for Health and Care Excellence (NICE) recommend statin therapy for adults with prevalent cardiovascular disease (CVD), and for adults with a 10-year CVD risk of ≥10%, estimated using the QRISK2 algorithm. To determine risk factor levels required to exceed the risk threshold for statin therapy, and to estimate the number of adults in England who would require statin therapy under the guidelines. Cross-sectional study using a s le representative of the English population aged 30–84 years. To estimate 10-year CVD risk different combinations of risk factor levels were entered into the QRISK2 algorithm. The NICE guidelines were applied to the s le using data from the Health Survey for England 2011. Even with optimal risk factor levels, males of different ethnicities would exceed the 10% risk threshold between the ages of 60 and 70 years, and females would exceed the threshold between 65 and 75 years. Under the NICE guidelines, 11.8 million males and females (37% of the adults aged 30–84 years) would require statin therapy, most of them (9.8 million) for primary prevention. When analysed by age, 95% of males and 66% of females without CVD in ages 60–74 years, including all males and females in ages 75–84 years, would require statin therapy. Under the 2014 NICE guidelines, 11.8 million (37%) adults in England aged 30–84 years, including almost all males years and all females years, require statin therapy.
Publisher: Elsevier BV
Date: 06-2012
Publisher: Public Library of Science (PLoS)
Date: 24-02-2017
Publisher: Elsevier BV
Date: 02-2020
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-045929
Abstract: Cardiovascular diseases (CVDs) are the leading causes of death and disability worldwide. Reducing dietary salt consumption is a potentially cost-effective way to reduce blood pressure and the burden of CVD. To date, economic evidence has focused on sodium reduction in food industry or processed food with blood pressure as the primary outcome. This study protocol describes the planned within-trial economic evaluation of a low-sodium salt substitute intervention designed to reduce the risk of stroke in China. The economic evaluation will be conducted alongside the Salt Substitute and Stroke Study: a 5-year large scale, cluster randomised controlled trial. The outcomes of interest are quality of life measured using the EuroQol-5-Dimensions and major adverse cardiovascular events. Costs will be estimated from a healthcare system perspective and will be sought from the routinely collected data available within the New Rural Cooperative Medical Scheme. Cost-effectiveness and cost-utility analyses will be conducted, resulting in the incremental cost-effectiveness ratio expressed as cost per cardiovascular event averted and cost per quality-adjusted life year gained, respectively. The trial received ethics approval from the University of Sydney Ethics Committee (2013/888) and Peking University Institutional Review Board (IRB00001052-13069). Informed consent was obtained from each study participant. Findings of the economic evaluation will be published in a peer-reviewed journal and presented at international conferences. ClinicalTrials.gov Registry ( NCT02092090 ).
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-08-2022
Abstract: Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial. Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke years no prestroke history of diabetes, coronary heart disease, or ischemic stroke prestroke history of depression, a relationship partner, living with others, independence, or paid employment no fluoxetine intervention ischemic stroke (compared with hemorrhagic) stroke treatment in Vietnam (compared with Australia or New Zealand) longer time since current stroke and lower baseline National Institutes of Health Stroke Scale & Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model. Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value. URL: www.anzctr.org.au Unique identifier: ACTRN12611000774921.
Publisher: Wiley
Date: 21-09-2018
DOI: 10.1002/SRES.2555
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 07-04-2011
DOI: 10.1007/S11136-011-9902-Y
Abstract: To review published studies on the effect of diabetes and its complications on utility scores to establish whether there is systematic variation across studies and to examine the implications for the estimation of quality-adjusted life years (QALYs). A systematic review was performed using studies reporting QALY measures elicited from people with diabetes including those with a history of complications. Meta-analysis was used to obtain the average utility, and meta-regression was employed to examine the impact of study characteristics and elicitation methods on these values. The effect of different utility scores on QALYs was examined using diabetes simulation models. In the meta-analysis based on 45 studies reporting 66 values, the average utility score was 0.76 (95% CI 0.75-0.77). A meta-regression showed significant variation due to age, method of elicitation and the proportion of males. The average utility score for in idual complications ranged from 0.48 (95% CI 0.25, 0.71) for chronic renal disease to 0.75 (95% CI 0.73, 0.78) for myocardial infarction, and these differences produced meaningful changes in simulated QALYs. There was significant heterogeneity between studies. We provide summary utility scores for diabetes and its major complications that could help inform economic evaluation and policy analysis.
Publisher: Springer Science and Business Media LLC
Date: 09-12-2020
DOI: 10.1007/S40273-019-00866-6
Abstract: Our objective was to identify age- and sex-specific utilities for children and adolescents by body mass index (BMI) z-score. We used data from 6822 participants and 12,094 observations from two cohorts and two waves of interviews from the Longitudinal Study of Australian Children. We fit linear models using generalised estimating equations to investigate associations between Child Health Utility 9D and BMI z-score in girls and boys aged 10-17 years. We initially fit models for each sex, fully adjusted for known predictors of health-related quality of life, including socioeconomic position, long-term medical condition and maternal smoking status and also included an interaction between age and BMI z-score to examine age-specific effects. Finally, we derived a minimal model for each sex by eliminating interaction terms with P > 0.01 and predictors with P > 0.05. Our adjusted results show different utility patterns in girls and boys. In girls, utility decrements for each unit increase in BMI z-score changed with age (P < 0.01 for interaction between age and BMI z-score). At age 10 years, the mean utility decrement for each unit increase in BMI z-score was 0.002 (95% confidence interval [CI] 0.011 decrement to 0.006 increment), but, by age 17 years, this utility decrement was 0.023 (95% CI 0.013 to 0.032). In boys, small non-significant decrements were found in utility for each unit increase in BMI z-score, with no observable change with age. Our analyses demonstrated that age and sex should be considered when attributing utility values and decrements to BMI z-scores.
Publisher: Springer Science and Business Media LLC
Date: 15-03-2013
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.ORCP.2021.09.006
Abstract: Economic evaluations of childhood obesity interventions are often used to assist decision making when presented with alternative course of action. Including indirect costs related to productivity losses is recommended in children this would include school absenteeism. Our aim was to determine the association between school absenteeism and weight status among Australian children and estimate the indirect costs of this. We used data from a nationally representative s le of 8551 Australian children in the Longitudinal study of Australian Children (LSAC) with follow-up between 2006 and 2018. A mixed-effects negative binomial regression model was used to investigate the relationship between school absenteeism and weight status, controlling for age, sex, socio-economic position, indigenous status, rural/remote status and long-term medical conditions. We used average daily wages for the year 2018 to value the indirect costs of school absenteeism (through caregiver lost productivity). Australian children with obesity aged 6-13 years missed on average an extra day of school annually compared to children of a healthy weight (p = 0.004), while adolescents with obesity aged 14-17 years missed on average an extra 0.69 days of school annually (p = 0.006). The estimated national cost for children with obesity aged 6-13 years was approximately $64 million AUD ($43 million USD) or $338 AUD ($230 USD) per child through caregiver lost productivity in 2018. There is a small but significant association between school absenteeism and childhood obesity in Australia which is estimated to generate a considerable national cost through caregiver productivity losses. Our results will assist health economists evaluating childhood obesity interventions capture the full extent of the associated costs with this condition.
Publisher: Springer Science and Business Media LLC
Date: 05-10-2021
Publisher: Oxford University Press (OUP)
Date: 13-03-2021
Abstract: Cardiovascular diseases (CVD) are the leading cause of death in Indonesia, and there are large disparities in access to recommended preventative treatments across the country, particularly in rural areas. Technology-enabled screening and management led by community health workers have been shown to be effective in better managing those at high risk of CVD in a rural Indonesian population however, the economic impacts of implementing such an intervention are unknown. We conducted a modelled cost-effectiveness analysis of the SMARThealth intervention in rural villages of Malang district, Indonesia from the payer perspective over a 10-year period. A Markov model was designed and populated with epidemiological and cost data collected in a recent quasi-randomized trial, with nine health states representing a differing risk for experiencing a major CVD event. Disability-Adjusted Life Years (DALYs) were estimated for the intervention and usual care using disability weights from the literature for major CVD events. Annual treatment costs for CVD treatment and prevention were $US83 under current care and $US144 for those receiving the intervention. The intervention had an incremental cost-effectiveness ratio of $4288 per DALY averted and $3681 per major CVD event avoided relative to usual care. One-way and probabilistic sensitivity analyses demonstrated that the results were robust to plausible variations in model parameters and that the intervention is highly likely to be considered cost-effective by decision-makers across a range of potentially acceptable willingness to pay levels. Relative to current care, the intervention was a cost-effective means to improve the management of CVD in this rural Indonesian population. Further scale-up of the intervention offers the prospect of significant gains in population health and sustainable progress toward universal health coverage for the Indonesian population.
Publisher: AMPCo
Date: 26-02-2018
DOI: 10.5694/MJA17.00564
Publisher: Public Library of Science (PLoS)
Date: 21-03-2018
Publisher: National Institute for Health and Care Research
Date: 02-2014
DOI: 10.3310/HTA18140
Publisher: Oxford University Press (OUP)
Date: 27-07-2017
Publisher: American Diabetes Association
Date: 12-06-2020
DOI: 10.2337/DC19-2249
Abstract: To develop a patient-level simulation model for predicting lifetime health outcomes of patients with type 1 diabetes and as a tool for economic evaluation of type 1 diabetes treatment based on data from a large, longitudinal cohort. Data for model development were obtained from the Swedish National Diabetes Register. We derived parametric proportional hazards models predicting the absolute risk of diabetes complications and death based on a wide range of clinical variables and history of complications. We used linear regression models to predict risk factor progression. Internal validation was performed, estimates of life expectancies for different age-sex strata were computed, and the impact of key risk factors on life expectancy was assessed. The study population consisted of 27,841 patients with type 1 diabetes with a mean duration of follow-up of 7 years. Internal validation showed good agreement between the predicted and observed cumulative incidence of death and 10 complications. Simulated life expectancy was ∼13 years lower than that of the sex- and age-matched general population, and patients with type 1 diabetes could expect to live with one or more complications for ∼40% of their remaining life. Sensitivity analysis showed the importance of preventing renal dysfunction, hypoglycemia, and hyperglycemia as well as lowering HbA1c in reducing the risk of complications and death. Our model was able to simulate risk factor progression and event histories that closely match the observed outcomes and to project events occurring over patients’ lifetimes. The model can serve as a tool to estimate the impact of changing clinical risk factors on health outcomes to inform economic evaluations of interventions in type 1 diabetes.
Publisher: BMJ
Date: 06-04-2021
DOI: 10.1136/BMJ.N740
Abstract: To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people. Assessor blinded, randomised controlled trial. Older people living independently in the community in Sydney, Australia. 503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise. Participants were block randomised to an intervention group (two hours of StandingTall per week and health education n=254) or a control group (health education n=249) for two years. The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number of injurious falls (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months and balance and mobility outcomes over 12 months. The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group 0.76 (1.25) in the control group incidence rate ratio 0.82, 95% confidence interval 0.66 to 1.02, P=0.070). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group relative risk 0.90, 95% confidence interval 0.72 to 1.12, P=0.348). However, the intervention group had a 16% lower rate of falls over 24 months (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027) and a 20% lower rate of injurious falls over 24 months compared with the control group (incidence rate ratio 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.74 to 1.02, P=0.077). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred. The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies. ACTRN12615000138583
Publisher: Springer Science and Business Media LLC
Date: 13-04-2013
DOI: 10.1007/S40273-013-0047-4
Abstract: The aim of this study was to develop a discrete-time simulation model for people with type 1 diabetes mellitus, to estimate and compare mean life expectancy and quality-adjusted life-years (QALYs) over a lifetime between intensive and conventional blood glucose treatment groups. We synthesized evidence on type 1 diabetes patients using several published sources. The simulation model was based on 13 equations to estimate risks of events and mortality. Cardiovascular disease (CVD) risk was obtained from results of the DCCT (diabetes control and complications trial). Mortality post-CVD event was based on a study using linked administrative data on people with diabetes from Western Australia. Information on incidence of renal disease and the progression to CVD was obtained from studies in Finland and Italy. Lower-extremity utation (LEA) risk was based on the type 1 diabetes Swedish inpatient registry, and the risk of blindness was obtained from results of a German-based study. Where diabetes-specific data were unavailable, information from other populations was used. We examine the degree and source of parameter uncertainty and illustrate an application of the model in estimating lifetime outcomes of using intensive and conventional treatments for blood glucose control. From 15 years of age, male and female patients had an estimated life expectancy of 47.2 (95 % CI 35.2-59.2) and 52.7 (95 % CI 41.7-63.6) years in the intensive treatment group. The model produced estimates of the lifetime benefits of intensive treatment for blood glucose from the DCCT of 4.0 (95 % CI 1.2-6.8) QALYs for women and 4.6 (95 % CI 2.7-6.9) QALYs for men. Absolute risk per 1,000 person-years for fatal CVD events was simulated to be 1.37 and 2.51 in intensive and conventional treatment groups, respectively. The model incorporates diabetic complications risk data from a type 1 diabetes population and synthesizes other type 1-specific data to estimate long-term outcomes of CVD, end-stage renal disease, LEA and risk of blindness, along with life expectancy and QALYs. External validation was carried out using life expectancy and absolute risk for fatal CVD events. Because of the flexible and transparent nature of the model, it has many potential future applications.
Publisher: AMPCo
Date: 27-06-2020
DOI: 10.5694/MJA2.50667
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.CHEMOSPHERE.2019.124579
Abstract: Nitroimidazoles are found in pharmaceuticals and personal care products (PPCPs) and, when discharged into the environment, have adverse effects on human health and survival. Advanced oxidation technologies (AOTs) based on persulfate (PS) can rapidly and efficiently degrade organic pollutants via strong oxidizing radicals under activation conditions. This study investigated the degradation of ronidazole (RNZ) by indirect electrolytic generation of PS and its activator, ferrous ion (Fe
Publisher: Springer Science and Business Media LLC
Date: 03-10-2019
DOI: 10.1038/S41366-018-0210-2
Abstract: Adult obesity has been shown to substantially heighten the risk of adverse health outcomes but its impact on life expectancy (LE) has not been quantified in Australia. Our aim is to estimate reductions in LE and years of life lost (YLL) associated with overweight and obesity, relative to those at a healthy weight for Australian adults aged 20-69 years. We used a microsimulation model of obesity progression in Australia that integrates annual change in BMI based on age and sex, with Australian life-table data and published relative risk of all-cause mortality for different BMI categories. Remaining LE and YLL compared to healthy weight were estimated using 10-year cohorts, by sex. A nationally representative s le of 12,091 adults aged 20-69 from the 2014/15 Australian National Health Survey were used to represent the input population of 14.9 million. Estimated remaining years of LE for healthy weight men and women aged 20-29 years was approximately 57.0 (95% CI 56.7-57.4) and 59.7 (95% CI 59.4-60.0) years, respectively. YLL associated with being overweight at baseline was approximately 3.3 years. For those obese and severely obese the loss in LE was predicted to be 5.6-7.6 years and 8.1-10.3 years for men and women aged 20-29 years, respectively. Across men and women, excess BMI in the adult population is responsible for approximately 36.3 million YLLs. Men stand to lose 27.7% more life years compared to women. Overweight and obesity is associated with premature mortality at all ages, for both men and women. Adults aged 20-39 years with severe obesity will experience the largest YLL, relative to healthy weight. More needs to be done in Australia to establish a coherent, sustained, cost-effective strategy to prevent overweight and obesity, particularly for men in early adulthood.
Publisher: American Diabetes Association
Date: 14-09-2020
DOI: 10.2337/DC20-0269
Publisher: Springer Science and Business Media LLC
Date: 25-09-2011
Publisher: Springer Science and Business Media LLC
Date: 20-06-2023
DOI: 10.1186/S43058-023-00452-0
Abstract: Emergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes. This study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped–wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys. Ethical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022. Australian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-05-2022
DOI: 10.1161/CIRCULATIONAHA.122.059573
Abstract: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among in iduals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. Mean follow-up of the 20 995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77–0.96] P =0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a .9% probability of being cost-effective. Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2022
DOI: 10.1186/S12937-022-00761-5
Abstract: There is a crisis of non-communicable diseases (NCDs) in the Pacific Islands, and poor diets are a major contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food systems. Pacific Island leaders have adopted a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Despite increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. Our 5-year collaborative project will test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and examine factors that support sustained implementation. We will engage government agencies and civil society in Fiji and Samoa, to support the design, implementation and monitoring of evidence-informed interventions. Specific objectives are to: (1) conduct policy landscape analysis to understand potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption (4) evaluate the impact, process and cost effectiveness of implementing these policies. Quantitative and qualitative data on outcomes and process will be analysed to assess impact and support scale-up of future interventions. The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes.
Publisher: Research Square Platform LLC
Date: 05-06-2020
DOI: 10.21203/RS.3.RS-31470/V1
Abstract: Background Non-communicable diseases (NCDs) have been declared a crisis in the Pacific Islands, and poor diets are a major contributor to this. The COVID-19 pandemic and resulting economic crisis will likely increase the burden on food systems, exacerbating this situation. Pacific Island leaders have been proactive in adopting a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Whilst there is increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. Methods Our 5-year collaborative research project will advance knowledge of how to scale up food policy interventions in the Pacific Islands. The overall aim of this implementation science research project is to test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and to examine factors that will support sustained implementation. We will engage, as partners, government agencies and civil society in Fiji and Samoa, and support the design, implementation and monitoring of a range of evidence-informed interventions aiming to reduce salt and sugar consumption, in the context of on-going health and environmental challenges, such as COVID-19 and climate change. Specific objectives are to: (1) conduct a policy landscape analysis to understand the potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption (4) evaluate the impact, process and cost effectiveness of implementing these policies. Discussion The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes. Contributions to the literature · Poor diets are one of the main contributors to non-communicable diseases. There is increasing evidence to show that food policy interventions (fiscal or regulatory) are an effective way of improving diets, globally. · This project will produce local context-specific evidence for the impact and cost-effectiveness of food policy interventions to improve diets in the Pacific Islands (Fiji and Samoa). It will also produce new insights into what is feasible and which factors contribute most to effective implementation in different contexts.· The findings will provide important insights into gaps in the implementation science literature on food policy implementation, particularly in Small Island Developing States. The project will also make an important contribution globally since the innovative methods of engaging policy makers and monitoring food and health developed through the project may be replicated elsewhere.
Publisher: Oxford University Press (OUP)
Date: 06-2022
Abstract: globally, falls and fall-related injuries are the leading cause of injury-related morbidity and mortality in older people. In our ageing society healthcare costs are increasing, therefore programmes that reduce falls and are considered value for money are needed. to complete an economic evaluation of an e-Health balance exercise programme that reduced falls and injurious falls in community-dwelling older people compared to usual care from a health and community-care funder perspective. a within-trial economic evaluation of an assessor-blinded randomised controlled trial with 2 years of follow-up. StandingTall was delivered via tablet-computer at home to older community-dwelling people in Sydney, Australia. five hundred and three in iduals aged 70+ years who were independent in activities of daily living, without cognitive impairment, progressive neurological disease or any other unstable or acute medical condition precluding exercise. cost-effectiveness was measured as the incremental cost per fall and per injurious fall prevented. Cost-utility was measured as the incremental cost per quality-adjusted life year (QALY) gained. the total average cost per patient for programme delivery and care resource cost was $8,321 (standard deviation [SD] 18,958) for intervention participants and $6,829 (SD 15,019) for control participants. The incremental cost per fall prevented was $4,785 and per injurious fall prevented was $6,585. The incremental cost per QALY gained was $58,039 (EQ5D-5L) and $110,698 (AQoL-6D). this evaluation found that StandingTall has the potential to be cost-effective in specific subpopulations of older people, but not necessarily the whole older population. ACTRN12615000138583.
Publisher: Wiley
Date: 05-2022
DOI: 10.1111/IMJ.15074
Abstract: To determine risk factors for incident chronic kidney disease (CKD) in a large population-based cohort. This prospective opt-in population-based cohort study is based on the 45 and Up Study, where New South Wales residents aged ≥45 years were randomly s led from the Services Australia database and agreed to complete the 45 and Up Study baseline questionnaire and have their responses linked to their health data in routinely collected databases. The primary outcome was the development of incident CKD, defined as eGFR < 60 mL/min/1.73 m In 39 574 participants who did not have CKD at enrolment, independent factors associated with developing CKD included: older age, regional residence (HR 1.38 (1.27-1.50) for outer regional vs major city), smoking (1.13 (1.00-1.27) for current smoker vs non-smoker), obesity (1.25 (1.16-1.35) for obese vs normal body mass index), diabetes mellitus (1.41 (1.33-1.50)), hypertension (1.53 (1.44-1.62)), coronary heart disease (1.13 (1.07-1.20)), depression/anxiety (1.16 (1.09-1.24)) and cancer (1.29 (1.20-1.39)). Migrants were less likely to develop CKD compared with people born in Australia (0.88 (0.83-0.94)). Gender, partner status and socioeconomic factors were not independently associated with developing CKD. This large population-based study found multiple modifiable and non-modifiable factors were independently associated with developing CKD. In the Australian setting, the risk of CKD was higher with regional residence. Differences according to socioeconomic status were predominantly explained by age, comorbidities and harmful health-related behaviours.
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12873-019-0296-4
Abstract: Previous systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions. A systematic literature review was conducted which screened the following databases: Pubmed, Medline, Embase, Cochrane and Econlit. An inclusion and exclusion criteria were developed following PRISMA guidelines. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies. One thousand three hundred eighty-nine papers were found and 16 were included in the review. All of the interventions were variations of a case management approach. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. There were no cost effectiveness studies. The majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2021
DOI: 10.1161/STROKEAHA.120.033070
Abstract: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76–1.14] P =0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%] P =0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%] P =0.08), bone fractures (23 [3.58%] versus 11 [1.72%] P =0.05), or seizures (11 [1.71%] versus 8 [1.25%] P =0.64) at 12 months. Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding. URL: www.anzctr.org.au/ Unique identifier: ACTRN12611000774921.
Publisher: American Medical Association (AMA)
Date: 09-2021
Publisher: Elsevier BV
Date: 07-2020
Publisher: Wiley
Date: 05-12-2022
DOI: 10.1002/OBY.23592
Abstract: This study aimed to determine whether the cost‐effectiveness of an infant sleep intervention from the Prevention of Overweight in Infancy (POI) trial was influenced by socioeconomic position (SEP). An SEP‐specific economic evaluation of the sleep intervention was conducted. SEP‐specific intervention costs and effects at age 5 years, derived from the trial data, were applied to a representative cohort of 4,898 4‐ to 5‐year‐old Australian children. Quality‐adjusted life years and health care costs were simulated until age 17 years using a purpose‐built SEP‐specific model. Incremental cost‐effectiveness ratios and acceptability curves were derived for each SEP group. The incremental cost‐effectiveness ratios, in Australian dollars per quality‐adjusted life year gained, were smaller in the low‐ ($23,010) and mid‐SEP ($18,206) groups compared with the high‐SEP group ($31,981). The probability that the intervention was cost‐effective was very high in the low‐ and mid‐SEP groups (92%‐100%) and moderately high in the high‐SEP group (79%). An infant sleep intervention is more cost‐effective in low‐ and mid‐SEP groups compared with high‐SEP groups. Targeting this intervention to low‐SEP groups would not require trade‐offs between efficiency and equity.
Publisher: Wiley
Date: 16-02-2020
DOI: 10.1111/DME.14237
Publisher: Springer Science and Business Media LLC
Date: 27-09-2017
DOI: 10.1038/IJO.2016.165
Abstract: Modelling is increasingly being used to predict the epidemiology of obesity progression and its consequences. The aims of this study were: (a) to present and validate a model for prediction of obesity among Australian adults and (b) to use the model to project the prevalence of obesity and severe obesity by 2025. In idual level simulation combined with survey estimation techniques to model changing population body mass index (BMI) distribution over time. The model input population was derived from a nationally representative survey in 1995, representing over 12 million adults. Simulations were run for 30 years. The model was validated retrospectively and then used to predict obesity and severe obesity by 2025 among different aged cohorts and at a whole population level. The changing BMI distribution over time was well predicted by the model and projected prevalence of weight status groups agreed with population level data in 2008, 2012 and 2014.The model predicts more growth in obesity among younger than older adult cohorts. Projections at a whole population level, were that healthy weight will decline, overweight will remain steady, but obesity and severe obesity prevalence will continue to increase beyond 2016. Adult obesity prevalence was projected to increase from 19% in 1995 to 35% by 2025. Severe obesity (BMI>35), which was only around 5% in 1995, was projected to be 13% by 2025, two to three times the 1995 levels. The projected rise in obesity severe obesity will have more substantial cost and healthcare system implications than in previous decades. Having a robust epidemiological model is key to predicting these long-term costs and health outcomes into the future.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Springer Science and Business Media LLC
Date: 23-06-2017
Publisher: Oxford University Press (OUP)
Date: 24-03-2021
DOI: 10.1093/PTJ/PZAB100
Abstract: The authors sought to describe the protocol of a randomized controlled trial that will investigate the effects of the TEXT4myBACK self-management text message intervention compared with control in people with low back pain (LBP). A single-blind (assessor and statistician), randomized controlled trial with economic analysis and process evaluation will be conducted. A total of 304 people with non-specific LBP of less than 12 weeks will be enrolled and randomly allocated either to TEXT4myBACK intervention or control groups. The TEXT4myBACK intervention group will receive 4 semi-personalized text messages per week providing advice, motivation, and information about LBP, physical activity, sleep, mood, use of care, and medication during 12 weeks. The control group will receive 1 text message with a link to a LBP and diet online information package. Outcomes will be assessed at baseline and 3, 6, and 12 months. The primary outcome will be function assessed with the Patient-Specific Functional Scale. Secondary outcomes will include pain intensity, physical activity participation, sedentary behavior, global impression of change, health-related quality of life, and eHealth literacy. Data on demographic characteristics, smallest worthwhile change (ie, smallest function scored needed to be achieved at the end of the intervention to consider it to be worthwhile), health care utilization, and adverse events (ie, any new health issue that occurs during participation in the study) will be collected. An economic and process evaluation will also be conducted. This study will assess if a self-management text message intervention is effective and cost-effective in improving function of people with LBP. This study can inform clinical practice of a simple, scalable, and affordable intervention for managing LBP.
Publisher: National Institute for Health and Care Research
Date: 12-2015
DOI: 10.3310/HTA191000
Abstract: Various lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation. To determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD. We searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke’s Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature. In two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year. A total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high ( I 2 = 98%) similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention. Heterogeneity in meta-analyses. While acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence. This study is registered as PROSPERO CRD42013003727. The National Institute for Health Research Health Technology Assessment programme.
Publisher: Springer Science and Business Media LLC
Date: 11-04-2022
DOI: 10.1186/S13063-022-06256-2
Abstract: Globally, bronchiectasis (BE) unrelated to cystic fibrosis (CF) is recognized as a major cause of respiratory morbidity, mortality, and healthcare utilization. Children with BE regularly experience exacerbations of their condition resulting in frequent hospitalizations and decreased health-related quality of life (HR-QoL). Guidelines for the treatment and management of BE call for regular exercise as a means of improving aerobic fitness and HR-QoL. Moreover, research in adults with BE has shown that exercise can reduce the frequency of exacerbations, a potent predictor of future lung function decline and respiratory morbidity. Yet, to date, the health benefits resulting from therapeutic exercise have not been investigated in children with BE. The BREATH, Bronchiectasis - Exercise as Therapy, trial will test the efficacy of a novel 8-week, play-based therapeutic exercise program to reduce the frequency of acute exacerbations over 12 months in children with BE (aged ≥ 4 and 13 years). Secondary aims are to determine the cost-effectiveness of the intervention and assess the program’s impact on aerobic fitness, fundamental movement skill (FMS) proficiency, habitual physical activity, HR-QoL, and lung function. This multi-center, observer-blinded, parallel-group (1:1 allocation), randomized controlled trial (RCT) will be conducted at three sites. One hundred and seventy-four children ≥ 4 and 13 years of age with BE will be randomized to a developmentally appropriate, play-based therapeutic exercise program (eight, 60-min weekly sessions, supplemented by a home-based program) or usual care. After completing the baseline assessments, the number of exacerbations and secondary outcomes will be assessed immediately post-intervention, after 6 months of follow-up, and after 12 months of follow-up. Monthly, parental contact and medical review will document acute respiratory exacerbations and parameters for cost-effectiveness outcomes. The BREATH trial is the first fully powered RCT to test the effects of a therapeutic exercise on exacerbation frequency, fitness, movement competence, and HR-QoL in children with bronchiectasis. By implementing a developmentally appropriate, play-based exercise program tailored to the in idual needs of children with bronchiectasis, the results have the potential for a major paradigm shift in the way in which therapeutic exercise is prescribed and implemented in children with chronic respiratory conditions. The exercise program can be readily translated. It does not require expensive equipment and can be delivered in a variety of settings, including the participant’s home. The program has strong potential for translation to other pediatric patient groups with similar needs for exercise therapy, including those with obesity, childhood cancers, and neurological conditions such as cerebral palsy. Australian and New Zealand Clinical Trials Register (ANZCTR) ACTRN12619001008112
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/BMJOPEN-2021-051085
Abstract: Falls have a multifactorial aetiology, which may limit the effectiveness of the common approach of exercise as the sole intervention strategy. Multifactorial interventions could be more effective in people at high risk of falling however, the focus of such interventions has traditionally been quite narrow. This paper describes the design of a randomised controlled trial that will evaluate the effectiveness of an eHealth programme, which addresses cumulative effects of key fall-risk factors across the triad of physical, affective and cognitive functions on falls in older people. 518 older people aged 65 years and over with high fall risk, defined as having a history of falls in the past 6 months, self-reported fear of falling or being aged 80 years or over, will be recruited via local advertisements, newsletters and presentations, and randomised to an intervention or health education control group. The intervention comprises balance exercise, cognitive-motor exercise and cognitive–behavioural therapy, with their dosage based on participant’s baseline balance, executive function and mood. The primary outcome is the rate of falls in the 12 months after randomisation. Secondary outcomes at 6 and 12 months comprise programme adherence, healthcare use, physical activity, balance and mobility, cognitive function, psychological well-being, quality of life, health literacy and user experience and attitudes towards the programme. Data will be analysed following intention to treat to gauge real-world effectiveness. We will further determine complier averaged causal effects to correct for varying adherence and conduct economic analyses to gain insight into cost-effectiveness and cost–utility. Ethical approval was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee in December 2017. Outcomes will be disseminated via peer-reviewed articles, conference presentations, community events and media releases. ACTRN12619000540112.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2018
End Date: 2021
Funder: National Health and Medical Research Council
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