ORCID Profile
0000-0002-8990-9514
Current Organisation
The University of Auckland
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Publisher: Elsevier BV
Date: 07-2022
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.LUNGCAN.2016.05.024
Abstract: To identify parameters that drive the cost-effectiveness of precision medicine by comparing the use of multiplex targeted sequencing (MTS) to select targeted therapy based on tumour genomic profiles to either no further testing with chemotherapy or no further testing with best supportive care in the fourth-line treatment of metastatic lung adenocarcinoma. A combined decision tree and Markov model to compare costs, life-years, and quality-adjusted life-years over a ten-year time horizon from an Australian healthcare payer perspective. Data sources included the published literature and a population-based molecular cohort study (Cancer 2015). Uncertainty was assessed using deterministic sensitivity analyses and quantified by estimating expected value of perfect artial perfect information. Uncertainty due to technological/scientific advancement was assessed through a number of plausible future scenario analyses. Point estimate incremental cost-effective ratios indicate that MTS is not cost-effective for selecting fourth-line treatment of metastatic lung adenocarcinoma. Lower mortality rates during testing and for true positive patients, lower health state utility values for progressive disease, and targeted therapy resulting in reductions in inpatient visits, however, all resulted in more favourable cost-effectiveness estimates for MTS. The expected value to decision makers of removing all current decision uncertainty was estimated to be between AUD 5,962,843 and AUD 13,196,451, indicating that additional research to reduce uncertainty may be a worthwhile investment. Plausible future scenarios analyses revealed limited improvements in cost-effectiveness under scenarios of improved test performance, decreased costs of testing/interpretation, and no biopsy costs/adverse events. Reductions in off-label targeted therapy costs, when considered together with the other scenarios did, however, indicate more favourable cost-effectiveness of MTS. As more clinical evidence is generated for MTS, the model developed should be revisited and cost-effectiveness re-estimated under different testing scenarios to further understand the value of precision medicine and its potential impact on the overall health budget.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.SOCSCIMED.2017.08.033
Abstract: Systematic differences in the ways that people use and interpret response categories (differential item functioning, DIF) can introduce bias when using self-assessments to compare health or quality of life across heterogeneous groups. This paper reports on an exploratory analysis involving the use of anchoring vignettes to identify DIF in a commonly used measure for assessing health-related quality of life - namely the EQ-5D. Using data from a bespoke (i.e. custom) survey that recruited a representative s le of 4300 respondents from the general Australian population in 2014 and 2015, we find that the assumptions of response consistency (RC) and vignette equivalence (VE) hold in a sub-s le of respondents aged 55-65 years (n = 914), which demonstrates that vignettes can appropriately identify DIF in EQ-5D reporting for this age group. We find that the EQ-5D is indeed subject to DIF, and that failure to account for DIF can lead to conclusions that are misleading when using the instrument to compare health or quality of life across heterogeneous groups. We also provide several important insights in terms of the identifying assumptions of RC and VE. We conclude that the implications of DIF could be of considerable importance, not only for outcomes research, but for funding decisions in healthcare more broadly given the strong reliance on patient-reported outcome measures in economic evaluations for health technology assessment.
Publisher: Wiley
Date: 10-10-2017
DOI: 10.1002/HEC.3433
Publisher: Wiley
Date: 12-01-2017
DOI: 10.1002/HEC.3313
Abstract: This paper discusses two types of response-scale heterogeneity, which may impact upon the EQ-5D. Response-scale heterogeneity in reporting occurs when in iduals systematically differ in their use of response scales when responding to self-assessments. This type of heterogeneity is widely observed in relation to other self-assessed measures but is often overlooked with regard to the EQ-5D. Analogous to this, preference elicitation involving the EQ-5D could be subject to a similar type of heterogeneity, where variations across respondents may occur in the interpretations of the levels (response categories) being valued. This response-scale heterogeneity in preference elicitation may differ from variations in preferences for health states, which have been observed in the literature. This paper explores what these forms of response-scale heterogeneity may mean for the EQ-5D and the potential implications for researchers who rely on the instrument as a measure of health and quality of life. We identify situations where they are likely to be problematic and present potential avenues for overcoming these issues. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Springer Science and Business Media LLC
Date: 21-11-2017
DOI: 10.1007/S40273-016-0475-Z
Abstract: Discrete choice experiments with duration (DCE A choice experiment presenting two health profiles and a third immediate death option was developed. A three-arm study was used, with the same 120 choice sets presented online across each arm (n = 360 per arm). Arm 1 presented the standard EQ-5D-5L dimension order, arm 2 randomised order between respondents, and arm 3 randomised within respondents. Conditional logit regression was used to assess model consistency, and scale parameter testing was used to assess model poolability. There were minor inconsistencies across each arm, but the magnitudes of the coefficients produced were generally consistent. Arm 3 produced the largest range of utility values (1 to -0.980). Scale parameter testing suggested that the models did not differ, and the data could be pooled. Follow-up questions did not suggest variation in terms of difficulty. The results suggest that the level of randomisation used in DCE health state valuation studies does not significantly impact values, and dimension order may not be as important as other study design issues. The results support past valuation studies that use the standard order of dimensions.
Publisher: Oxford University Press (OUP)
Date: 27-01-2018
Abstract: To investigate the attributes of Australian clinical quality registries (CQR). Survey of 40 CQRs between September 2015 and April 2016. CQR lead investigators roject managers. None. Registry organization, geographical coverage, data quality, management, characteristics, output and outcomes. Of those who responded (34/40 85.0%), 12 (34.3%) were binational (Australia and New Zealand) 22 (64.7%) were Australian-only registries and 13 (38.2%) had national coverage. CQRs covered critical care, infection control, cardiovascular diseases, cancer, chronic diseases, procedures and devices, and transplants. Overall, 24/34 CQRs (70.6%) were public sector funded. In total, 14 (41.2%) scored >75% on a composite score developed to assess data quality. Overall, 29/34 (85.3%) produced an annual multi-centred report only 15/34 (44.1%) produced provider-specific reports. Mortality/survival and quality of life were collected by 82.4 and 32.4% of CQRs, respectively. Most CQRs displayed data in bar/column charts (28/34, 82.4%) and funnel plots (17/34, 50%). Most CQRs adopted an opt-out consent process (n = 17/31 54.8%). Linear regression indicated that longer duration of CQR was associated with higher data quality (>20 vs 0-5 years coefficient = 4.76, 95% CI: 0.26, 9.26). Opt-in consent was associated with lower data quality (no active consent vs opt-in approval method, coefficient = -5.22, 95% CI: -8.71, -1.72). Six CQRs self-reported having undertaken an economic evaluation of their registry. CQRs varied in geographical coverage stage of development, approach to recruitment method and frequency of reporting their output and data quality assurance. An accreditation system for CQRs would likely assist in recognizing high-quality registries.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2014
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: BMJ
Date: 10-2014
DOI: 10.1136/BMJOPEN-2014-006661
Abstract: Medical decision-making in oncology is a complicated process and to date there are few studies examining how patients with cancer make choices with respect to different features of their care. It is also unknown whether patient choices vary by geographical location and how location could account for observed rural and metropolitan cancer differences. This paper describes an ongoing study that aims to (1) examine patient and healthcare-related factors that influence choices of patients with cancer (2) measure and quantify preferences of patients with cancer towards cancer care using a discrete choice experiment (DCE) and (3) explore preference heterogeneity between metropolitan and rural locations. A DCE is being conducted to understand how patients with cancer choose between two clinical scenarios accounting for different patient and healthcare-related factors (and levels). Preliminary qualitative research was undertaken to guide the development of an appropriate DCE design including characteristics that are important and relevant to patients with cancer. A fractional factorial design using the D-efficiency criteria was used to estimate interactions among attributes. Multinomial logistic regression will be used for the primary DCE analysis and to control for sociodemographic and clinical characteristics. The Barwon Health Human Research Ethics Committee approved the study. Findings from the study will be presented in national/international conferences and peer-reviewed journals. Our results will form the basis of a feasibility study to inform the development of a larger scale study into preferences of patients with cancer and their association with cancer outcomes.
Publisher: BMJ
Date: 03-2016
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.DRUDIS.2015.10.009
Abstract: Genomic cancer medicine promises revolutionary change in oncology. The impacts of 'personalized medicine', based upon a molecular classification of cancer and linked to targeted therapies, will extend from in idual patient outcomes to the health economy at large. To address the 'whole-of-system' impact of genomic cancer medicine, we have established a prospective cohort of patients with newly diagnosed cancer in the state of Victoria, Australia, about whom we have collected a broad range of clinical, demographic, molecular, and patient-reported data, as well as data on health resource utilization. Our goal is to create a model for investigating public investment in genomic medicine that maximizes the cost:benefit ratio for the Australian community at large.
Publisher: Informa UK Limited
Date: 21-08-2015
DOI: 10.1586/14737159.2014.929499
Abstract: The successful use of a targeted therapy is intrinsically linked to the ability of a companion diagnostic to correctly identify patients most likely to benefit from treatment. The aim of this study was to review the characteristics of companion diagnostics that are of importance for inclusion in an economic evaluation. Approaches for including these characteristics in model-based economic evaluations are compared with the intent to describe best practice methods. Five databases and government agency websites were searched to identify model-based economic evaluations comparing a companion diagnostic and subsequent treatment strategy to another alternative treatment strategy with model parameters for the sensitivity and specificity of the companion diagnostic (primary synthesis). Economic evaluations that limited model parameters for the companion diagnostic to only its cost were also identified (secondary synthesis). Quality was assessed using the Quality of Health Economic Studies instrument. 30 studies were included in the review (primary synthesis n = 12 secondary synthesis n = 18). Incremental cost-effectiveness ratios may be lower when the only parameter for the companion diagnostic included in a model is the cost of testing. Incorporating the test's accuracy in addition to its cost may be a more appropriate methodological approach. Altering the prevalence of the genetic biomarker, specific population tested, type of test, test accuracy and timing/sequence of multiple tests can all impact overall model results. The impact of altering a test's threshold for positivity is unknown as it was not addressed in any of the included studies. Additional quality criteria as outlined in our methodological checklist should be considered due to the shortcomings of standard quality assessment tools in differentiating studies that incorporate important test-related characteristics and those that do not. There is a need to refine methods for incorporating the characteristics of companion diagnostics into model-based economic evaluations to ensure consistent and transparent reimbursement decisions are made.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2016
DOI: 10.1007/S40273-015-0343-2
Abstract: There is a growing appetite for large complex databases that integrate a range of personal, socio-demographic, health, genetic and financial information on in iduals. It has been argued that 'Big Data' will provide the necessary catalyst to advance both biomedical research and health economics and outcomes research. However, it is important that we do not succumb to being data rich but information poor. This paper discusses the benefits and challenges of building Big Data, analysing Big Data and making appropriate inferences in order to advance cancer care, using Cancer 2015 (a prospective, longitudinal, genomic cohort study in Victoria, Australia) as a case study. Cancer 2015 has been linked to State and Commonwealth reimbursement databases that have known limitations. This partly reflects the funding arrangements in Australia, a country with both public and private provision, including public funding of private healthcare, and partly the legislative frameworks that govern data linkage. Additionally, linkage is not without time delays and, as such, achieving a contemporaneous database is challenging. Despite these limitations, there is clear value in using linked data and creating Big Data. This paper describes the linked Cancer 2015 dataset, discusses estimation issues given the nature of the data and presents panel regression results that allow us to make possible inferences regarding which patient, disease, genomic and treatment characteristics explain variation in health expenditure.
Publisher: Springer Science and Business Media LLC
Date: 05-03-2016
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.APMR.2012.07.007
Abstract: To explore the perceived impact of disease-related foot problems and foot care in juvenile idiopathic arthritis (JIA) from the perspectives of patients, parents, pediatric rheumatologists, and health professionals. A qualitative study using an interpretative phenomenological approach. Outpatients department, public health service children's hospital. Patients (N=15 4 adult patients, 2 parents of children with JIA, 3 pediatric rheumatologists, and 6 health professionals) from 2 National Health Service rheumatology centers (1 pediatric and 1 adult). Not applicable. Qualitative outcomes were participants' perceptions elicited using semistructured interviews (telephone or face-to-face) and focus groups using an interpretative phenomenological approach. A data-driven inductive approach to coding and theme development was adopted for transcript analysis. Participants volunteered to take part in a total of 7 interviews and 2 focus groups. The analysis revealed 6 key themes related to the impact of foot problems and perceptions of foot care from respective groups. These were the following: (1) pain, (2) mobility impairment, (3) reduced ability to perform activities of daily living, (4) footwear difficulties, (5) poor referral pathways/delayed access to care, and (6) lack of evidence in support of conservative foot care. Several areas for development of foot care services were identified including a need for improved referral pathways, shorter waiting times for initial consultations, greater attention to patient compliance, and a need for better evidence in support of customized foot orthoses. Several key foot health-related outcomes were identified, which may be of importance for measuring therapeutic response to foot-related interventions.
Publisher: BMJ
Date: 11-2016
Publisher: Future Medicine Ltd
Date: 2015
DOI: 10.2217/PME.14.81
Publisher: Springer Science and Business Media LLC
Date: 03-01-2014
DOI: 10.1007/S11136-013-0615-2
Abstract: Self-rated health (SRH) is widely used to measure and compare the health status of different groups of in iduals. However, SRH can suffer from heterogeneity in reporting styles, making health comparisons problematic. Anchoring vignettes is a promising technique for improving inter-group comparisons of SRH. A key identifying assumption of the approach is response consistency-that respondents rate themselves using the same underlying response scale that they rate the vignettes. Despite growing research into response consistency, it remains unclear how respondents rate vignettes and why respondents may not assess vignettes and themselves consistently. Vignettes for the EQ-5D-5L were developed and included in an online survey. In-depth interviews were conducted with participants following survey completion. Response consistency was examined through qualitative analysis of the interview responses and quantitative coding of participants' thought processes. Our analysis showed that anchoring vignettes for the EQ-5D-5L is feasible, but that response consistency may not hold for some participants. Respondents are more likely to rate their own health and vignettes in the same way if presented with overall health state vignettes than single health dimension vignettes, and if they imagined themselves in the health state of the hypothetical in idual. This research highlights opportunities to improve the design of anchoring vignettes in order to enhance response consistency. It additionally provides new evidence on the feasibility of employing anchoring vignettes for the EQ-5D-5L, which is promising for future work to address reporting heterogeneity in the EQ-5D-5L.
Publisher: Hindawi Limited
Date: 2016
DOI: 10.1155/2016/9754230
Abstract: Objective . Treating complications associated with diabetes and hypertension imposes significant costs on health care systems. This study estimated the hospitalization costs for inpatients in a public hospital in Zimbabwe. Methods . The study was retrospective and utilized secondary data from medical records. Total hospitalization costs were estimated using generalized linear models. Results . The median cost and interquartile range (IQR) for patients with diabetes, $994 (385–1553) mean $1319 (95% CI: 981–1657), was higher than patients with hypertension, $759 (494–1147) mean $914 (95% CI: 825–1003). Female patients aged below 65 years with diabetes had the highest estimated mean costs ($1467 (95% CI: 1177–1828)). Wound care had the highest estimated mean cost of all procedures, $2884 (95% CI: 2004–4149) for patients with diabetes and $2239 (95% CI: 1589–3156) for patients with hypertension. Age below 65 years, medical procedures ( utation, wound care, dialysis, and physiotherapy), the presence of two or more comorbidities, and being prescribed two or more drugs were associated with significantly higher hospitalization costs. Conclusion . Our estimated costs could be used to evaluate and improve current inpatient treatment and management of patients with diabetes and hypertension and determine the most cost-effective interventions to prevent complications and comorbidities.
Publisher: BMJ
Date: 23-09-2014
Publisher: Medical Journals Sweden AB
Date: 2013
Abstract: To evaluate the effectiveness of multidisciplinary foot-care, and to evaluate the methodological considerations of a trial of multidisciplinary care in juvenile idiopathic arthritis. Exploratory randomised controlled trial. Children/adolescents with juvenile idio-pathic arthritis and inflammatory joint disease affecting the foot/ankle. Standard medical care was compared with a 12 month program of multidisciplinary foot-care informed by musculoskeletal ultrasound. This program was centred on strict disease control through rigorous examination and interventions delivered by a team comprised of a paediatric rheumatologist, podiatrist, physiotherapist and musculoskeletal ultrasonographer. Patients were assessed on foot impairment and disability scores using the Juvenile Arthritis Foot Disability Index. Forty-four participants, aged 3-17 years were randomly assigned to receive the experimental (n = 21) or usual care (n = 23) interventions. There was an overall improvement in levels of foot related impairments in both groups over 12 months. Between-group differences in change scores for the Juvenile Arthritis Foot Disability Index were not statistically significant at 6 or 12 month follow-ups. The integrated multidisciplinary foot care interventions described in this trial were safe, but did not improve foot impairment levels relative to usual care. This trial identified several methodological challenges including recruitment/retention, difficulties with outcome tools and potential confounders.
Publisher: Springer Science and Business Media LLC
Date: 31-01-2023
Publisher: Springer Science and Business Media LLC
Date: 23-01-2017
Publisher: Springer Science and Business Media LLC
Date: 09-11-2016
Publisher: Springer Science and Business Media LLC
Date: 29-11-2014
DOI: 10.1007/S00038-014-0626-Y
Abstract: Diabetes appears to be a growing problem in the African region. This study aims to estimate the prevalence of diabetes in Zimbabwe by collating and analyzing previously published data. Systematic review and meta-analysis of data reporting prevalence of diabetes in Zimbabwe was conducted based on the random effects model. We searched for studies published between January 1960 and December 2013 using MEDLINE, EMBASE and Scopus and University of Zimbabwe electronic publication libraries. In the meta-analysis, sub-groups were created for studies conducted before 1980 and after 1980, to understand the potential effect of independence on prevalence. Seven studies were included in the meta-analysis with a total of 29,514 study participants. The overall pooled prevalence of diabetes before 1980 was 0.44% (95% CI 0.0-1.9%), after 1980 the pooled prevalence was 5.7% (95% CI 3.3-8.6%). This study showed that the prevalence of diabetes in Zimbabwe has increased significantly over the past three decades. This poses serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting.
Publisher: Harborside Press, LLC
Date: 03-2016
Abstract: This study sought to understand the preferences of patients with cancer and the trade-offs between appointment attributes using discrete choice experiment (DCE). Patients with cancer at 3 hospitals completed a self-administered DCE. Each scenario described 6 attributes: expertise of health care professionals (HCPs), familiarity of doctors with patients' medical history, waiting time, accompaniment by family/friends, travel time, and out-of-pocket costs. Patient preferences were estimated using logistic regression. Willingness to pay (WTP) estimates were derived from regression coefficients. Of 512 patients contacted, 185 returned the questionnaire. The mean age was 61 years, and 60% of respondents were female. The mean time since cancer diagnosis was 34 months, 90% had received treatment and 61% had early-stage disease. The most important attributes were expertise and familiarity of doctors with patients' medical history distance traveled was least likely to influence patient preferences. The WTP analysis estimated that patients were willing to pay $680 (95% CI, 470-891) for an appointment with a specialist, $571 (95% CI, 388-754) for doctors familiar with their history, $422 (95% CI, 262-582) for shorter waiting times, $399 (95% CI, 249-549) to be accompanied by family/friends, and $301 (95% CI, 162-441) for shorter traveling times. Male patients had a stronger preference for accompaniment by family/friends. The expertise of HCP was the most important attribute for patients regardless of geographic remoteness. Our study can assist the development of patient-centered health care models that improve patient access to experienced HCPs, support the role of primary care providers during the cancer journey, and educate patients about the roles of non-oncology HCPs to cope with increasing demand for cancer care.
Publisher: Springer Science and Business Media LLC
Date: 30-06-2009
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.HEALTHPOL.2019.07.007
Abstract: Pay-for-Performance (P4P) schemes have become increasingly common internationally, yet evidence of their effectiveness remains ambiguous. P4P has been widely used in England for over a decade both in primary and secondary care. A prominent P4P programme in secondary care is the Commissioning for Quality and Innovation (CQUIN) framework. The most recent addition to this framework is Prescribed Specialised Services (PSS) CQUIN, introduced into the NHS in England in 2013. This study offers a review and critique of the PSS CQUIN scheme for specialised care. A key feature of PSS CQUIN is that whilst it is centrally developed, performance targets are agreed locally. This means that there is variation across providers in the schemes selected from the national menu, the achievement level needed to earn payment, and the proportion of the overall payment attached to each scheme. Specific schemes vary in terms of what is incentivised - structure, process and/or outcome - and how they are incentivised. Centralised versus decentralised decision making, the nature of the performance measures, the tiered payment structure and the dynamic nature of the schemes have created a sophisticated but complex P4P programme which requires evaluation to understand the effect of such incentives on specialised care.
Publisher: Informa UK Limited
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 13-10-2023
Publisher: Springer Science and Business Media LLC
Date: 04-11-2013
Publisher: SAGE Publications
Date: 18-09-2018
Abstract: Objectives. To assess the external validity of mapping algorithms for predicting EQ-5D-3L utility values from EORTC QLQ-C30 responses not previously validated and to assess whether statistical models not previously applied are better suited for mapping the EORTC QLQ-C30 to the EQ-5D-3L. Methods. In total, 3866 observations for 1719 patients from a longitudinal study (Cancer 2015) were used to validate existing algorithms. Predictive accuracy was compared to previously validated algorithms using root mean squared error, mean absolute error across the EQ-5D-3L range, and for 10 tumor-type specific s les as well as using differences between estimated quality-adjusted life years. Thirteen new algorithms were estimated using a subset of the Cancer 2015 data (3203 observations for 1419 patients) applying various linear, response mapping, beta, and mixture models. Validation was performed using 2 data sets composed of patients with varying disease severity not used in the estimation and all available algorithms ranked on their performance. Results. None of the 5 existing algorithms offer an improvement in predictive accuracy over preferred algorithms from previous validation studies. Of the newly estimated algorithms, a 2-part beta model performed the best across the validation criteria and in data sets composed of patients with different levels of disease severity. Validation results did, however, vary widely between the 2 data sets, and the most accurate algorithm appears to depend on health state severity as the distribution of observed EQ-5D-3L values varies. Linear models performed better for patients in relatively good health, whereas beta, mixture, and response mapping models performed better for patients in worse health. Conclusion. The most appropriate mapping algorithm to apply in practice may depend on the disease severity of the patient s le whose utility values are being predicted.
Publisher: Wiley
Date: 29-06-2015
DOI: 10.1111/AJR.12203
Abstract: This paper aims to describe cancer survival and examine association between survival and socio-demographic characteristics across Barwon South-Western region (BSWR) in Victoria, Australia. This study is based on the retrospective cohort database of patients accessing oncology services across BSWR. Six rural and three urban hospital settings across the BSWR. The participants were patients who were diagnosed with cancer in 2009. Overall survival (OS) of participants was the main outcome measure. Total of 1778 eligible patients had four-year OS for all cancers combined of 59.7% (95% CI, 57.4-62.0). Improved OS was observed for patients in the upper socio-economic tertile (64.2% 95% CI, 60.9-67.5) compared to the middle (59.3% 95% CI, 55.5-63.1) and lowest tertiles (49.6% 95% CI, 44.2-54.9) (P < 0.01). On multivariate analyses, higher socio-economic status remained a significant predictor of OS adjusting for gender, remoteness and age (HR [hazard ratio] 0.81 95% CI 0.74-0.89 P < 0.01). Remoteness was significantly associated with improved OS after adjusting for age, gender and socio-economic status (HR 0.86 95% CI, 0.77-0.97 P = 0.01). Older age ≥70 years compared to <70 years conferred inferior OS (HR 3.08 95% CI, 2.64-3.59 P < 0.01). Our study confirmed improved survival outcomes for patients of higher socio-economic status and younger age. Future research to explain the unexpected survival benefit in patients who lived in more remote areas should examine factors including the correlation between geographical residence and eventual treatment facility as well as compare the BSWR care model to other regions' approaches.
Publisher: Future Medicine Ltd
Date: 09-2013
DOI: 10.2217/PGS.13.142
Abstract: The development of genomic technologies has ushered in the era of pharmacogenomics. However, discoveries and clinical use of targeted therapies are still in their infancy. A focus on monogenic pharmacogenetic traits may contribute to this lack of progress. Variation in drug response is likely a complex paradigm involving not only genomic factors but proteomic, metabolomic and epigenomic influences. The incorporation of these omics elements into pharmaceutical development and clinical decision-making will ultimately require the use of methods to determine clinical and economic value. Current methodologies and guidelines for determining clinical effectiveness and cost–effectiveness may have limited applicability to the increasingly personalized nature of omics treatment strategies. Using ex les from oncology, this article argues for the adaptation and tailoring of three existing methods for ensuring development and clinical use of multiomics-guided therapies that are effective, safe and offer value for money.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2018
DOI: 10.1007/S11136-018-2061-7
Abstract: The purpose of the study was to compare completeness, timeliness and cost of patient-reported outcome measures (PROMs) collection using telephone, email and post in men with prostate cancer. A parallel, three-arm randomised controlled equivalence trial. 1168 patients were randomised to telephone (n = 295), postal (n = 388) and email (n = 385) arms. Participants were asked to provide self-reported responses for 26 items of Expanded Prostate Cancer Index Composite. Cost and resource data were collected from a provider perspective. Equivalence tests showed no difference in completeness in the three arms within a 10% equivalence margin. Men diagnosed in public hospitals were less likely to complete the survey compared to those in private hospitals, OR = 0.19 (95% CI 0.04-0.89) (p = 0.035). The email survey required significantly less time to complete than telephone and postal methods [median time of 2 min (IQR 1,8) vs. 7 min (IQR 6,9) vs. 10 min (IQR 9,12), respectively (p < 0.001)]. The incremental cost effectiveness ratio for email compared to telephone was AUD$1.90, cost-effective if users valued an additional 1% improvement in survey completion greater than AUD$1.90. Email method took less time and cost and should be used as the primary PROMs collection, with telephone if men without email or do not respond to email.
Publisher: Wiley
Date: 08-07-2013
DOI: 10.1002/HEC.2957
Abstract: This paper studies short-run cyclical behaviour of public (government and social) and private health expenditure and GDP using both time series and panel data techniques. First, national time series data have been used within a multivariate Beveridge-Nelson decomposition framework to construct the permanent and cyclical components. The correlation analysis results for the cyclical components suggest that current public health expenditure is pro-cyclical while there is no clear evidence of a correlation between cycles in private health expenditure and in GDP growth. Next, using an instrumental variable method and the generalised method of moments estimator, provincial-level panel data analyses confirm pro-cyclical impacts of government spending on health. The provincial analysis also suggests that private health expenditure in urban China has a pro-cyclical association with GDP growth, but a lack of good instruments makes it difficult to identify a clear causal link between cycles in income growth and private health expenditure. The results suggest two policy recommendations relevant to public health expenditure, in line with China's current health reforms.
Publisher: Public Library of Science (PLoS)
Date: 30-11-2022
DOI: 10.1371/JOURNAL.PONE.0277936
Abstract: As mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs. This study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID. Ethical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID. Researchregistry: rowse-the-registry#home/registrationdetails/6246bfeeeaaed6001f08dadc/ .
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2014
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2011
End Date: 2017
Funder: National Health and Medical Research Council
View Funded Activity