Review of methods and study designs of evaluations related to clinical pathways.

Objective The HealthPathways program is an online information portal that helps clinicians provide consistent and integrated patient care within a local health system through localised pathways for diagnosis, treatment and management of various health conditions. These pathways are consistent with the definition of clinical pathways. Evaluations of HealthPathways programs have thus far focused primarily on website utilisation and clinical users' experience and satisfaction, with limited evidence on changes to patient outcomes. This lack motivated a literature review of the effects of clinical pathways on patient and economic outcomes to inform a subsequent HealthPathways evaluation. Methods A systematic review was performed to summarise the analytical methods, study designs and results of studies evaluating clinical pathways with an economic outcome component published between 1 January 2000 and 31 August 2017 in four academic literature databases. Results Fifty-five relevant articles were identified for inclusion in this review. The practical pre-post study design with retrospective baseline data extraction and prospective intervention data collection was most commonly used in the evaluations identified. Straightforward statistical methods for comparing outcomes, such as the t-test or χ2 test, were frequently used. Only four of the 55 articles performed a cost-effectiveness analysis. Clinical pathways were generally associated with improved patient outcomes and positive economic outcomes in hospital settings. Conclusions Clinical pathways evaluations commonly use pragmatic study designs, straightforward statistical tests and cost-consequence analyses. More HealthPathways program evaluations focused on patient and economic outcomes, clinical pathway evaluations in a primary care setting and cost-effectiveness analyses of clinical pathways are needed. What is known about the topic? HealthPathways is a web-based program that originated from Canterbury, New Zealand, and has seen uptake elsewhere in New Zealand, Australia and the UK. The HealthPathways program aims to assist the provision of consistent and integrated health services through dedicated, localised pathways for various health conditions specific to the health region. Evaluations of HealthPathways program focused on patient and economic outcomes have been limited. What does this paper add? This review synthesises the academic literature of clinical pathways evaluations in order to inform a subsequent HealthPathways evaluation. The focus of the synthesis was on the analytical methods and study designs used in the previous evaluations. The previous clinical pathway evaluations have been pragmatic in nature with relatively straightforward study designs and analysis. What are the implications for practitioners? There is a need for more economic and patient outcome evaluations for HealthPathways programs. More sophisticated statistical analyses and economic evaluations could add value to these evaluations, where appropriate and taking into consideration the data limitations.

The economic impact of pig-associated parasitic zoonosis in Northern Lao PDR.

The parasitic zoonoses human cysticercosis (Taenia solium), taeniasis (other Taenia species) and trichinellosis (Trichinella species) are endemic in the Lao People's Democratic Republic (Lao PDR). This study was designed to quantify the economic burden pig-associated zoonotic disease pose in Lao PDR. In particular, the analysis included estimation of the losses in the pork industry as well as losses due to human illness and lost productivity. A Markov-probability based decision-tree model was chosen to form the basis of the calculations to estimate the economic and public health impacts of taeniasis, trichinellosis and cysticercosis. Two different decision trees were run simultaneously on the model's human cohort. A third decision tree simulated the potential impacts on pig production. The human capital method was used to estimate productivity loss. The results found varied significantly depending on the rate of hospitalisation due to neurocysticerosis. This study is the first systematic estimate of the economic impact of pig-associated zoonotic diseases in Lao PDR that demonstrates the significance of the diseases in that country.

Cost estimate of bovine tuberculosis to Ethiopia.

While bovine tuberculosis (BTB) has been eliminated in some industrialized countries, it prevails worldwide, particularly in Africa. In Ethiopia, BTB is prevalent as numerous studies have shown its occurrence in livestock and in abattoirs but it has not been demonstrated in wildlife and only very few cases have been found in humans. The objective of this study is to estimate the cost of BTB to Ethiopia with the aim of informing Ethiopian policy on options for BTB control. BTB in livestock affects both animal productivity and herd demographic composition. The Livestock Development Planning System (LDPS2, FAO) was modified to allow for stochastic simulation of parameters. We performed an incremental cost of disease analysis, comparing livestock production with and without BTB. For the rural scenario we considered an endemically stable 4 % comparative intradermal test (CIDT) prevalence and for the urban scenario an endemically stable 32 % CIDT prevalence among cattle. The net present value of rural Ethiopian livestock products in 2005 is estimated at 65.7 billion (thousand million) Ethiopian Birr (95 % Confidence Interval (CI) 53.8-77.7 billion Birr), which is the equivalent of 7.5 billion US$ (95 %CI 6.1-8.9 billion US$) at a rate of 8.7 Birr per US$ in 2005. The cost of BTB ranges from 646 million Birr (75.2 million US$) in 2005 to 3.1 Billion Birr in 2011 (358 million US$) but is within the range of uncertainty of our estimate and can thus not be distinguished from zero. The cost of disease in the urban livestock production ranges from 5 to 42 million Birr (500,000-4.9 million US$) between 2005 and 2011 but is also within the range of uncertainty of our estimate. Our study shows no measurable loss in asset value or cost of disease due to BTB in rural and urban production systems in Ethiopia. This does not mean that there is not a real cost of disease, but the variability of the productivity parameters and prices are high and would require more precise estimates. This study does not preclude in any way the urgent need to control BTB in the urban dairy herd of Addis Ababa for other than financial reasons.