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1.
Australas J Ageing ; 38 Suppl 2: 75-82, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31496068

RESUMEN

OBJECTIVE: To investigate the decision-making processes applied by people with dementia and family carers participating in using health economic approaches to value dementia-specific quality of life states. METHODS: People with dementia (n = 13) and family carers (n = 14) participated in valuing quality of life states using two health economic approaches: Discrete Choice Experiment (DCE) and Best Worst Scaling (BWS). Participants were encouraged to explain their reasoning using a "Think Aloud" approach. RESULTS: People with dementia and family carers adopted a range of decision-making strategies including "anchoring" the presented states against current quality of life, or simplifying the decision-making by focusing on the sub-set of attributes deemed most important. Overall, there was strong evidence of task engagement for BWS and DCE. CONCLUSIONS: Health economic valuation approaches can be successfully applied with people with dementia and family carers. These data can inform the assessment of benefits from their perspectives for incorporation within economic evaluation.

2.
Blood Transfus ; : 1-10, 2019 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-31403930

RESUMEN

BACKGROUND: Hospital-based intravenous immunoglobulin (IVIg) treatment has been the standard treatment mode for patients with primary immunodeficiency disease (PID). With the newer home-based subcutaneous immunoglobulin (SCIg) becoming approved for use in most countries, the question arises as to whether SCIg is a cost-effective treatment mode compared to IVIg in Australia. MATERIALS AND METHODS: We developed a Markov cohort simulation model with six health states: PID without infection, PID with infection treated at home or hospital, bronchiectasis without infection, bronchiectasis with infection treated at home or hospital, bronchiectasis with chronic Pseudomonas aeruginosa infection, and death, from an Australian healthcare system perspective. A 10-year time horizon with weekly cycles was chosen, and the expected costs and quality-adjusted life-years (QALYs) of the two treatment options estimated. RESULTS: The cumulative 10-year cost per patient was 297,547 Australian dollars (A$) with IVIg and A$ 251,713 for SCIg. IVIg resulted in 5.55 QALYs and SCIg 5.57 QALYs. Thus, SCIg appears to be a cost-saving option and possibly improves QALY from the Australian healthcare system perspective (i.e., the dominant treatment option). A probabilistic sensitivity analysis showed that the SCIg option is preferred in 93.2% of simulations given willingness to pay of A$ 50,000 per QALY gained. DISCUSSION: The results suggest that home-based SCIg is a cost-effective treatment option for patients with PID in Queensland, Australia.

3.
Artículo en Inglés | MEDLINE | ID: mdl-31226787

RESUMEN

Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident's quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings.


Asunto(s)
Eficiencia Organizacional , Casas de Salud/organización & administración , Asignación de Recursos para la Atención de Salud , Humanos , Calidad de Vida
4.
Vox Sang ; 114(3): 237-246, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30883804

RESUMEN

BACKGROUND AND OBJECTIVE: Immunoglobulin replacement therapy (IRT) is often used to support patients with primary immunodeficiency disease (PID) and secondary immunodeficiency disease (SID). Home-based subcutaneous immunoglobulin (SCIg) is reported to be a cheaper and more efficient option compared to hospital-based intravenous immunoglobulin (IVIg) for PID. In contrast, there is little information on the cost-effectiveness of IRT in SID. However, patients who develop hypogammaglobulinaemia secondary to other conditions (SID) have different clinical aetiology compared to PID. This study assesses whether SCIg provides a good value-for-money treatment option in patients with secondary immunodeficiency disease (SID). METHODS: A Markov cohort simulation model with six health states was used to compare cost-effectiveness of IVIg with SCIg from a healthcare system perspective. The costs of treatment, infection and quality-adjusted life years (QALYs) for IVIg and SCIg treatment options were modelled with a time horizon of 10 years and weekly cycles. Deterministic and probabilistic sensitivity analyses were performed around key parameters. RESULTS: The cumulative cost for IVIg was A$151 511 and for SCIg A$144 296. The QALYs with IVIg were 3·07 and with SCIg 3·51. Based on the means, SCIg is the dominant strategy with better outcomes and at lower cost. The probabilistic sensitivity analysis shows that 88·3% of the 50 000 iterations fall below the nominated willingness to pay threshold of A$50 000 per QALY. Therefore, SCIg is a cost-effective treatment option. CONCLUSION: For SID patients in Queensland (Australia), the home-based SCIg treatment option provides better health outcomes and cost savings.


Asunto(s)
Análisis Costo-Beneficio , Inmunización Pasiva/economía , Inmunoglobulinas Intravenosas/economía , Australia , Femenino , Costos de Hospital , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Inmunoglobulinas Intravenosas/uso terapéutico , Síndromes de Inmunodeficiencia/terapia , Masculino
5.
J Interprof Care ; 33(6): 619-627, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30822181

RESUMEN

Interprofessional education (IPE) programs in residential aged care facilities (RACF) contributes to the care of older adults whilst providing an environment for students to learn and practise in an interprofessional manner. Clinical placements are provided by RACF through funding and support from universities in collaboration with the RACF. Conducting a benefit-cost analysis (BCA) can determine the sustainability of a clinical placement program such as an IPE program but there is limited research reporting the economic aspects of clinical placements even though it is a university and government priority. This study provides a benefit-cost analysis of an interprofessional education program offered by a residential aged care provider in Western Australia. Analysis using a BCA methodology was conducted to provide information about the level and distribution of the costs and benefits from different analytical perspectives over the three-year period of the IPE program. The analysis showed that the program was highly beneficial from an economic efficiency viewpoint, even though it did not present a financial gain for the aged care provider. The benefits accrued mainly to students in terms of increased education and skill, and to residents in terms of health outcomes and quality of life, while the cost was mostly incurred by the care provider. An IPE program in a RACF is a valuable educational learning experience for students and is also socially beneficial for residents and the broader health sector. For IPE programs in aged care to be sustainable, they require the development of collaborative partnerships with external funding.

6.
BMC Geriatr ; 18(1): 297, 2018 12 03.
Artículo en Inglés | MEDLINE | ID: mdl-30509204

RESUMEN

BACKGROUND: To evaluate a Geriatric Emergency Department Intervention (GEDI) model of service delivery for adults aged 70 years and older. METHODS: A pragmatic trial of the GEDI model using a pre-post design. GEDI is a nurse-led, physician-championed, Emergency Department (ED) intervention; developed to improve the care of frail older adults in the ED. The nurses had gerontology experience and education and provided targeted geriatric assessment and streamlining of care. The final format included 2.4 full time equivalent nurses working 7 days from 0700 h to 1730 h (1530 h at weekends). There were three implementations periods: pre-implementation (2012); a developmental phase from January 2013 to August 2015; and full implementation from September 2015 to August 2016. The outcomes measured were disposition (discharged home, admitted or died); ED length of stay; hospital length of stay; all cause in-hospital mortality within 28 days; time to ED re-presentation up to 28 days post-discharge; in-hospital costs. The setting was a tertiary hospital ED, with 385 beds, in Queensland, Australia. Approximately 53,000 patients presented to the ED annually with 20% aged 70 years and older. All patients over the age 70 who presented to the ED between January 2012 and August 2016 (n = 44,983) were included in the trial. RESULTS: Older persons who presented to the ED when the GEDI team were working had increased likelihoods of discharge (Hazard ratio (HR) = 1.19; 95% CI: 1.13-1.24) and reduced ED length of stay (HR = 1.42; 95% CI: 1.33-1.52) compared with those who presented when GEDI were not working. There was no increase in the risk of mortality (HR = 1.01; 95% CI = 0.23-4.43) or risk of same cause re-presentation to 28 days (HR = 1.21; 95% CI: 0.99-1.49). The GEDI service resulted in average cost savings per ED presentation of $35 [95% CI, $21, $49] and savings of $1469 [95% CI, $1105, $1834] per hospital admission. CONCLUSIONS: Implementation of a nurse-led physician-championed model of ED care, focused on frail older adults, reduced ED length of stay, hospital admission and if admitted, hospital length of stay and cost, without increasing mortality or same cause re-presentation. These increases were sustained over time and after the initial implementation team had changed roles. TRIAL REGISTRATION: Australian Clinical Trials Registration Number ACTRN12615001157561 - retrospectively registered on 29/10/2015. Data were retrieved via retrospective access to clinical information systems. First data access was on 1/7/2015.


Asunto(s)
Servicios Médicos de Urgencia/tendencias , Servicio de Urgencia en Hospital/tendencias , Evaluación Geriátrica , Tiempo de Internación/tendencias , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia/economía , Servicios Médicos de Urgencia/métodos , Servicio de Urgencia en Hospital/economía , Femenino , Anciano Frágil , Evaluación Geriátrica/métodos , Mortalidad Hospitalaria/tendencias , Hospitalización/economía , Hospitalización/tendencias , Humanos , Tiempo de Internación/economía , Masculino , Alta del Paciente/economía , Alta del Paciente/tendencias , Queensland/epidemiología , Estudios Retrospectivos
7.
Int Psychogeriatr ; 30(11): 1593-1605, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30475198

RESUMEN

ABSTRACTObjective:To identify, review, and critically appraise model-based economic evaluations of all types of interventions for people with dementia and their carers. DESIGN: A systematic literature search was undertaken to identify model-based evaluations of dementia interventions. A critical appraisal of included studies was carried out using guidance on good practice methods for decision-analytic models in health technology assessment, with a focus on model structure, data, and model consistency. SETTING: Interventions for people with dementia and their carers, across prevention, diagnostic, treatment, and disease management. RESULTS: We identified 67 studies, with 43 evaluating pharmacological products, 19 covering prevention or diagnostic strategies, and 5 studies reporting non-pharmacological interventions. The majority of studies use Markov models with a simple structure to represent dementia symptoms and disease progression. Half of all studies reported taking a societal perspective, with the other half adopting a third-party payer perspective. Most studies follow good practices in modeling, particularly related to the decision problem description, perspective, model structure, and data inputs. Many studies perform poorly in areas related to the reporting of pre-modeling analyses, justifying data inputs, evaluating data quality, considering alternative modeling options, validating models, and assessing uncertainty. CONCLUSIONS: There is a growing literature on the model-based evaluations of interventions for dementia. The literature predominantly reports on pharmaceutical interventions for Alzheimer's disease, but there is a growing literature for dementia prevention and non-pharmacological interventions. Our findings demonstrate that decision-makers need to critically appraise and understand the model-based evaluations and their limitations to ensure they are used, interpreted, and applied appropriately.


Asunto(s)
Enfermedad de Alzheimer/economía , Enfermedad de Alzheimer/terapia , Cuidadores , Costos de la Atención en Salud , Modelos Económicos , Modelos Estadísticos , /economía , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Cuidadores/economía , Cuidadores/psicología , Cognición , Costo de Enfermedad , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Progresión de la Enfermedad , Indicadores de Salud , Humanos , Factores de Tiempo , Resultado del Tratamiento
8.
Value Health ; 21(4): 471-481, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29680105

RESUMEN

BACKGROUND: Several utility-based instruments have been applied in cost-utility analysis to assess health state values for people with dementia. Nevertheless, concerns and uncertainty regarding their performance for people with dementia have been raised. OBJECTIVES: To assess the performance of available utility-based instruments for people with dementia by comparing their psychometric properties and to explore factors that cause variations in the reported health state values generated from those instruments by conducting meta-regression analyses. METHODS: A literature search was conducted and psychometric properties were synthesized to demonstrate the overall performance of each instrument. When available, health state values and variables such as the type of instrument and cognitive impairment levels were extracted from each article. A meta-regression analysis was undertaken and available covariates were included in the models. RESULTS: A total of 64 studies providing preference-based values were identified and included. The EuroQol five-dimension questionnaire demonstrated the best combination of feasibility, reliability, and validity. Meta-regression analyses suggested that significant differences exist between instruments, type of respondents, and mode of administration and the variations in estimated utility values had influences on incremental quality-adjusted life-year calculation. CONCLUSIONS: This review finds that the EuroQol five-dimension questionnaire is the most valid utility-based instrument for people with dementia, but should be replaced by others under certain circumstances. Although no utility estimates were reported in the article, the meta-regression analyses that examined variations in utility estimates produced by different instruments impact on cost-utility analysis, potentially altering the decision-making process in some circumstances.


Asunto(s)
Demencia/economía , Demencia/terapia , Costos de la Atención en Salud , Indicadores de Salud , /economía , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Demencia/diagnóstico , Demencia/psicología , Estado de Salud , Humanos , Salud Mental , Modelos Económicos , Valor Predictivo de las Pruebas , Calidad de Vida , Encuestas y Cuestionarios , Resultado del Tratamiento
9.
BMJ Open ; 8(1): e018996, 2018 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-29358437

RESUMEN

INTRODUCTION: Generic instruments for assessing health-related quality of life may lack the sensitivity to detect changes in health specific to certain conditions, such as dementia. The Quality of Life in Alzheimer's Disease (QOL-AD) is a widely used and well-validated condition-specific instrument for assessing health-related quality of life for people living with dementia, but it does not enable the calculation of quality-adjusted life years, the basis of cost utility analysis. This study will generate a preference-based scoring algorithm for a health state classification system -the Alzheimer's Disease Five Dimensions (AD-5D) derived from the QOL-AD. METHODS AND ANALYSIS: Discrete choice experiments with duration (DCETTO) and best-worst scaling health state valuation tasks will be administered to a representative sample of 2000 members of the Australian general population via an online survey and to 250 dementia dyads (250 people with dementia and their carers) via face-to-face interview. A multinomial (conditional) logistic framework will be used to analyse responses and produce the utility algorithm for the AD-5D. ETHICS AND DISSEMINATION: The algorithms developed will enable prospective and retrospective economic evaluation of any treatment or intervention targeting people with dementia where the QOL-AD has been administered and will be available online. Results will be disseminated through journals that publish health economics articles and through professional conferences. This study has ethical approval.


Asunto(s)
Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/terapia , Escalas de Valoración Psiquiátrica , Calidad de Vida , Proyectos de Investigación , Australia , Cuidadores/psicología , Análisis Costo-Beneficio , Humanos , Modelos Logísticos , Estudios Prospectivos , Psicometría , Años de Vida Ajustados por Calidad de Vida , Estudios Retrospectivos , Encuestas y Cuestionarios
10.
Trials ; 19(1): 37, 2018 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-29329559

RESUMEN

BACKGROUND: Complex medication regimens are highly prevalent in residential aged care facilities (RACFs). Strategies to reduce unnecessary complexity may be valuable because complex medication regimens can be burdensome for residents and are costly in terms of nursing time. The aim of this study is to investigate application of a structured process to simplify medication administration in RACFs. METHODS: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) is a non-blinded, matched-pair, cluster randomised controlled trial of a single multidisciplinary intervention to simplify medication regimens. Trained study nurses will recruit English-speaking, permanent residents from eight South Australian RACFs. Medications taken by residents in the intervention arm will be assessed once using a structured tool (the Medication Regimen Simplification Guide for Residential Aged CarE) to identify opportunities to reduce medication regimen complexity (e.g. by administering medications at the same time, or through the use of longer-acting or combination formulations). Residents in the comparison group will receive routine care. Participants will be followed for up to 36 months after study entry. The primary outcome measure will be the total number of charted medication administration times at 4 months after study entry. Secondary outcome measures will include time spent administering medications, medication incidents, resident satisfaction, quality of life, falls, hospitalisation and mortality. Individual-level analyses that account for clustering will be undertaken to determine the impact of the intervention on the study outcomes. DISCUSSION: Ethical approval has been obtained from the Monash University Human Research Ethics Committee and the aged care provider organisation. Research findings will be disseminated through conference presentations and peer-reviewed publications. SIMPLER will enable an improved understanding of the burden of medication use in RACFs and quantify the impact of regimen simplification on a range of outcomes important to residents and care providers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617001060336 . Retrospectively registered on 20 July 2017.


Asunto(s)
Cuidados a Largo Plazo , Administración del Tratamiento Farmacológico , Anciano , Análisis por Conglomerados , Recolección de Datos , Estudios de Evaluación como Asunto , Médicos Generales , Humanos , Garantía de la Calidad de Atención de Salud , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
BMC Health Serv Res ; 17(1): 797, 2017 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-29191183

RESUMEN

BACKGROUND: Advance care planning (ACP) is a process of planning for future health and personal care. A person's values and preferences are made known so that they can guide decision making at a future time when that person cannot make or communicate his or her decisions. This is particularly relevant for people with dementia because their ability to make decisions progressively deteriorates over time. This study aims to evaluate the cost-effectiveness of delivering a nationwide ACP program within the Australian primary care setting. METHODS: A decision analytic model was developed to identify the costs and outcomes of an ACP program for people aged 65+ years who were at risk of developing dementia. Inputs for the model was sourced and estimated from the literature. The reliability of the results was thoroughly tested in sensitivity analyses. RESULTS: The results showed that, compared to usual care, a nationwide ACP program for people aged 65+ years who were at risk of dementia would be cost-effective. However, the results only hold if ACP completion is higher than 50% and adherence to ACP wishes is above 75%. CONCLUSIONS: A nationwide ACP program in the primary care setting is a cost-effective or cost-saving intervention compared to usual care in a population at-risk of developing dementia. Cost savings are generated from providing treatment and care that is consistent with patient preferences, resulting in fewer hospitalisations and less-intensive care at end-of-life.


Asunto(s)
Planificación Anticipada de Atención/economía , Análisis Costo-Beneficio , Demencia/terapia , Modelos Económicos , Prioridad del Paciente/economía , Anciano , Australia , Toma de Decisiones , Demencia/economía , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Reproducibilidad de los Resultados
12.
Asian Pac J Cancer Prev ; 18(4): 1063-1067, 2017 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-28547942

RESUMEN

Background: Effective skin self-examination can enable early diagnosis and treatment of skin cancer, which otherwise could result in significant morbidity and mortality. We compare the effects of watching a DVD and reading printed materials on self skin examination. Methods: Longitudinal data from the Randomized Skin Awareness Trial were analysed (n=984). The control group were provided with written materials describing how to conduct effective skin self-examination. The intervention group received additional instruction from a DVD. It was hypothesized that self skin examination may be confounded by unobserved variables. A recursive model was specified to control for this potential source of bias. Results: At six months only watching the DVD had a statistically significant effect on diagnosed skin cancer. By 12 months both interventions were statistically significant; reading the printed materials was 63% as effective as watching the DVD. Conclusion: Watching a DVD was associated with the largest increase in diagnosed skin cancer. However, reading written materials was also associated with an increase in diagnosed skin cancer. Both visual and written communication should be considered when designing an effective skin self-examination programme.

13.
BMC Geriatr ; 17(1): 76, 2017 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-28330452

RESUMEN

BACKGROUND: Emergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed. The aim of this Geriatric Emergency Department Intervention is to maximise the quality of care for this vulnerable cohort in a cost effective manner. METHODS: The Geriatric Emergency Department Intervention research project consists of three interrelated studies within a program evaluation design. The research comprises of a structure, process and outcome framework to ascertain the overall utility of such a program. The first study is a pre-post comparison of the Geriatric Emergency Department Intervention in the emergency department, comparing the patient-level outcomes before and after service introduction using a quasi-experimental design with historical controls. The second study is a descriptive qualitative study of the structures and processes required for the operation of the Geriatric Emergency Department Intervention and clinician and patient satisfaction with service models. The third study is an economic evaluation of the Geriatric Emergency Department Intervention model of care. DISCUSSION: There is a paucity of evidence in the literature to support the implementation of nurse-led teams in emergency departments designed to target frail older persons living in the community and residential aged care facilities. This is despite the high economic and patient morbidity and mortality experienced in these vulnerable cohorts. This research project will provide guidance related to the optimal structures and processes required to implement the model of care and the associated cost related outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registration Number is 12615001157561 . Date of registration 29 October 2015.


Asunto(s)
Servicio de Urgencia en Hospital , Servicios de Salud para Ancianos/organización & administración , Anciano , Anciano de 80 o más Años , Australia , Análisis Costo-Beneficio , Femenino , Evaluación Geriátrica , Humanos , Masculino , Alta del Paciente , Pautas de la Práctica en Enfermería , Evaluación de Programas y Proyectos de Salud
14.
Health Qual Life Outcomes ; 15(1): 21, 2017 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-28122626

RESUMEN

BACKGROUND: With an ageing population, the number of people with dementia is rising. The economic impact on the health care system is considerable and new treatment methods and approaches to dementia care must be cost effective. Economic evaluation requires valid patient reported outcome measures, and this study aims to develop a dementia-specific health state classification system based on the Quality of Life for Alzheimer's disease (QOL-AD) instrument (nursing home version). This classification system will subsequently be valued to generate a preference-based measure for use in the economic evaluation of interventions for people with dementia. METHODS: We assessed the dimensionality of the QOL-AD to develop a new classification system. This was done using exploratory and confirmatory factor analysis and further assessment of the structure of the measure to ensure coverage of the key areas of quality of life. Secondly, we used Rasch analysis to test the psychometric performance of the items, and select item(s) to describe each dimension. This was done on 13 items of the QOL-AD (excluding two general health items) using a sample of 284 residents living in long-term care facilities in Australia who had a diagnosis of dementia. RESULTS: A five dimension classification system is proposed resulting from the three factor structure (defined as 'interpersonal environment', 'physical health' and 'self-functioning') derived from the factor analysis and two factors ('memory' and 'mood') from the accompanying review. For the first three dimensions, Rasch analysis selected three questions of the QOL-AD ('living situation', 'physical health', and 'do fun things') with memory and mood questions representing their own dimensions. The resulting classification system (AD-5D) includes many of the health-related quality of life dimensions considered important to people with dementia, including mood, global function and skill in daily living. CONCLUSIONS: The development of the AD-5D classification system is an important step in the future application of the widely used QOL-AD in economic evaluations. Future valuation studies will enable this tool to be used to calculate quality adjusted life years to evaluate treatments and interventions for people diagnosed with mild to moderate dementia.


Asunto(s)
Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/diagnóstico , Demencia/clasificación , Demencia/diagnóstico , Indicadores de Salud , Calidad de Vida/psicología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/terapia , Australia , Demencia/psicología , Femenino , Hogares para Ancianos , Humanos , Masculino , Persona de Mediana Edad , Casas de Salud , Psicometría
15.
PLoS One ; 10(9): e0138369, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26406592

RESUMEN

Indigenous Australians experience a high rate of ear disease and hearing loss, yet they have a lower rate of service access and utilisation compared to their non-Indigenous counterparts. Screening, surveillance and timely access to specialist ear, nose and throat (ENT) services are key components in detecting and preventing the recurrence of ear diseases. To address the low access and utilisation rate by Indigenous Australians, a collaborative, community-based mobile telemedicine-enabled screening and surveillance (MTESS) service was trialled in Cherbourg, the third largest Indigenous community in Queensland, Australia. This paper aims to evaluate the cost-effectiveness of the MTESS service using a lifetime Markov model that compares two options: (i) the Deadly Ears Program alone (current practice involving an outreach ENT surgical service and screening program), and (ii) the Deadly Ears Program supplemented with the MTESS service. Data were obtained from the Deadly Ears Program, a feasibility study of the MTESS service and the literature. Incremental cost-utility ratios were calculated from a societal perspective with both costs (in 2013-14 Australian dollars) and quality-adjusted life years (QALYs) discounted at 5% annually. The model showed that compared with the Deadly Ears Program, the probability of an acceptable cost-utility ratio at a willingness-to-pay threshold of $50,000/QALY was 98% for the MTESS service. This cost effectiveness arises from preventing hearing loss in the Indigenous population and the subsequent reduction in associated costs. Deterministic and probability sensitivity analyses indicated that the model was robust to parameter changes. We concluded that the MTESS service is a cost-effective strategy. It presents an opportunity to resolve major issues confronting Australia's health system such as the inequitable provision and access to quality healthcare for rural and remotes communities, and for Indigenous Australians. Additionally, it may encourage effective health service delivery at a time when the healthcare funding and workforce capacity are limited.


Asunto(s)
Prestación de Atención de Salud , Pérdida Auditiva , Tamizaje Masivo , Grupo de Ascendencia Oceánica , Telemedicina , Adolescente , Australia/epidemiología , Niño , Preescolar , Costos y Análisis de Costo , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/métodos , Femenino , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/economía , Pérdida Auditiva/epidemiología , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Telemedicina/economía , Telemedicina/métodos
16.
Value Health ; 18(5): 597-604, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26297087

RESUMEN

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) therapy is a clinically safe, noninvasive, nonsystemic treatment for major depressive disorder. OBJECTIVE: We evaluated the cost-effectiveness of rTMS versus pharmacotherapy for the treatment of patients with major depressive disorder who have failed at least two adequate courses of antidepressant medications. METHODS: A 3-year Markov microsimulation model with 2-monthly cycles was used to compare the costs and quality-adjusted life-years (QALYs) of rTMS and a mix of antidepressant medications (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, noradrenergic and specific serotonergic antidepressants, and monoamine oxidase inhibitors). The model synthesized data sourced from published literature, national cost reports, and expert opinions. Incremental cost-utility ratios were calculated, and uncertainty of the results was assessed using univariate and multivariate probabilistic sensitivity analyses. RESULTS: Compared with pharmacotherapy, rTMS is a dominant/cost-effective alternative for patients with treatment-resistant depressive disorder. The model predicted that QALYs gained with rTMS were higher than those gained with antidepressant medications (1.25 vs. 1.18 QALYs) while costs were slightly less (AU $31,003 vs. AU $31,190). In the Australian context, at the willingness-to-pay threshold of AU $50,000 per QALY gain, the probability that rTMS was cost-effective was 73%. Sensitivity analyses confirmed the superiority of rTMS in terms of value for money compared with antidepressant medications. CONCLUSIONS: Although both pharmacotherapy and rTMS are clinically effective treatments for major depressive disorder, rTMS is shown to outperform antidepressants in terms of cost-effectiveness for patients who have failed at least two adequate courses of antidepressant medications.


Asunto(s)
Antidepresivos/economía , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/economía , Trastorno Depresivo Mayor/terapia , Trastorno Depresivo Resistente al Tratamiento/economía , Trastorno Depresivo Resistente al Tratamiento/terapia , Costos de los Medicamentos , Estimulación Magnética Transcraneal/economía , Simulación por Computador , Ahorro de Costo , Análisis Costo-Beneficio , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Resistente al Tratamiento/diagnóstico , Trastorno Depresivo Resistente al Tratamiento/psicología , Humanos , Cadenas de Markov , Modelos Económicos , Años de Vida Ajustados por Calidad de Vida , Factores de Tiempo , Resultado del Tratamiento
17.
Aust Health Rev ; 39(3): 329-336, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25725696

RESUMEN

OBJECTIVE: Pressure injuries (PI) are largely preventable and can be viewed as an adverse outcome of a healthcare admission, yet they affect millions of people and consume billions of dollars in healthcare spending. The existing literature in Australia presents a patchy picture of the economic burden of PI on society and the health system. The aim of the present study was to provide a more comprehensive and updated picture of PI by state and severity using publicly available data. METHODS: A cost-of-illness analysis was conducted using a prevalence approach and a 1-year time horizon based on data from the existing literature extrapolated using simulation methods to estimate the costs by PI severity and state subgroups. RESULTS: The treatment cost across all states and severity in 2012-13 was estimated to be A$983 million per annum, representing approximately 1.9% of all public hospital expenditure or 0.6% of the public recurrent health expenditure. The opportunity cost was valued at an additional A$820 million per annum. These estimates were associated with a total number of 121 645 PI cases in 2012-13 and a total number of 524 661 bed days lost. CONCLUSIONS: The costs estimated in the present study highlight the economic waste for the Australian health system associated with a largely avoidable injury. Wastage can also be reduced by preventing moderate injuries (Stage I and II) from developing into severe cases (Stage III and IV), because the severe cases, accounting for 12% of cases, mounted to 30% of the total cost.


Asunto(s)
Costo de Enfermedad , Costos de Hospital/tendencias , Hospitales Públicos/economía , Úlcera por Presión/economía , Australia
18.
PLoS One ; 9(8): e106234, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25171152

RESUMEN

BACKGROUND: Over recent years there has been a strong movement towards the improvement of vital statistics and other types of health data that inform evidence-based policies. Collecting such data is not cost free. To date there is no systematic framework to guide investment decisions on methods of data collection for vital statistics or health information in general. We developed a framework to systematically assess the comparative costs and outcomes/benefits of the various data methods for collecting vital statistics. METHODOLOGY: The proposed framework is four-pronged and utilises two major economic approaches to systematically assess the available data collection methods: cost-effectiveness analysis and efficiency analysis. We built a stylised example of a hypothetical low-income country to perform a simulation exercise in order to illustrate an application of the framework. FINDINGS: Using simulated data, the results from the stylised example show that the rankings of the data collection methods are not affected by the use of either cost-effectiveness or efficiency analysis. However, the rankings are affected by how quantities are measured. CONCLUSION: There have been several calls for global improvements in collecting useable data, including vital statistics, from health information systems to inform public health policies. Ours is the first study that proposes a systematic framework to assist countries undertake an economic evaluation of DCMs. Despite numerous challenges, we demonstrate that a systematic assessment of outputs and costs of DCMs is not only necessary, but also feasible. The proposed framework is general enough to be easily extended to other areas of health information.


Asunto(s)
Conjuntos de Datos como Asunto/economía , Estadísticas Vitales , Costos y Análisis de Costo , Conjuntos de Datos como Asunto/normas , Humanos
19.
J Med Econ ; 17(2): 159-65, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24246063

RESUMEN

BACKGROUND: Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs. AIM: To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB). METHODS: Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included. RESULTS: Patients receiving RAAT had lower costs (n = 27, median AU$2716) and shorter time to treatment (median = 194 days) than for conventional management (n = 13, median $5005, 420 days; p < 0.01). Differences related to the lower TE test costs and the lower cost of consults between first medical review and establishment of a treatment plan. CONCLUSIONS: Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small sample size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.


Asunto(s)
Diagnóstico por Imagen de Elasticidad/estadística & datos numéricos , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/economía , Triaje/métodos , Listas de Espera , Adulto , Australia , Análisis Costo-Beneficio , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medicina Estatal/economía , Medicina Estatal/estadística & datos numéricos , Factores de Tiempo
20.
BMC Public Health ; 13: 779, 2013 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-23978236

RESUMEN

BACKGROUND: India has the world's highest total number of under-five deaths of any nation. While progress towards Millennium Development Goal 4 has been documented at the state level, little information is available for greater disaggregation of child health markers within states. In 2000, new states were created within the country as a partial response to political pressures. State-level information on child health trends in the new states of Chhattisgarh and Jharkhand is scarce. To fill this gap, this article examines under-five and neonatal mortality across various equity markers within these two new states, pre-and post-split. METHODS: Both direct and indirect estimation using pooled data from five available sources were undertaken. Inter-population disparities were evaluated by mortality data stratification of rural-urban location, ethnicity, wealth and districts. RESULTS: Both states experienced an overall reduction in under-five and neonatal mortality, however, this has stagnated post-2001 and various disparities persist. In cases where disparities have declined, such as between urban-rural populations and low- and high-income groups, this has been driven by modest declines within the disadvantaged groups (i.e. low-income rural households) and stagnation or worsening of outcomes within the advantaged groups. Indeed, rising trends in mortality are most prevalent in urban middle-income households. CONCLUSIONS: The results suggest that rural health improvements may have come at the expense of urban areas, where poor performance may be attributed to factors such as lack of access to quality private health facilities. In addition, the disparities may in part be associated with geographical access, traditional practices and district-level health resource allocation.


Asunto(s)
Mortalidad del Niño/tendencias , Disparidades en el Estado de Salud , Servicios de Salud del Niño , Preescolar , Humanos , India/epidemiología , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Población Rural , Factores Socioeconómicos , Población Urbana
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