Cost effectiveness of newborn screening for cystic fibrosis: a simulation study.

BACKGROUND: Early detection of cystic fibrosis (CF) by newborn screening (NBS) reduces the rate of avoidable complications. NBS protocols vary by jurisdiction and the cost effectiveness of these different protocols is debated. OBJECTIVE: To compare the cost effectiveness of various CF NBS options. METHODS: A Markov model was built to simulate the cost effectiveness of various CF-NBS options for a hypothetical CF-NBS program over a 5-year time horizon assuming its integration into an existing universal NBS program. NBS simulated options were based on a combination of tests between the two commonly used immunoreactive trypsinogen (IRT) cutoffs (96th percentile and 99.5th percentile) as first tier tests, and, as a second tier test, either a second IRT, pancreatic-associated protein (PAP) or CFTR mutation panels. CFTR mutation panels were also considered as an eventual third tier test. Data input parameters used were retrieved from a thorough literature search. Outcomes considered were the direct costs borne by the Quebec public health care system and the number of cases of CF detected through each strategy, including the absence of screening option. RESULTS: IRT-PAP with an IRT cutoff at the 96th percentile is the most favorable option with a ratio of CAD$28,432 per CF case detected. The next most favorable alternative is the IRT1-IRT2 option with an IRT1 cutoff at the 96th percentile. The no-screening option is dominated by all NBS screening protocols considered. Results were robust in sensitivity analyses. CONCLUSION: This study suggests that NBS for cystic fibrosis is a cost-effective strategy compared to the absence of NBS. The IRT-PAP newborn screening algorithm with an IRT cutoff at the 96th percentile is the most cost effective NBS approach for Quebec.

[Individual determinants of the Quebec electronic health record adoption]. / Étude des déterminants individuels de l'adoption du dossier de santé électronique du Québec.

AIM: The potential of electronic health records to improve effectiveness, safety and quality of health care has been shown in several previous studies. However healthcare professionals remain reticent as for its use, which limits its potential effect on the health care system. The present study aimed to evaluate physicians' perceptions towards the electronic health record of Quebec. METHODS: Based on a literature review of the factors affecting the adoption of information and communication technologies in general, and e-health in particular, questionnaire was developed. A total of 12 doctors who represent potential users of the Quebec electronic health record completed and returned the questionnaire. Afterwards we performed a thematic analysis of content which was followed by a theorisation of emerging concepts. RESULTS: Physicians' intention to adopt the Quebec electronic health record is positively influenced by perceived usefulness, perceived ease of use, demonstrability of the results, system's compatibility with practice, and computer self-efficacy. Conversely, resistance to change negatively influences physicians' adoption of the electronic health record. CONCLUSION: It is crucial to understand factors that influence the acceptance of the Quebec electronic health records to inform decision makers. This will allow identifying potential users' expectations and to adjust implementation strategies accordingly in order to favour a better integration of this technology into medical practices.