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1.
Medicine (Baltimore) ; 98(41): e17289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593081

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS: A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l'Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. ANALYSIS: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04049006.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Qualidade de Vida , Adulto , Terapia Cognitivo-Comportamental/economia , Terapia Combinada , Análise Custo-Benefício , Terapia por Exercício/economia , Estudos de Viabilidade , Feminino , Fibromialgia/economia , Fibromialgia/psicologia , Implementação de Plano de Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
2.
Folia Med (Plovdiv) ; 61(2): 163-171, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31301669

RESUMO

INTRODUCTION: Pharmacoeconomics (PE) treats the problems of pharmacotherapy policy, drug marketing and reimbursement and clinical trials. It guides policy makers for effective health resources utilization and determines the profitability of the new drugs on the basis of their price, efficacy and benefits for society. Types of health costs and pharmacoeconomic analyses: In the current review the main types of health costs are discussed. The main PE analyses with their advantages and disadvantages are presented. Pharmacoeconomic of bronchial asthma: The main aspects of PE of bronchial asthma are available in the current review. The costs of health services (direct and indirect), the educational programs and asthma medications in different countries are discussed. Recently published data showed correlation between asthma cost and disease severity, control, social status and therapy adherence. CONCLUSION: PE analyses provide the benefit of making cost consistent decisions in the field of asthma care. This review adds more data on the cost of current asthma treatment worldwide and in Bulgaria.


Assuntos
Asma/economia , Custos de Cuidados de Saúde , Absenteísmo , Antiasmáticos/economia , Asma/terapia , Bulgária , Custos Diretos de Serviços , Custos de Medicamentos , Farmacoeconomia , Serviços de Saúde/economia , Humanos , Educação de Pacientes como Assunto/economia
3.
Rev Esp Salud Publica ; 932019 Jul 15.
Artigo em Espanhol | MEDLINE | ID: mdl-31273187

RESUMO

In Navarre, the Smoking Cessation Program (PAF) was launched in 1994, result of the collaboration between Public Health and Primary Care. In 2001 it was integrated into the Tobacco Regional Action Plan, together with the other two lines of action: prevention of smoking initiation and promotion of smoke-free spaces. PAF includes two levels of intervention, a basic and an intensive one, with programmed educational support, individual and group. Medications for smoking cessation have been intermittently subsidized by the Health Department of Navarre. In December 2017, funding of medications for smoking cessation was reintroduced, in the same conditions of any other medication. Treatments are limited to one per patient and year, always including educational support. In 2018, 6139 people benefited from this funding, 50% women and 60% with yearly income lower than 18000 euros. We carried out a preliminary evaluation through a telephone survey. Overall, 35% of participants reported to keep abstinent after one year, 40% among those who also received intensive educational support.


Assuntos
Promoção da Saúde/métodos , Programas Nacionais de Saúde , Atenção Primária à Saúde/métodos , Abandono do Hábito de Fumar/métodos , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Promoção da Saúde/economia , Promoção da Saúde/estatística & dados numéricos , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/métodos , Pobreza , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/estatística & dados numéricos , Espanha
4.
Public Health ; 172: 43-51, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31195128

RESUMO

OBJECTIVES: An educational healthcare circuit (EHC) is proposed with the objective of preventing weight recovery of patients after bariatric surgery through education and lifestyle change. The objective of this study was to measure the viability of the EHC (shared medical appointments [SMAs] combined with bariatric surgery) through cost-effectiveness analysis. The EHC presented in this study is innovative because it offers a multidisciplinary approach based on medical, psychological and dietetic expertise to combat obesity. The strategy is to give the patient a diagnosis and then a personalised follow-up. STUDY DESIGN: A mathematical model based on a decision tree (1 year) and a Markov model (10 years) to measure the efficiency and cost of an EHC in comparison with the customary care offered in France were built. METHODS: The effects of the EHC were observed for the prevalence of type 2 diabetes and the risk of cardiovascular disease. The chosen financial perspective is from the point of view of the French social security system. RESULTS: The EHC records an incremental cost-effective ratio (ICER) of € 48,315.43 per quality-adjusted life year (QALY) over a 1-year horizon and € 28,283.77 per QALY over 10 years (with discount rate of 8%: € 25,362.85 per QALY). CONCLUSION: The results suggest that an EHC is more expensive yet more effective than usual care. That is, in the short term, the costs are high, but at 10 years, the treatment is cost-effective, representing a feasible alternative for those patients who qualify for bariatric surgery in France.


Assuntos
Cirurgia Bariátrica , Obesidade/cirurgia , Educação de Pacientes como Assunto/economia , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/epidemiologia , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Risco , Adulto Jovem
5.
Trials ; 20(1): 272, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092278

RESUMO

BACKGROUND: Evidence is limited on the effectiveness of mobile health programs which provide stage-based health information messages to pregnant and postpartum women. Kilkari is an outbound service that delivers weekly, stage-based audio messages about pregnancy, childbirth, and childcare directly to families in 13 states across India on their mobile phones. In this protocol we outline methods for measuring the effectiveness and cost-effectiveness of Kilkari. METHODS: The study is an individually randomized controlled trial (iRCT) with a parallel, partially concurrent, and unblinded design. Five thousand pregnant women will be enrolled from four districts of Madhya Pradesh and randomized to an intervention or control arm. The women in the intervention arm will receive Kilkari messages while the control group will not receive any Kilkari messages as part of the study. Women in both arms will be followed from enrollment in the second and early third trimesters of pregnancy until one year after delivery. Differences in primary outcomes across study arms including early and exclusive breastfeeding and the adoption of modern contraception at 1 year postpartum will be assessed using intention to treat methodology. Surveys will be administered at baseline and endline containing modules on phone ownership, geographical and demographic characteristics, knowledge, practices, respectful maternity care, and coverage for antenatal care, delivery, and postnatal care. In-depth interviews and focus group discussions will be carried out to understand user perceptions of Kilkari, and more broadly, experiences providing phone numbers and personal health information to health care providers. Costs and consequences will be estimated from a societal perspective for the 2018-2019 analytic time horizon. DISCUSSION: Kilkari is the largest maternal messaging program, in terms of absolute numbers, currently being implemented globally. Evaluations of similar initiatives elsewhere have been small in scale and focused on summative outcomes, presenting limited evidence on individual exposure to content. Drawing upon system-generated data, we explore linkages between successful receipt of calls, user engagement with calls, and reported outcomes. This is the first study of its kind in India and is anticipated to provide the most robust and comprehensive evidence to date on maternal messaging programs globally. TRIAL REGISTRATION: Clinicaltrials.gov, 90075552, NCT03576157 . Registered on 22 June 2018.


Assuntos
Telefone Celular , Saúde do Lactente , Saúde Materna , Informática Médica/métodos , Educação de Pacientes como Assunto/métodos , Assistência Perinatal/métodos , Aleitamento Materno , Telefone Celular/economia , Comportamento Contraceptivo , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Comunicação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Lactente , Saúde do Lactente/economia , Recém-Nascido , Masculino , Saúde Materna/economia , Informática Médica/economia , Estudos Multicêntricos como Assunto , Educação de Pacientes como Assunto/economia , Assistência Perinatal/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
6.
World J Gastroenterol ; 25(11): 1327-1340, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30918426

RESUMO

BACKGROUND: Hepatitis C virus (HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral (DAA) treatment coverage, to compute the total costs (including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in Greece. AIM: To estimate the required interventions and subsequent costs to achieve HCV elimination in Greece. METHODS: A previously validated mathematical model was adapted to the Greek HCV-infected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs (direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price scenarios. RESULTS: Without the implementation of awareness or screening campaigns, approximately 20000 patients would be diagnosed and treated with DAAs by 2030. This strategy would result in a 19.6% increase in HCV-related mortality in 2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by 78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros (€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very cost-effective. Furthermore, HCV elimination strategy would save €560-895 million by 2035. CONCLUSION: Without large screening programs, elimination of HCV cannot be achieved. The HCV elimination strategy is feasible and cost-saving despite the uncertainty of the future cost of DAAs in Greece.


Assuntos
Antivirais/uso terapêutico , Análise Custo-Benefício , Erradicação de Doenças/economia , Custos de Cuidados de Saúde , Hepatite C/prevenção & controle , Antivirais/economia , Antivirais/farmacologia , Redução de Custos , Efeitos Psicossociais da Doença , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Estudos de Viabilidade , Grécia , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Hepacivirus/efeitos dos fármacos , Hepacivirus/isolamento & purificação , Hepatite C/economia , Hepatite C/virologia , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Educação de Pacientes como Assunto/economia , Anos de Vida Ajustados por Qualidade de Vida
7.
PLoS One ; 14(2): e0210497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807573

RESUMO

BACKGROUND: In economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Few analyses however use locally relevant cost data. We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country's HIV programme. METHODS: We systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. Where no data was found in the literature, we constructed unit costs either based on available information regarding ingredients and relevant public-sector prices, or based on expenditure records. RESULTS: Only 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. Other papers detailed the costs of HCT, MMC, palliative and inpatient care; no papers were found on the costs of PrEP, social and behaviour change communication, and PMTCT. The results informed unit costs for 5 of 11 intervention categories included in the Investment Case, with the remainder costed based on ingredients (35%) and expenditure data (10%). CONCLUSIONS: A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. More primary cost analyses of non-ART interventions are needed.


Assuntos
Infecções por HIV/economia , Fármacos Anti-HIV/economia , Terapia Antirretroviral de Alta Atividade/economia , Custos e Análise de Custo , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Modelos Econômicos , Assistência ao Paciente/economia , Educação de Pacientes como Assunto/economia , África do Sul/epidemiologia
8.
Daru ; 27(1): 361-378, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30674033

RESUMO

OBJECTIVES: There are many studies about Iranian clinical pharmacists' interventions and their impacts on medication safety and cost. The aim of this study is to collect data and critically evaluate the clinical and economic effects of Iranian clinical pharmacist interventions and activities. To our best of knowledge, this research is the first review of publications about Iranian clinical pharmacists' interventions and activities. EVIDENCE ACQUISITION: Six online databases, including PubMed, Scopus, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews, and Google Scholar were searched using the terms '"Iranian", "clinical pharmacist", 'adverse drug reactions", "medication errors", "drug interaction", "drug utilization evaluation", "cost", and "interventions" for English studies conducted in Iran and described clinical pharmacist-initiated interventions, published before December 2018. The search and extraction process followed PRISMA guidelines. Observational or retrospective studies, clinical trials, congress abstracts, and case reports or case series were excluded. The search strategy after full-text review identified 39 articles matching the eligibility criteria. RESULTS: Thirty-nine articles were recruited. They included establishing pharmaceutical care in out-patient clinics and drug information centers (n = 4); prevention, detection, and management of adverse drug reactions(n = 4), designing protocols and improving drug utilization pattern(n = 16), prevention, detection, and management of medication errors (n = 11), and all clinical pharmacist services(n = 4). Most clinical pharmacist interventions and activities were regarding designing protocols, improving drug utilization pattern, as well as detection, prevention, and management of medication errors. About three-fourth (74.35%) of included studies were from either ambulatory care or in-patient settings in Tehran. The median (interquartile range) duration of intervention as well as follow-up phases was 9 (5) months. CONCLUSION: Data of our review support the beneficial role of clinical pharmacists in the improvement of quality, safety, and efficiency of patients' pharmaceutical care in Iran. Graphical abstract Clinical pharmacists' interventions in Iran.


Assuntos
Educação de Pacientes como Assunto/métodos , Assistência Farmacêutica/economia , Medicamentos sob Prescrição/normas , Prestação Integrada de Cuidados de Saúde , Revisão de Uso de Medicamentos , Humanos , Irã (Geográfico) , Erros de Medicação/prevenção & controle , Educação de Pacientes como Assunto/economia , Papel Profissional , Estudos Retrospectivos
9.
Eur Psychiatry ; 57: 10-18, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30658275

RESUMO

BACKGROUND: Late-life depression is a highly prevalent disorder that causes a large economic burden. A stepped collaborative care program was set up in order to improve care for patients with late-life depression in primary care in Germany: GermanIMPACT is the adaption of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program that has already been established in primary care in the USA. The aim of this study was to determine the cost-effectiveness of GermanIMPACT compared with treatment as usual from a societal perspective. METHODS: This study is part of a 12-month bi-centric cluster-randomized controlled trial aiming to assess the effectiveness of GermanIMPACT compared with treatment as usual among patients with late-life depression. A cost-effectiveness analysis using depression-free days (DFDs) was performed. Net-monetary benefit (NMB) regressions adjusted for baseline differences for different willingness-to-pay (WTP) thresholds were conducted and cost-effectiveness acceptability curves were constructed. RESULTS: In total, n = 246 patients (intervention group: n = 139; control group: n = 107) with a mean age of 71 from 71 primary care practices were included in the analysis. After 12 months, adjusted mean differences in costs and DFDs between intervention group and control group were +€354 and +21.4, respectively. Only the difference in DFDs was significant (p = 0.022). According to the unadjusted incremental cost-effectiveness ratio, GermanIMPACT was dominant compared with treatment as usual. The probability of GermanIMPACT being cost-effective was 80%, 90% or 95% if societal WTP per DFD was ≥€70, ≥€110 or ≥€180, respectively. CONCLUSION: Evidence for cost-effectiveness of GermanIMPACT relative to treatment as usual is not clear. Only if societal WTP was ≥€180 for an additional DFD, GermanIMPACT could be considered cost-effective with certainty.


Assuntos
Depressão/economia , Depressão/terapia , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Idoso , Análise Custo-Benefício , Transtorno Depressivo/economia , Transtorno Depressivo/terapia , Feminino , Alemanha , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Resultado do Tratamento
10.
Eur J Cancer Care (Engl) ; 28(2): e12966, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30478975

RESUMO

OBJECTIVE: The present parallel randomised control trial evaluated the feasibility of a nurse-led psycho-educational intervention aimed at improving the self-management of prostate cancer survivors. METHODS: We identified 305 eligible patients from a district general hospital, diagnosed 9-48 months previously, who completed radical treatment, or were monitored clinically (ineligible for treatment). Ninety-five patients were recruited by blinded selection and randomised to Intervention (N = 48) and Control (N = 47) groups. Participant allocation was revealed to patients and researchers after recruitment was completed. For 36 weeks, participants received augmented usual care (Control) or augmented usual care and additional nurse support (Intervention) provided in two community hospitals and a university clinic, or by telephone. RESULTS: Data from 91 participants (Intervention, N = 45; Control, N = 46) were analysed. All feasibility metrics met predefined targets: recruitment rate (31.15%; 95% CI: 25.95%-36.35%), attrition rate (9.47%; 95% CI: 3.58%-15.36%) and outcome measures completion rates (77%-92%). Forty-five patients received the intervention, with no adverse events. The Extended Prostate Cancer Index Composite can inform the minimum sample size for a future effectiveness trial. The net intervention cost was £317 per patient. CONCLUSIONS: The results supported the feasibility and acceptability of the intervention, suggesting that it should be evaluated in a fully powered trial to assess its effectiveness and cost-effectiveness.


Assuntos
Educação de Pacientes como Assunto/métodos , Neoplasias da Próstata/enfermagem , Psicoterapia/métodos , Idoso , Idoso de 80 Anos ou mais , Sobreviventes de Câncer/psicologia , Análise Custo-Benefício , Assistência à Saúde/economia , Assistência à Saúde/métodos , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Satisfação do Paciente , Medicina de Precisão/economia , Medicina de Precisão/enfermagem , Medicina de Precisão/psicologia , Neoplasias da Próstata/economia , Neoplasias da Próstata/psicologia , Psicoterapia/economia , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
11.
Postgrad Med ; 131(1): 60-67, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30445893

RESUMO

OBJECTIVE: Patient education is important in irritable bowel syndrome (IBS), but its effects on outcomes have not been studied extensively. METHODS: Patients were enrolled and prospectively divided into an interventional and usual care group. Both received standard of care, but the former additionally received video-assisted patient education. Self-administered questionnaires IBS-quality of life (QOL), Beck Anxiety-Depression Inventory II (BAI, BDI), and Hospital Anxiety and Depression Scale (HADS) were administered at baseline, 3 months, and 6 months. Compliance was defined as drug intake of >80% of the prescribed dose. COI included prospective, prevalence-based, societal perspective. RESULTS: Of the 107 patients included, 84 [78.5%; male = 66 (78.57%); median age = 44 (range 20-77 years)] completed the follow up. While the median (inter-quartile range; IQR) QOL scores decreased significantly in both the groups (p < 0.001 for either group), the final scores were significantly better in the interventional group [49 (44-52.5) versus 80 (76-103), respectively; p < 0.005]. There was a significant improvement in the BDI; p < 0.001]. However, the rest did not achieve statistical significance. At 6 months, total median (IQR) semi-annual cost per patient was INR 14,639 (8253-17,909) [US $240 (135-294]. CONCLUSION: Video-assisted patient education should be a part of the treatment of IBS since it improves the QOL and depression scores.


Assuntos
Síndrome do Intestino Irritável/terapia , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Qualidade de Vida/psicologia , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/etiologia , Efeitos Psicossociais da Doença , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Síndrome do Intestino Irritável/economia , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Estudos Prospectivos , Psicometria/métodos , Inquéritos e Questionários , Gravação em Vídeo/métodos , Adulto Jovem
12.
Int J Rheum Dis ; 22(4): 545-554, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30556300

RESUMO

AIM: Medication non-adherence influences outcomes of therapies for chronic diseases. Allopurinol is a cornerstone therapy for patients with gout; however, non-adherence to allopurinol is prevalent in Singapore and limits its effectiveness. Between 2008-2010, an adherence-enhancing program was implemented at the rheumatology division of a public tertiary hospital. The cost-effectiveness of this program has not been fully evaluated. With healthcare resources being finite, the value of investing in adherence-enhancing interventions should be ascertained. This study aims to evaluate the cost-effectiveness of this adherence-enhancing program to inform optimal resource allocation toward better gout management. METHOD: Adopting a real-world data approach, we utilized patient clinical and financial records generated in their course of routine care. Intervention and control groups were identified in a standing database and matched on nine risk factors through propensity score matching. Cost and effect data were followed through 1-2 years. A decision tree was developed in TreeAge using a societal perspective. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS: At an assumed willingness-to-pay threshold of $50 000 USD ($70 000 SGD) per quality-adjusted life year (QALY), the intervention had an 85% probability of being cost-effective compared to routine care. The incremental cost-effectiveness ratio was $12 866 USD per QALY for the base case and ranged from $4 139 to $21 593 USD per QALY in sensitivity analyses. CONCLUSION: The intervention is cost-effective in the short-term, although its long-term cost-effectiveness remains to be evaluated.


Assuntos
Alopurinol/uso terapêutico , Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Gota/economia , Custos de Cuidados de Saúde , Adesão à Medicação , Educação de Pacientes como Assunto/economia , Adulto , Idoso , Alopurinol/efeitos adversos , Alopurinol/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Árvores de Decisões , Custos de Medicamentos , Feminino , Gota/diagnóstico , Gota/psicologia , Supressores da Gota/efeitos adversos , Supressores da Gota/economia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Avaliação de Programas e Projetos de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Singapura , Fatores de Tempo , Resultado do Tratamento
13.
Value Health ; 21(12): 1357-1364, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30502778

RESUMO

BACKGROUND: A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina. OBJECTIVES: To assess the cost-effectiveness of this intervention. METHODS: A total of 1432 hypertensive participants were recruited from 18 primary health care centers. The intervention included home visits led by community health workers, physician education, and text messaging. Resource use and quality of life data using the three-level EuroQol five-dimensional questionnaire were prospectively collected. The study perspective was that of the public health care system, and the time horizon was 18 months. Intention-to-treat analysis was used to analyze cost and health outcomes (systolic blood pressure [SBP] change and quality-adjusted life-years [QALYs]). A 1 time gross domestic product per capita per QALY was used as the cost-effectiveness threshold (US $14,062). RESULTS: Baseline characteristics were similar in the two arms. QALYs significantly increased by 0.06 (95% confidence interval [CI] 0.04-0.09) in the intervention group, and SBP net difference favored the intervention group: 5.3 mm Hg (95% CI 0.27-10.34). Mean total costs per participant were higher in the intervention arm: US $304 in the intervention group and US $154 in the control group (adjusted difference of US $140.18; 95% CI US $75.41-US $204.94). The incremental cost-effectiveness ratio was $3299 per QALY (95% credible interval 1635-6099) and US $26 per mm Hg of SBP (95% credible interval 13-46). Subgroup analysis showed that the intervention was cost-effective in all prespecified subgroups (age, sex, cardiovascular risk, and body mass index). CONCLUSIONS: The multicomponent intervention was cost-effective for blood pressure control among low-income hypertensive patients.


Assuntos
Pressão Sanguínea , Análise Custo-Benefício , Promoção da Saúde/economia , Hipertensão/terapia , Educação de Pacientes como Assunto/economia , Pobreza , Atenção Primária à Saúde/economia , Adulto , Idoso , Argentina , Agentes Comunitários de Saúde , Feminino , Custos de Cuidados de Saúde , Promoção da Saúde/métodos , Recursos em Saúde , Serviços de Assistência Domiciliar/economia , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Médicos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Mensagem de Texto
14.
J Pediatr Nurs ; 43: e51-e58, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30268713

RESUMO

PURPOSE: The aim was to evaluate the impact of age-appropriate information and preparation procedures for children with cancer undergoing radiotherapy on 1) parents and family functioning, parents' anxiety and 2) hospital costs compared to traditional care. DESIGN AND METHODS: An un-matched quasi-experimental controlled clinical trial was conducted consisting of a control group including 31 parents of 16 children receiving traditional care and an intervention group including 32 parents of 17 children receiving age-appropriate preparation including seven parts. Validated instruments measured parents and family functioning and parents' anxiety. Hospital costs were calculated. RESULTS: Parents in the intervention group showed better communication throughout their child's radiotherapy (p = 0.01) and at their child's last fraction, parental social functioning improved (p = 0.02). Parents of children receiving general anesthesia, regardless of group, showed higher levels of anxiety (p = 0.04). In general, results regarding hospital costs lacked statistical significance. Development of the intervention was calculated to be USD 4.624. CONCLUSION: Parents who receive age-appropriate information and preparation together with their child benefits in terms of improved communication and social functioning. When children avoid general anesthesia the parents experienced less anxiety and costs for the hospital was lowered. PRACTICE IMPLICATION: Age-appropriate preparations consisting of basic, non-costly utilities and a structured approach are important. If more children are able to undergo radiotherapy without general anesthesia, it means for the individual child fewer risks and restrictions, and for the parents decreased anxiety. For the healthcare, it means lower costs, which enables the hospital to prioritize other areas of pediatric care.


Assuntos
Custos Hospitalares , Neoplasias/radioterapia , Pais/psicologia , Educação de Pacientes como Assunto/métodos , Adolescente , Adulto , Fatores Etários , Ansiedade/epidemiologia , Ansiedade/fisiopatologia , Criança , Pré-Escolar , Relações Familiares/psicologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Relações Pais-Filho , Educação de Pacientes como Assunto/economia , Radioterapia/economia , Radioterapia/psicologia , Medição de Risco , Estresse Psicológico
15.
Health Technol Assess ; 22(58): 1-134, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30375324

RESUMO

BACKGROUND: Between 50% and 80% of people with multiple sclerosis (PwMS) experience neurogenic bowel dysfunction (NBD) (i.e. constipation and faecal incontinence) that affects quality of life and can lead to hospitalisation. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of abdominal massage plus advice on bowel symptoms on PwMS compared with advice only. A process evaluation investigated the factors that affected the clinical effectiveness and possible implementation of the different treatments. DESIGN: A randomised controlled trial with process evaluation and health economic components. Outcome analysis was undertaken blind. SETTING: The trial took place in 12 UK hospitals. PARTICIPANTS: PwMS who had 'bothersome' NBD. INTERVENTION: Following individualised training, abdominal massage was undertaken daily for 6 weeks (intervention group). Advice on good bowel management as per the Multiple Sclerosis Society advice booklet was provided to both groups. All participants received weekly telephone calls from the research nurse. MAIN OUTCOME MEASURES: The primary outcome was the difference between the intervention and control groups in change in the NBD score from baseline to week 24. Secondary outcomes were measured via a bowel diary, adherence diary, the Constipation Scoring System, patient resource questionnaire and the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). RESULTS: A total of 191 participants were finalised, 189 of whom were randomised (two participants were finalised in error) (control group, n = 99; intervention group, n = 90) and an intention-to-treat analysis was performed. The mean age was 52 years (standard deviation 10.83 years), 81% (n = 154) were female and 11% (n = 21) were wheelchair dependent. Fifteen participants from the intervention group and five from the control group were lost to follow-up. The change in NBD score by week 24 demonstrated no significant difference between groups [mean difference total score -1.64, 95% confidence interval (CI) -3.32 to 0.04; p = 0.0558]; there was a significant difference between groups in the change in the frequency of stool evacuation per week (mean difference 0.62, 95% CI 0.03 to 1.21; p = 0.039) and in the number of times per week that participants felt that they emptied their bowels completely (mean difference 1.08, 95% CI 0.41 to 1.76; p = 0.002), in favour of the intervention group. Of participant interviewees, 75% reported benefits, for example less difficulty passing stool, more complete evacuations, less bloated, improved appetite, and 85% continued with the massage. A cost-utility analysis conducted from a NHS and patient cost perspective found in the imputed sample with bootstrapping a mean incremental outcome effect of the intervention relative to usual care of -0.002 quality-adjusted life-years (QALYs) (95% CI -0.029 to 0.027 QALYs). In the same imputed sample with bootstrapping, the mean incremental cost effect of the intervention relative to usual care was £56.50 (95% CI -£372.62 to £415.68). No adverse events were reported. Limitations include unequal randomisation, dropout and the possibility of ineffective massage technique. CONCLUSION: The increment in the primary outcome favoured the intervention group, but it was small and not statistically significant. The economic analysis identified that the intervention was dominated by the control group. Given the small improvement in the primary outcome, but not in terms of QALYs, a low-cost version of the intervention might be considered worthwhile by some patients. FUTURE WORK: Research is required to establish possible mechanisms of action and modes of massage delivery. TRIAL REGISTRATION: Current Controlled Trials ISRCTN85007023 and NCT03166007. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 58. See the NIHR Journals Library website for further project information.


Assuntos
Massagem/economia , Massagem/métodos , Esclerose Múltipla/complicações , Intestino Neurogênico/etiologia , Intestino Neurogênico/terapia , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Análise Custo-Benefício , Feminino , Gastos em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Fatores Sexuais , Método Simples-Cego
17.
J Manag Care Spec Pharm ; 24(12): 1284-1294, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29848186

RESUMO

BACKGROUND: Glaucoma is a progressive, irreversible disease that can lead to vision loss and lower quality of life if treatment is not optimized. Effective glaucoma therapies are available to lower intraocular pressure (IOP) and minimize or delay disease progression. Nonetheless, adherence to treatment remains suboptimal for many patients. OBJECTIVE: To identify potentially nonadherent patients and evaluate the effect of patient- and physician-centric educational interventions on adherence by using a validated predictive model of nonadherence to glaucoma medication. METHODS: This prospective, randomized, controlled, and interventional study included Humana Medicare Advantage Prescription Drug plan patients with a glaucoma diagnosis between May and October 2014, ≥ 1 pharmacy claim for glaucoma medication, and ≥ 50% likelihood of nonadherence. Patients and physicians were randomized to cohorts A (no interventions), B (physician intervention), or C (patient and physician interventions). Physicians in cohorts B and C received information on the model, adherence, and patient profiles at baseline and months 3, 6, and 9. Patients in cohort C received educational materials on glaucoma and adherence (same schedule). The primary outcome was the proportion of days covered (PDC) with medication over 12 months. Adherence was defined as PDC ≥ 0.80. RESULTS: Overall, 23,306 patients and 2,955 physicians were eligible. After excluding physicians with < 3 nonadherent patients, each cohort included 200 physicians and 600 patients. Mean PDC was 0.54-0.56 across cohorts. At 12 months, ≥ 90.5% of physicians and ≥ 75.5% of patients remained in the study; mean PDC was 0.53-0.54 across cohorts. No statistically significant between-cohort differences in PDC and adherence were observed. CONCLUSIONS: Intensive educational mailings to patients and their physicians did not improve PDC or adherence in this large population of potentially nonadherent patients with glaucoma. Findings highlight the difficulty of improving adherence in a disease that requires lifelong therapy despite being largely asymptomatic and can inform development of future interventions aimed at improving adherence to glaucoma therapy. DISCLOSURES: This study was sponsored by Allergan plc (Dublin, Ireland). Fiscella and Chandwani are employees of Allergan plc. Caplan, Kamble, Bunniran, and Uribe are employees of Comprehensive Health Insights, a Humana company. The authors did not receive honoraria or other payments for authorship.


Assuntos
Anti-Hipertensivos/uso terapêutico , Glaucoma/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/organização & administração , Educação de Pacientes como Assunto/economia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Previsões , Glaucoma/economia , Humanos , Pressão Intraocular/efeitos dos fármacos , Irlanda , Masculino , Conduta do Tratamento Medicamentoso/economia , Modelos Teóricos , Estudos Prospectivos , Qualidade de Vida
18.
Health Technol Assess ; 22(21): 1-142, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29717699

RESUMO

BACKGROUND: Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. OBJECTIVES: To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. DESIGN: A parallel pragmatic randomised controlled trial. SETTING: Participants were recruited from eight hospitals in London and south-east England. PARTICIPANTS: Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. INTERVENTION: A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. MAIN OUTCOME MEASURES: The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. RANDOMISATION: A 1 : 1 ratio between trial arms using fixed block sizes of two. BLINDING: Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. RESULTS: The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. CONCLUSIONS: For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. FUTURE WORK: More research is needed on self-management courses, with psychological components and integration with routine monitoring. TRIAL REGISTRATION: Current Controlled Trials ISRCTN57937389. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.


Assuntos
Epilepsia/terapia , Educação de Pacientes como Assunto/organização & administração , Qualidade de Vida , Autogestão/métodos , Adulto , Anticonvulsivantes/uso terapêutico , Ansiedade/epidemiologia , Análise Custo-Benefício , Depressão/epidemiologia , Inglaterra , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Feminino , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Anos de Vida Ajustados por Qualidade de Vida , Autogestão/economia , Autogestão/psicologia , Método Simples-Cego , Estigma Social , Medicina Estatal , Estresse Psicológico/epidemiologia , Avaliação da Tecnologia Biomédica
19.
J Manag Care Spec Pharm ; 24(2): 165-172, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29384024

RESUMO

BACKGROUND: Pharmacists have demonstrated the ability to improve patient adherence to antiretroviral therapy (ART). OBJECTIVE: To determine the clinical and economic effects of a pharmacist-administered ART adherence clinic for patients living with human immunodeficiency virus (HIV). METHODS: This pilot study with a pretest-posttest design examined the effect of a pharmacy adherence clinic on patient HIV viral load and CD4 count over a 6-month period. Patients with documented adherence problems were referred to the clinic. The pharmacist counseled patients at baseline and met with patients 1-2 weeks, 6 weeks, 3 months, and 6 months after starting ART. A societal perspective net cost analysis of the pharmacy adherence clinic was conducted to assess the economic efficiency of the intervention. RESULTS: Twenty-eight patients were enrolled in the study, and 16 patients reached completion. Median HIV RNA significantly decreased from 48,000 copies/mL (interquartile range [IQR] = 16,750-139,000) to undetectable (< 20 copies/mL) at 6 months for all study participants who completed the full intervention (P = 0.001). In the 3 months following the intervention, we estimated that it prevented approximately 0.13 secondary HIV infections among the sexual partners of the 16 participants who completed the intervention. The total cost of the intervention was $16,811 ($1,051 per patient), which was less than the future savings in averted HIV-related medical care expenditures ($49,702). CONCLUSIONS: A pharmacy adherence clinic that focused on early and sustained ART adherence interventions helped patients with documented medication adherence problems achieve an undetectable HIV RNA. The intervention was highly cost saving, with a return of nearly $3 in future medical care savings per dollar spent on the intervention. DISCLOSURES: This work was supported in part by a research grant to Dilworth, Mercier, and Borrego from the American Society of Health-System Pharmacists Foundation. Klein and Pinkerton were supported in part by grants T32-MH19985 and P30-MH52776, respectively, from the National Institute of Mental Health. No funding bodies had any role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Health Resources and Services Administration. The authors have no conflicts of interest to disclose. Study concept and design were contributed primarily by Dilworth, Mercier, and Borrego, along with the other authors. Dilworth took the lead in data collection, along with Pinkerton, Klein, Mercier, and Jakeman. Data interpretation was performed by Dilworth and Pinkerton, along with the other authors. The manuscript was written by Dilworth, Klein, and Jakeman, with assistance from the other authors, and revised by Dilworth, Jakeman, and Klein, with assistance from the other authors. The results from this study were presented in part at the 2015 United States Conference on AIDS in Washington, DC, on September 10-13, 2015.


Assuntos
Instituições de Assistência Ambulatorial/economia , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Custos de Medicamentos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Adesão à Medicação , Assistência Farmacêutica/economia , Farmacêuticos/economia , Papel Profissional , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Contagem de Linfócito CD4 , Redução de Custos , Análise Custo-Benefício , Aconselhamento/economia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Gastos em Saúde , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/economia , Assistência Farmacêutica/organização & administração , Farmacêuticos/organização & administração , Projetos Piloto , Fatores de Tempo , Resultado do Tratamento , Carga Viral , Adulto Jovem
20.
Child Care Health Dev ; 44(3): 501-506, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29436011

RESUMO

BACKGROUND: Increasing knowledge and understanding of disease is known to improve outcomes in persons living with a chronic illness. In this paper, we aim to compare the disease knowledge of children with sickle cell disease (SCD), age 6-10 years, who received an intervention (an educational colouring book on SCD) geared towards improving disease knowledge, to those who did not received the colouring book. METHODS: A quasi-experimental study was conducted where disease knowledge was determined in 56 children who had received the colouring book and compared to 60 children who did not receive this intervention. RESULTS: The mean knowledge score was significantly higher in the intervention group (mean difference = 2.65; 95% CI [1.43, 3.86]), as well as in older children and in those in higher grades but there was no difference between sexes. In a multiple regression model (adjusted R2 : 0.39; p value < .001), knowledge score was significantly higher in those who received the intervention (ß: 2.62; 95% CI [1.48, 3.76]) while adjusting for age, gender, persons living at home, and the father's employment status. CONCLUSION: The study highlights that a simple, inexpensive (cost: US$1/book) child-friendly intervention can significantly improve knowledge about SCD even in young children. It also underlines various social factors that are associated with children's understanding of their disease.


Assuntos
Anemia Falciforme/psicologia , Serviços de Saúde da Criança , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Anemia Falciforme/economia , Criança , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/organização & administração , Análise Custo-Benefício , Feminino , Inquéritos Epidemiológicos , Humanos , Jamaica , Masculino , Educação de Pacientes como Assunto/economia , Educação de Pacientes como Assunto/métodos
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