1,721,036 research outputs found
Safety gains don't translate into reduced costs or increased QALYs for doxycycline compared with prednisolone for patients with bullous pemphigoid
No full textPRM271 Exploring the Use of Value of Information Methods to Prioritise Research to Address the Treatment Uncertainties Identified By the James Lind Alliance Priority Setting Partnerships
No full textEconomic analysis is regularly used to inform decisions on allocating healthcare budgets but not routinely for allocating health research budgets which may mean that the research budget is not delivering value for money. The study aims to use ‘value of information’ analysis to prioritise research funding across an entire clinical area. In particular, exploring the usefulness of such methods in prioritising the treatment uncertainties identified by the James Lind Alliance (JLA) Priority Setting Partnership (PSP) for atopic eczema. Whilst the research will primarily identify what the future research priorities within eczema should be, it will also act as a case study of how such methods could be applied to JLA PSPs for other conditions. The potential benefit of this research is in reducing the first two stages of research waste (i) ‘Questions relevant to research users?’ And (ii) ‘Appropriate research design, conduct and analysis?’ identified by Chalmers and Glasziou (2009). The methods proposed for doing the work will be described, with a focus on those stages already underway. This includes defining the decision problems, building on the work of the eczema JLA PSP, and conceptual modelling, understanding the disease process and service pathways for eczema with expert input. The potential usefulness and challenges of the approach will be discussed. Strengthening methods around research prioritisation and study design is important to ensure value for money from limited research funding. Reference: Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence
The long-term costs of preterm birth and low birth weight: results of a systematic review
No full textThe high rates of morbidity and mortality arising from preterm birth and low birth weight impose an immense burden on the health, education and social services, and on families. This paper presents the results of a systematic review of the published and unpublished evidence regarding the long-term economic implications of preterm birth and low birth weight for various sectors of the economy and for individuals. The paper highlights the variable methodological quality of the bulk of long-term economic studies of preterm birth and low birth weight and suggests ways in which these methodological limitations can be overcome. The paper reveals that preterm birth and low birth weight can result in substantial costs to the health sector following the infant's initial discharge from hospital. It can also impose a substantial burden on special education and social services, on families and carers of the infants and on society generally. In addition to the costs identified by the literature, preterm birth and low birth weight can have other long-term consequences that require evaluation from an economic perspective.</p
A multicentre randomized controlled trial of ion-exchange water softeners for the treatment of eczema in children: protocol for the Softened Water Eczema Trial (SWET) (ISRCTN: 71423189)*
No full textBACKGROUND: There is epidemiological evidence linking increased water hardness with increased eczema prevalence. A number of plausible mechanisms can be forwarded to suggest why hard water could exacerbate eczema. The most likely explanation is increased soap usage in hard water areas, the deposits of which can cause skin irritation in individuals with eczema. OBJECTIVES: To assess the cost and cost-effectiveness of ion-exchange water softeners for the treatment of eczema in children. PATIENTS/METHODS: Three hundred and ten children aged 6 months to 16 years, with moderate to severe eczema. The children must live in hard water areas (>or= 200 mg L(-1) of calcium carbonate) and have a home that is suitable for the installation of a water softener. This is a single-blind, parallel-group, randomized controlled trial of 12 weeks duration followed by a 4-week cross-over period. RESULTS/ANALYSIS PLAN: Primary outcome: difference in the mean change in disease severity (Six Area, Six Sign Atopic Dermatitis score) at 12 weeks compared with baseline. Secondary outcomes: (i) proportion of time spent moving during the night; (ii) self-reported global changes in eczema severity; (iii) amount of topical treatment used; (iv) Patient Oriented Eczema Measure; (v) number of totally controlled and well controlled weeks; (vi) impact on health-related quality of life for the child (EQ-5D) and the family (Dermatitis Family Impact questionnaire); and (vii) cost-effectiveness. It is planned that recruitment will be completed by the end of 2008 and results will be available towards the end of 2009
PRM39 Resource Use Measurement In Trials Conducted In Care Homes: A Study Of Level-Of-Agreement Between Data Collected From Gp Records And Care Home Records
No full textObjectivesMethodological research focused on resource use measurement has been limited in comparison to the amount of research focussed on measuring outcomes within the economic evaluation context. This study was designed to assess the level-of-agreement between two different sources of health and social care resource use data collected on care home residents.MethodsThe methods were informed by a review of level-of-agreement studies concerned with resource use in older people. In the base case, resource use data collected from both GP medical records (electronic records) and care home records (paper-based records) on 362 care home residents were obtained as part of the CAREMED cluster randomised controlled trial. Descriptive statistics were explored before assessing level-of-agreement through percent agreement, 95% limits of agreement, and Lin’s concordance correlation coefficient (CCC). Sensitivity analyses excluded non-users and tested timeframe. Factors affecting the magnitude of difference were explored using multi-level modelling.ResultsSeveral resource items (number of GP, out of hours GP and podiatrist contacts) were found to have substantial agreement (0.61 to 0.80) between the GP records and care home records according to the CCC. The number of total visits, dietician, paramedic and SLT contacts showed moderate agreement (0.41 to 0.60). Most resources showed a poor (less than 0.00) or slight (0.00 to 0.22) level-of-agreement either due to care home records (for chiropodist, music therapy, and social worker contacts) or GP records (for phlebotomist and practice nurse) recording a greater number of visits. Patient classification (residential/nursing), number of falls, number of STOPP criteria met, number of medications and comorbidities significantly affected the magnitude of differences observed.ConclusionsThis research suggests that both sources of data are reliable for some resources but not others, indicating dual sources may be necessary where a wider perspective is important and feasible in terms of costs of data collection
Evidence of improving cost-effectiveness of pediatric cochlear implantation
No full textObjectives: to examine the cost-effectiveness of pediatric cochlear implantation over time.Methods: a prospective study based on ninety-eight children implanted between 1989 and 1996 at Nottingham's Paediatric Cochlear Implantation Programme, UK. The influence of outcomes and other variables on total costs was examined using multivariate regression analysis.Results: having controlled for potential confounding variables, total cost was negatively related to year of implant and positively related to the number of hours of rehabilitation (p=.000).Conclusions: having controlled for outcomes (Categories of Auditory Performance and Speech Intelligibility Rating), the cost-effectiveness improved over time. This finding may be due to a learning curve and have policy implications.</p
Are vitiligo treatments cost-effective? A systematic review
Get PDFVitiligo is characterised by well demarcated, cutaneous, macular depigmentation, with worldwide prevalence estimated to be between 0.2-1.8% [1]. Vitiligo treatments aim to encourage re-pigmentation and include topical corticosteroids, calcineurin inhibitors and NB-UVB phototherapy. Camouflage can also be prescribed to help mask the appearance of vitiligo, although this is frequently only prescribed for the face
Variations in gains in auditory performance from pediatric cochlear implantation
No full textObjective: to investigate variations in gains in auditory performance in children with cochlear implants.Study design: the auditory performance of 98 children was measured with the Category of Auditory Performance survey instrument. All data were collected prospectively. Variables used to explain gain in Category of Auditory Performance were age at implantation, sex, the duration of "untreated" deafness, the year in which implantation occurred, health care inputs, and cause of hearing impairment. The data were analyzed by ordered probabilistic regression analysis.Results: gain in Category of Auditory Performance was observed to be negatively related to age at implantation, the year in which implantation took place, and the number of medical consultations the child received. None of the other variables were significant determinants of gain in Category of Auditory Performance.Conclusion: this study demonstrates the value of examining incremental gain from implantation rather than simply examining outcome levels. It was found that pediatric implantation is subject to diminishing returns. This suggests that further relaxation of entry criteria to implant programs should be undertaken only after careful consideration. The study also confirmed that age at implantation is an important determinant of outcomes. Greater gain in Category of Auditory Performance was experienced by those who underwent implantation at a younger age. This finding has implications for screening, as well as for purchasers and providers of implant services, highlighting the importance of responding in a timely fashion to identified need.</p
Investigation of the effect of a countywide protected learning time scheme on prescribing rates of ramipril: interrupted time series study
No full textBACKGROUND: Protected learning time (PLT) schemes have been set up in primary care across the UK. There is little published evidence of their effectiveness. OBJECTIVE: To investigate the effect of a PLT intervention for general practice to increase prescribing of ramipril for prevention of cardiovascular outcomes. DESIGN: Quasi-experimental, interrupted time series. SETTING: Lincolnshire, UK. METHODS: Prescribing data were analysed one year before and after the education for change in rate of increase of prescribing of ramipril, whether change in prescribing was related to postulated explanatory variables and to determine intervention costs. MAIN OUTCOME: The primary outcome was the rate of change of ramipril (10 mg) prescription items 12 months after compared with before the educational intervention. Secondary outcomes included cost. RESULTS: Ramipril prescribing at therapeutic dosage increased significantly (odds ratio 1.50, 95% CI 1.07-1.93) following education by 52,345 items (31,132 items at 10 mg) at a cost of pound 292k to pound 460k depending on formulation. This occurred despite a background of secular change. Most practices were represented by GPs, nurses or both during the education. Single-handed GPs were less likely to attend. Practices showed considerable variation in response to the educational intervention. The only predictor of whether practices increased in prescribing rate after the education was whether a practice nurse had undertaken specific diabetes training. Total list size, dispensing, training or single-handed status and GP attendance did not predict a change in prescribing. CONCLUSION: PLT schemes can contribute to beneficial changes in prescribing across a large geographical area
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