Suchergebnisse

ABSTRACTBackgroundAtrial Fibrillation (AF) is a highly debilitating condition with significant economic burden. Previous studies have estimated the cost of hospitalisations associated with AF in Scotland. However, patients with AF are often elderly with co-morbidities requiring substantial outpatient and social care.
ObjectivesThis study seeks to estimate inpatient, outpatient and social care costs associated with AF in a Scottish cohort, by using individual-level linked data.
MethodsThe AF cohort of 50 years and older patients, hospitalised with a known diagnosis of AF or atrial flutter between 1997 and 2014, was followed up for five years following the first AF event. Individual-level data on hospitalisation and discharge to social care home were obtained from the Scottish Morbidity Records (SMR01); whereas data on outpatient attendance were obtained from (SMR00). Death records for the same time period were extracted from National Records of Scotland (NRS). Hospital and outpatient costs associated with the corresponding data were estimated utilising the Scottish National Tariff (SNT) based on Healthcare Resource Groups (HRGs), and the Scottish Health Service Costs report, respectively. Social care costs were identified from the Care Home Census. Following data linkage, the econometric analysis was carried out using a two-part model where, the first part estimates through a probit model the probability of using a healthcare service, and the second part estimates costs conditional on having incurred positive costs. The regression model was adjusted for demographic characteristics, socio-economic status, year of admission and location.
ResultsOverall, a cohort of 253,963 AF patients accounted for 2,988,607 hospital admissions and 4,452,476 outpatient attendances. The mean cost per patient was estimated to be £3,071 (95% CI 3,033-3,109). Overall, hospital admissions and outpatient visits accounted for 71.7% and 3.7% of the total cost, respectively; social care accounted for 24.6% of the total costs. The cost increased with age and females incurred higher costs than males. Significant differences were observed among the urban/rural classifications, individual health boards and the socio-economic status.
ConclusionsThis study has shown the importance of taking into account healthcare resource use incurred beyond hospitalisation. In addition to inpatient costs, outpatient and social care costs contribute considerably to the overall economic burden.

ABSTRACTBackgroundAnalyses of inpatient care admissions have shown that population ageing does not lead to an increase in future healthcare expenditure to the extent that might be expected and that remaining time to death (TTD) is an equally important cost element. But as people live longer and the onset of disease and death are postponed to older ages the utilisation of social care services is another major cost component for elderly people, in particular those with chronic diseases. However, there is a distinct lack of social care data in Scotland to estimate the impact of population ageing and TTD on social care expenditure.
ObjectivesThis study aims to estimate the utilisation and associated costs of inpatient and home care services among end-of-life patients. It will also determine the feasibility of undertaking the linkage of home care service utilisation data, inpatient care episodes and death records.
MethodsNHS Greater Glasgow and Clyde (NHSGGC) social home care data (Cordia), Scottish Morbidity Records (SMR01) and death records (National Records for Scotland, NRS) will be utilised in order to estimate utilisation and costs for home care services and inpatient care at the end of life. The 'Cordia' data is available for the period September 2013 to November 2013 and includes information on the type, duration and frequency of home care services utilised. Costs will be assigned using 'Personal Social Services Research Unit' (PSSRU) costs. Using multilevel modelling techniques the association between TTD, age, demographic and socio-economic measures and expenditure on home care services will be estimated, while allowing the effect of covariates to vary over hierarchical levels, such as episode of care and the patient.
Expected OutcomesThe wider literature suggests that contrary to inpatient care, costs at the end of life for the oldest old might be higher when considering elements of social care provision. The 'Cordia' data consists of 7,367 individuals with 1,620 observed deaths. Further results are forthcoming and findings will significantly add to the knowledge base in the area of population ageing and related health- and social care expenditure. This is a novel linkage and given the difficulties in obtaining social care data, this study will i) help to evaluate the feasibility of using these data for research, and ii) identify where costs at the end of life occur, thus facilitating more targeted approaches to end-of-life care.

OBJECTIVE: Very few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam. METHODS: A hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed. RESULTS: All DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens. CONCLUSIONS: Allocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.

Objective: Very few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam. Methods: A hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed. Results: All DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens. Conclusions: Allocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.

Whilst much research has been undertaken on establishing what factors influence improved decision-making including good governance structures, expertise, political and institutional factors, resources and participation, how such influences on decision-making interact with local context and health systems, leading to impact on health outcomes, is less understood. The focus of our research is on the impact of Health Technology Assessment (HTA) as a tool for priority-setting with its explicit consideration of costs and benefits. Where evaluations have been undertaken, they mainly focus on processes or outcomes at the decision-making level, with impact on health outcomes rarely measured. Even in countries where HTA programmes are well established, evidence which identifies their outcomes and impact in terms of health gains is limited. For countries with greater capacity constraints, how decision-making interacts with 'context' leading to health outcomes is even less explored and arguably of critical importance. This research aims to provide a methodological framework and evidence base to: quantify the returns on investment in HTA; and produce explanatory programme theory that considers individual, interpersonal, institutional and systems-level components and their interactions on the mechanisms by which HTA impact can be optimised.

BACKGROUND: The Scottish Government set out its policy on addressing the poor oral health of Scottish children in 2005. This led to the establishment of Childsmile, a national programme designed to improve the oral health of children in Scotland. One element of the programme promotes daily tooth brushing in all nurseries in Scotland (Childsmile Core). A second targeted component (Childsmile Nursery) offers twice-yearly application of fluoride varnish to children attending nurseries in deprived areas. Studies suggest that fluoride varnish application can reduce caries in both adult and child populations. This trial aims to explore the effectiveness and cost-effectiveness of additional preventive value fluoride varnish application compared to Childsmile Core. METHODS/DESIGN: The Protecting Teeth@3 Study is an ongoing 2 year parallel group randomised treatment as usual controlled trial. Three-year-old children attending the ante pre-school year are randomised (1:1) to the intervention arm (fluoride varnish & treatment as usual) or the control arm (treatment as usual). Children in the intervention arm will have Duraphat® fluoride varnish painted on the primary tooth surfaces and will continue to receive treatment as usual: the core Childsmile Nursery intervention. Children in the treatment as usual arm will receive the same series of contacts, without the application of varnish and will also continue with the Childsmile Core intervention. Interventions are undertaken by Childsmile trained extended duty dental nurses at six-monthly intervals. Participants receive a baseline dental inspection in nursery and an endpoint inspection in Primary 1 at the age of 5 years old. We will use primary and secondary outcome measures to compare the effectiveness of Duraphat® fluoride varnish plus treatment as usual with treatment as usual only in preventing any further dental decay. We will also undertake a full economic evaluation of the trial. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov. Number: NCT01674933 (24 August 2012).

Background: The Scottish Government set out its policy on addressing the poor oral health of Scottish children in 2005. This led to the establishment of Childsmile, a national programme designed to improve the oral health of children in Scotland. One element of the programme promotes daily tooth brushing in all nurseries in Scotland (Childsmile Core). A second targeted component (Childsmile Nursery) offers twice-yearly application of fluoride varnish to children attending nurseries in deprived areas. Studies suggest that fluoride varnish application can reduce caries in both adult and child populations. This trial aims to explore the effectiveness and cost-effectiveness of additional preventive value fluoride varnish application compared to Childsmile Core. Methods/Design: The Protecting Teeth@3 Study is an ongoing 2 year parallel group randomised treatment as usual controlled trial. Three-year-old children attending the ante pre-school year are randomised (1:1) to the intervention arm (fluoride varnish & treatment as usual) or the control arm (treatment as usual). Children in the intervention arm will have Duraphat® fluoride varnish painted on the primary tooth surfaces and will continue to receive treatment as usual: the core Childsmile Nursery intervention. Children in the treatment as usual arm will receive the same series of contacts, without the application of varnish and will also continue with the Childsmile Core intervention. Interventions are undertaken by Childsmile trained extended duty dental nurses at six-monthly intervals. Participants receive a baseline dental inspection in nursery and an endpoint inspection in Primary 1 at the age of 5 years old. We will use primary and secondary outcome measures to compare the effectiveness of Duraphat® fluoride varnish plus treatment as usual with treatment as usual only in preventing any further dental decay. We will also undertake a full economic evaluation of the trial.

INTRODUCTION: Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke. METHODS: The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke. RESULTS: Of 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article. CONCLUSION: The protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.

Introduction Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke. Methods The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke. Results Of 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article. Conclusion The protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.

Abstract Introduction: Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke. Methods: The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke. Results: Of 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article. Conclusion: The protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.

The Future of Cancer and Collective Intelligence in the Post-Covid World project was jointly conceived by the Innovation School at Glasgow School of Art and the Institute of Cancer Sciences at the University of Glasgow. Graduating year Product Design students from the Innovation School were presented with a challenge-based project to produce a vision of the future based on current trends that relate to the Future of Cancer and Collective Intelligence in the Post-Covid World. Currently, cancer research and development occur in isolated pockets within stages across the cancer care continuum, which often negatively impacts on the potential for cancer professionals to exchange, integrate and share data, insights and knowledge across the framework. One of the most significant societal shifts currently taking place within Cancer and Collective Intelligence is the transformation from the siloed clinic point of care model to a seamless continuum of care with greater focus on prevention and early intervention, changing what it means to be someone living with cancer and a professional working within this context. From this new dynamic, emerges the concept of living-labs; transdisciplinary communities of practice involving people working within and living with cancer, capable, through collective intelligence-enabled systems and services, of generating knowledge which can be used locally, and shared globally, to deliver focused innovations across the whole cancer ecosystem. If collective intelligence holds the potential to truly connect people to people, and people to data, across diverse communities, linking peoples' lived experiences locally and globally, what kinds of new health and care services might emerge to improve cancer control across the continuum from prevention, detection, treatment and survivorship, and what types of new roles might emerge for citizens, patients and community groups to collaboratively drive these forward with health professionals? In order to address this challenge, the GSA Innovation School's final year Product Design students and faculty formed a dynamic community of practice with cancer practitioners and researchers from the Institute of Cancer Sciences at The University of Glasgow and beyond to envisage a 2030 cancer blueprint as a series of future world exhibits, and create the designed products, services and experiences for the people who might live and work within this ecosystem. This project involved the students working in partnership with an Expert Faculty composed of Cancer Physicians, Cancer Researchers, Social Scientists, Biomedical Engineers, Health Research Specialists, Past Patients, Digital Health Specialists, Design Experts and Government Agencies. The Expert Faculty was assembled from a range of local to global organisations including the University of Glasgow, the Beatson West of Scotland Cancer Centre, the Malawi Ministry of Health and the International Agency for Research on Cancer (IARC is part of the World Health Organization). This project asked the students to embark on a speculative design exploration into future experiences of working and living with cancer ten years from now, where advances in collective intelligence have evolved to the extent that new forms and ecosystems of medical practice, cancer care and experiences of living with, through and beyond cancer transform how we interact with each other, with health professionals and the communities around us. This project was conceived and carried out during the global COVID-19 pandemic. Throughout the project the students positively used this situation to creatively embrace a digital studio practice and innovate around digital and remote access platforms and forums for collaboration, development and engagement. Thus, the designed products, services and experiences for the people who might live and work within the cancer ecosystem are presented as innovative, highly creative, fully immersive, experiential exhibits. The project was divided into two sections: The first was a collaborative stage based on Future Worlds. The worlds are groups of students working together on specific topics, to establish the context for their project and collaborate on research and development. These were clustered together around 'Future Working' and 'Future Living' but also joined up across these groups to create pairs of worlds, and in the process generate collective intelligence between the groups. The worlds clustered around 'Future Working' are Education, Care and Treatment, Prevention and Detection. Future Worlds clustered around 'Future Living' are Personal Wellbeing, Communicating Cancer, Beyond Cancer. The second stage saw students explore their individual response to their assigned Future World that had been created in the first stage. Each student developed their own research by iteratively creating a design outcome that was appropriate to the Future cancer World. This culminated in each student producing designed products, services or systems and a communication of the future experiences created. Throughout the project, the results were presented as a series live interactive digitally curated, virtual work-in-progress exhibitions for specific audiences including a special global event to participate in World Cancer Day on the 4th February 2021. An event which allowed the students to actively interact and discuss the project with a global audience of cancer community leaders. The deposited materials are arranged as follows: 1. Readme files - two readme files relate to tage one and stage two of the project as outlined above. 2. Project overview document - gives a visual overview of the structure and timeline of the project. 3. Stage one data folders - the data folders for stage one of the project are named by the six Future Worlds through which each group explored possible futures. 4. Stage two data folders - the data folders for stage two of the project are named for the individual students who conducted the work and organised by the Future World cluster they worked within.