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Thomsen AML, Tayyari N, Duvald I, Kirkegaard H, Obel B, Nielsen CP. Hospital at home for elderly acute patients: a study protocol for a randomised controlled trial. BMJ Open 2024; 14:e083372. [PMID: 38697766 PMCID: PMC11086463 DOI: 10.1136/bmjopen-2023-083372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION The increasing elderly population has led to a growing demand for healthcare services. A hospital at home treatment model offers an alternative to standard hospital admission, with the potential to reduce readmission and healthcare consumption while improving patients' quality of life. However, there is little evidence regarding hospital at home treatment in a Danish setting. This article describes the protocol for a randomised controlled trial (RCT) comparing standard hospital admission to hospital at home treatment. The main aim of the intervention is to reduce 30-day acute readmission after discharge and improve the quality of life of elderly acute patients. METHODS AND ANALYSIS A total of 849 elderly acute patients will be randomised in a 1:2 ratio to either the control or intervention group in the trial. The control group will receive standard hospital treatment in a hospital emergency department while the intervention group will receive treatment at home. The primary outcomes of the trial are the rate of 30-day acute readmission and quality of life, assessed using the European Quality of Life-5 Dimensions-5-Level instrument. Primary analyses are based on the intention-to-treat principle. Secondary outcomes are basic functional mobility, resource use in healthcare, primary and secondary healthcare cost, incremental cost-effectiveness ratio, and the mortality rate 3 months after discharge. ETHICS AND DISSEMINATION The RCT was approved by the Ethical Committee, Central Denmark Region (no. 1-10-72-67-20). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Danish healthcare system. TRIAL REGISTRATION NUMBER NCT05360914.
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Affiliation(s)
- Anne Marie Ladehoff Thomsen
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Nasrin Tayyari
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark
| | - Iben Duvald
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Aarhus University School of Business and Social Sciences, Aarhus, Denmark
- The Emergency Department, Viborg Regional Hospital, Regional Hospital Central Jutland, Central Denmark Region, Viborg, Denmark
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Børge Obel
- Interdisciplinary Centre for Organizational Architecture, Department of Management, Aarhus BSS, Aarhus, Denmark
| | - Camilla Palmhøj Nielsen
- Central Denmark Region, Defactum, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Davies-Abbott I, Anthony BF, Jackson K, Windle G, Edwards RT. The Diagnostic Pathway Experiences of People Living with Rare Dementia and Their Family Caregivers: A Cross-Sectional Mixed Methods Study Using Qualitative and Economic Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:231. [PMID: 38397720 PMCID: PMC10888730 DOI: 10.3390/ijerph21020231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The pathways for receiving a diagnosis of a rare type of dementia are poorly understood. Diagnostic challenges decrease access to relevant health promotion activities and post-diagnostic support. This study was focused on pathways experienced by people affected by rare dementia in Wales, United Kingdom (UK), considering the practical, emotional, and economic consequences. Semi-structured interviews were completed with 10 people affected by rare dementia across Wales, UK (nine family caregivers and one person living with rare dementia). The interview data were subject to a thematic analysis and a bottom-up costing approach was used to cost the pathway journeys. Five transitional points occurred across the diagnostic pathway (initial contact, initial referral, further referrals-provider, further referrals-private, and diagnosis) alongside two further themes (i.e., involved in the diagnostic process and disputes between stakeholders). The timeliness of the diagnosis was perceived to often be subject to 'luck', with access to private healthcare a personal finance option to expedite the process. Higher economic costs were observed when, in retrospect, inappropriate referrals were made, or multiple referrals were required. The confusion and disputes relating to individual diagnostic pathways led to further emotional burdens, suggesting that higher economic costs and emotional consequences are interlinked. Clearer diagnostic pathways for rare dementia may prevent unnecessary service contacts, waiting times, and associated distress. Prioritising appropriate and timely service contacts leads to diagnosis and support to families and enables people to increase control over their health. Appropriate diagnostic pathways may be less costly and reduce costs for families.
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Affiliation(s)
- Ian Davies-Abbott
- The Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP, UK
| | - Bethany F. Anthony
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Bangor LL57 2PZ, UK
| | - Kiara Jackson
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Bangor LL57 2PZ, UK
| | - Gill Windle
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Bangor LL57 2PZ, UK
| | - Rhiannon Tudor Edwards
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Bangor LL57 2PZ, UK
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Crealey GE, Hickey G, McGilloway S. A cost-effectiveness analysis of a universal, preventative-focused, parent and infant programme. BMC Health Serv Res 2024; 24:176. [PMID: 38331766 PMCID: PMC10851506 DOI: 10.1186/s12913-023-10492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/18/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND This study assessed whether a relatively newly developed Parent and Infant (PIN) parenting support programme was cost-effective when compared to services as usual (SAU). METHODS The cost-effectiveness of the PIN programme versus SAU was assessed from an Irish health and social care perspective over a 24-month timeframe and within the context of a non-randomised, controlled before-and-after trial. In total, 163 parent-infant dyads were included in the study (86 intervention, 77 control). The primary outcome measure for the economic evaluation was the Parenting Sense of Competence Scale (PSOC). RESULTS The average cost of the PIN programme was €647 per dyad. The mean (SE) cost (including programme costs) was €7,027 (SE €1,345) compared to €4,811 (SE €593) in the control arm, generating a (non-significant) mean cost difference of €2,216 (bootstrap 95% CI -€665 to €5,096; p = 0.14). The mean incremental cost-effectiveness of the PIN service was €614 per PSOC unit gained (bootstrap 95% CI €54 to €1,481). The probability that the PIN programme was cost-effective, was 87% at a willingness-to-pay of €1,000 per one unit change in the PSOC. CONCLUSIONS Our findings suggest that the PIN programme was cost-effective at a relatively low willingness-to-pay threshold when compared to SAU. This study addresses a significant knowledge gap in the field of early intervention by providing important real world evidence on the implementation costs and cost-effectiveness of a universal early years parenting programme. The challenges involved in assessing the cost-effectiveness of preventative interventions for very young children and their parents are also discussed. TRIAL REGISTRATION ISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered.
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Affiliation(s)
| | - Gráinne Hickey
- Barnardos Ireland, Christchurch Sq., Dublin 8, Dublin, D08DT63, Ireland
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, W23 F2H6, Co. Kildare, Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, W23 F2H6, Co. Kildare, Ireland.
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Edgar B, Jones C, Aitken E, Stevenson K, Jackson A, Gaianu L, Thomson P, Kasthuri R, Stove C, Kingsmore D. What are the observed procedural costs of vascular access surgery? Protocol for a systematic review. BMJ Open 2024; 14:e079773. [PMID: 38272545 PMCID: PMC10824010 DOI: 10.1136/bmjopen-2023-079773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION A central component in the introduction of a novel surgical procedure or technique is an evaluation of its cost efficiency when compared with a benchmark standard of care. Accurate assessment of costs is thus essential in ensuring appropriate allocation of resources within a healthcare system. The treatment of kidney failure requires a significant volume of resources, and vascular access provision is the main modifiable cost. The costs of providing this service are obscured by generic NHS reference costs, which lack adequate granularity to allow meaningful comparisons between treatments. The aim of this systematic review will be to assess the reporting of procedural costs in all published economic analyses of vascular access surgery and perform a comparison of the reported procedural costs involved in arteriovenous fistula (AVF) and arteriovenous graft (AVG) creation. This will provide an estimate as to the accuracy of the NHS reference costs in this field. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed. A systematic search will be performed of the MEDLINE, Embase and Cochrane databases to identify full-text economic analyses of vascular access for haemodialysis in which the procedural cost of AVF or AVG creation is reported. Publications in English from 1 January 2000 to 30 August 2023, will be eligible for inclusion. Studies will be selected by title and abstract review, followed by a full-text review using inclusion and exclusion criteria. Studies not reporting the procedural costs of surgery will be excluded. Data collected will pertain to procedural costs of AVF and AVG creation. Costs will be adjusted to a common currency using a gross domestic product (GDP) deflator index and conversion rates based on purchasing power parities for GDP. Comparison with NHS reference costs will indicate their reliability for use in future economic analyses in this field. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42023458779.
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Affiliation(s)
- Ben Edgar
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Catrin Jones
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma Aitken
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Karen Stevenson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Andrew Jackson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Lucian Gaianu
- Independent Health Economist, Healthonomics UK Ltd, Reading, UK
| | - Peter Thomson
- Department of Renal Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ram Kasthuri
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Callum Stove
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David Kingsmore
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Rabbitt L, Curneen J, Hobbins A, Browne D, Joyce M, Lappin D, McEvoy JW, Gillespie P, Dennedy MC. A cost-analysis of managing secondary and apparent treatment-resistant hypertension in a specialist multidisciplinary hypertension clinic. J Hypertens 2024; 42:58-69. [PMID: 38009268 DOI: 10.1097/hjh.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
OBJECTIVES A knowledge gap exists around the costs and budget impact of specialist hypertension clinics. This study reports on the cost of providing care in a multidisciplinary hypertension clinic staffed by nephrologist, endocrinologist and cardiologist, which manages patients with suspected secondary hypertension and/or apparent treatment-resistant hypertension. The aim of this study is to provide the evidence required to inform policy and planning care pathways for this patient group. METHODS A cost analysis from a healthcare provider perspective using micro-costing techniques was conducted to estimate the direct implementation costs of existing standard practice for the care pathway of patients attending the multidisciplinary hypertension clinic. Sixty-five patients originally recruited for a study of medication adherence in hypertension were included in the sample. RESULTS The total care-pathway cost per patient, taking into account clinic visits, clinical reviews, investigations and MDT discussion, was estimated to be €3277, on average. For the patient subgroups, the average cost was €5644 for patients diagnosed with primary aldosteronism and €1446 for patients diagnosed with essential hypertension. CONCLUSION There is significant cost associated with providing specialized hypertension care for patients with apparent treatment-resistant hypertension. Given the high rates of nonadherence in this population, it is likely that some of this cost could be avoided with better detection and management of medication adherence in this challenging population. Future studies should consider the cost-effectiveness of this or similar models of care by exploring the benefit to patients and the wider healthcare context of providing care of this type.
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Affiliation(s)
- Louise Rabbitt
- Discipline of Pharmacology and Therapeutics, School of Medicine, University of Galway
| | - James Curneen
- Department of Clinical Pharmacology and Therapeutics, St James' Hospital, Dublin
| | - Anna Hobbins
- Centre for Research in Medical Devices (CÚRAM, SFI 13/RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, Ireland
| | | | - Mary Joyce
- Centre for Endocrinology, Diabetes and Metabolism
| | - David Lappin
- Department of Nephrology, Saolta University Healthcare Group (SUHCG), Galway University Hospitals
| | - John William McEvoy
- Department of Cardiology, School of Medicine, University of Galway
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Paddy Gillespie
- Centre for Research in Medical Devices (CÚRAM, SFI 13/RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, Ireland
| | - Michael Conall Dennedy
- Discipline of Pharmacology and Therapeutics, School of Medicine, University of Galway
- Centre for Endocrinology, Diabetes and Metabolism
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Mordaunt DA, Stark Z, Santos Gonzalez F, Dalziel K, Goranitis I. Development of a microcosting protocol to determine the economic cost of diagnostic genomic testing for rare diseases in Australia. BMJ Open 2023; 13:e069441. [PMID: 38030253 PMCID: PMC10689401 DOI: 10.1136/bmjopen-2022-069441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Genomic testing is a relatively new, disruptive and complex health technology with multiple clinical applications in rare diseases, cancer and infection control. Genomic testing is increasingly being implemented into clinical practice, following regulatory approval, funding and adoption in models of care, particularly in the area of rare disease diagnosis. A significant barrier to the adoption and implementation of genomic testing is funding. What remains unclear is what the cost of genomic testing is, what the underlying drivers of cost are and whether policy differences contribute to cost variance in different jurisdictions, such as the requirement to have staff with a medical license involved in testing. This costing study will be useful in future economic evaluations and health technology assessments to inform optimal levels of reimbursement and to support comprehensive and comparable assessment of healthcare resource utilisation in the delivery of genomic testing globally. METHODS A framework is presented that focuses on uncovering the process of genomic testing for any given laboratory, evaluating its utilisation and unit costs, and modelling the cost drivers and overall expenses associated with delivering genomic testing. The goal is to aid in refining and implementing policies regarding both the regulation and funding of genomic testing. A process-focused (activity-based) methodology is outlined, which encompasses resources, assesses individual cost components through a combination of bottom-up and top-down microcosting techniques and allows disaggregation of resource type and process step. ETHICS AND DISSEMINATION The outputs of the study will be reported at relevant regional genetics and health economics conferences, as well as submitted to a peer-reviewed journal focusing on genomics. Human research ethics committee approval is not required for this microcosting study. This study does not involve research on human subjects, and all data used in the analysis are either publicly available.
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Affiliation(s)
- Dylan A Mordaunt
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Women's and Children's Division, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Zornitza Stark
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Australian Genomics Health Alliance, Australian Genomics Health Alliance, Australia, UK
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Francisco Santos Gonzalez
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ilias Goranitis
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Mooney KE, Bywater T, Hinde S, Richardson G, Wright J, Dickerson J, Blower SL. A quasi-experimental effectiveness evaluation of the 'Incredible Years Toddler' parenting programme on children's development aged 5: A study protocol. PLoS One 2023; 18:e0291557. [PMID: 37756300 PMCID: PMC10529533 DOI: 10.1371/journal.pone.0291557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Child behavioural and mental health problems have become a public health crisis. The consequences of poor mental health in childhood have large economic costs and consequences for the individual, their families, and for society. Early intervention through parenting programmes can reduce the onset of poor mental health in childhood, hence evaluating the effectiveness of parenting programmes is critical. The 'Incredible Years Toddler' parent programme is an education and training intervention designed to enhance the social and emotional wellbeing of children aged 1-3 years. Whilst previous studies show Incredible Years Toddler to provide promising effects on child outcomes in the short term, the research samples have lacked ethnic diversity and representation from socioeconomically deprived families. This quasi-experimental study is registered on ISRCTN (ISRCTN49991769). We will investigate the effectiveness of Incredible Years Toddler being delivered in three neighbourhoods in inner city Bradford, England. These neighbourhoods contain a socially and ethnically diverse population with 84% living in the poorest decile for England and Wales. Parents with a child aged 1-3 years old who are enrolled in Born in Bradford's Better Start interventional family cohort study are eligible for this study. Intervention participants will be matched to a demographically comparable control group using propensity score matching. This study will use retrospective and prospective data from participants who attended Incredible Years groups between September 2018 and April 2024. The required minimum sample is n = 1336 (ratio 1:3) to detect a small effect (odds = 1.5, d = .20) on the Early Years Foundation Stage profile total score at age 5; a measure of early child development that is routinely collected by teachers. We will also establish whether these effects are moderated by child age at entry to intervention, programme delivery mode, socioeconomic status, and ethnicity. We will also estimate the cost of the intervention and conduct a cost-consequence analysis.
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Affiliation(s)
- Kate E. Mooney
- Department of Health Sciences, University of York, York, United Kingdom
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Tracey Bywater
- Department of Health Sciences, University of York, York, United Kingdom
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, United Kingdom
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Sarah L. Blower
- Department of Health Sciences, University of York, York, United Kingdom
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Jennings L, West RL, Halim N, Kaiser JL, Gwadz M, MacLeod WB, Gifford AL, Haberer JE, Orrell C, Sabin LL. Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa-a multiphase optimization strategy (MOST) approach using a fractional factorial design. Trials 2023; 24:310. [PMID: 37147725 PMCID: PMC10163747 DOI: 10.1186/s13063-023-07322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town. METHODS We will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package. DISCUSSION To our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic. TRIAL REGISTRATION ClinicalTrials.gov NCT05040841. Registered on 10 September 2021.
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Affiliation(s)
- Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rebecca L West
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Allen L Gifford
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA
- Department of Health Policy and Management, Boston University School of Public Health, Talbot Building, T348W, Boston, MA, 02118, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Stanley N, Devaney J, Kurdi Z, Ozdemir U, Barter C, Monks C, Edwards RT, Batool F, Charles J, Farrelly N, Hayes D, Millar A, Thompson T, Winrow E, Radford L. What makes for effectiveness when starting early - Learning from an integrated school-based violence and abuse prevention programme for children under 12. CHILD ABUSE & NEGLECT 2023; 139:106109. [PMID: 36870266 DOI: 10.1016/j.chiabu.2023.106109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/19/2022] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Integrated programmes addressing varying forms of violence and abuse are increasingly delivered to children under 12 but uncertainty remains about what should be delivered to whom, when and in what dose. OBJECTIVE To examine the impact of Speak Out Stay Safe (SOSS) - an integrated prevention programme for children under 12 - and whether impact varied by age, gender and context. PARTICIPANTS AND SETTING A representative UK sample of primary schools in receipt of SOSS was matched with comparison schools not receiving SOSS. At 6 months follow-up, 1553 children from 36 schools completed the survey. METHODS The matched control study incorporated economic and process evaluations. Survey measures included: children's knowledge and understanding of different forms of violence and abuse, readiness to seek help, knowledge of sexual abuse, perceptions of school culture and health and wellbeing. Perceptions of children, teachers, and facilitators were captured. RESULTS At 6 months, children aged 9-10 who received SOSS retained their improved knowledge of neglect and their ability to identify a trusted adult who they would tell about violence or abuse. Children aged 6-7 receiving a shorter version of the programme were less likely to benefit and boys made fewer gains than girls. SOSS improved the knowledge of children with low knowledge of abuse. School culture was closely associated with programme impact. CONCLUSION School-based prevention programmes deliver benefits at low cost but should acknowledge and engage with the specific school context to achieve school readiness and embed programme messages.
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Affiliation(s)
- Nicky Stanley
- University of Central Lancashire, Preston PR1 2HE, UK.
| | | | - Zain Kurdi
- University of Edinburgh, Edinburgh EH8 9YL, UK
| | | | | | | | | | - Farwa Batool
- University of Central Lancashire, Preston PR1 2HE, UK
| | | | | | - David Hayes
- Queen's University Belfast, Belfast BT7 1NN, UK
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10
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Anthony BF, Disbeschl S, Goulden N, Hendry A, Hiscock J, Hoare Z, Roberts J, Rose J, Surgey A, Williams NH, Walker D, Neal R, Wilkinson C, Edwards RT. Earlier cancer diagnosis in primary care: a feasibility economic analysis of ThinkCancer! BJGP Open 2023; 7:BJGPO.2022.0130. [PMID: 36543386 DOI: 10.3399/bjgpo.2022.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND UK cancer survival rates are much lower compared with other high-income countries. In primary care, there are opportunities for GPs and other healthcare professionals to act more quickly in response to presented symptoms that might represent cancer. ThinkCancer! is a complex behaviour change intervention aimed at primary care practice teams to improve the timely diagnosis of cancer. AIM To explore the costs of delivering the ThinkCancer! intervention to expedite cancer diagnosis in primary care. DESIGN & SETTING Feasibility economic analysis using a micro-costing approach, which was undertaken in 19 general practices in Wales, UK. METHOD From an NHS perspective, micro-costing methodology was used to determine whether it was feasible to gather sufficient economic data to cost the ThinkCancer! INTERVENTION Owing to the COVID-19 pandemic, ThinkCancer! was mainly delivered remotely online in a digital format. Budget impact analysis (BIA) and sensitivity analysis were conducted to explore the costs of face-to-face delivery of the ThinkCancer! intervention as intended pre-COVID-19. RESULTS The total costs of delivering the ThinkCancer! intervention across 19 general practices in Wales was £25 030, with an average cost per practice of £1317 (standard deviation [SD]: 578.2). Findings from the BIA indicated a total cost of £34 630 for face-to-face delivery. CONCLUSION Data collection methods were successful in gathering sufficient health economics data to cost the ThinkCancer! INTERVENTION Results of this feasibility study will be used to inform a future definitive economic evaluation alongside a pragmatic randomised controlled trial (RCT).
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Affiliation(s)
- Bethany Fern Anthony
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Stefanie Disbeschl
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | | | - Annie Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Zoe Hoare
- NWORTH, Bangor University, Bangor, UK
| | - Jessica Roberts
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jan Rose
- National Cancer Research Institute (NCRI), Consumer Member, London, UK
| | - Alun Surgey
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Nefyn Howard Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Daniel Walker
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Richard Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
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11
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Flannery C, Burke LA, Gillespie P, O'Donoghue K. Estimating the costs associated with the implementation of a best practice model of care for recurrent miscarriage clinics in Ireland: a cost analysis. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13625.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Recurrent miscarriage (RM) affects 1%-5% of the reproductive age population. Given increasing calls for dedicated recurrent miscarriage clinics (RMC), decision makers will require data on the resultant budgetary implications. The aim of this study was to identify the potential costs to the Irish healthcare system of implementing a best practice RMC model of care. Methods A ‘best practice’ RMC was developed as part of the RE:CURRENT Project. A micro-costing approach was employed by identifying, measuring, and valuing resource usage by unit costs for the RMC for ≥2 consecutive losses. Per patient costs were estimated using two care pathway scenarios: typical and complex. Per patient costs were extrapolated, using population data and published prevalence rates for RM, to estimate the total cost to the Irish health system. A sensitivity analysis was also performed. Results The cost for a RM patient who has another pregnancy after receiving investigations, treatment and reassurance scans ranges between €1,634 (typical) and €4,818 (complex). For a RM patient who does not conceive again, costs range from €1,384 (typical) to €4,318 (complex). Using population estimates for ≥2 losses, the total cost to the Irish health service ranges from €20,336,229 (complex) to €61,927,630 (typical) for those who progress to pregnancy, and from €7,789,437 (complex) to €22,480,630 (typical) for those who do not progress to another pregnancy. Together, the total cost of the proposed best practice RMC is €112,533,926 with an average cost per patient €1,871. Conclusions This study advocates for a new model of care for RMCs in Ireland and provides a set of cost estimates at the patient and healthcare system level. While future studies should explicitly consider the cost effectiveness of this or similar models of care, this analysis provides a valuable first step in providing a detailed breakdown of the associated costs and budget implications.
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12
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Brown V, Tran H, Williams J, Laws R, Moodie M. Exploring the economics of public health intervention scale-up: a case study of the Supporting Healthy Image, Nutrition and Exercise (SHINE) cluster randomised controlled trial. BMC Public Health 2022; 22:1338. [PMID: 35836222 PMCID: PMC9281014 DOI: 10.1186/s12889-022-13754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost. The aim of this study was to explore the potential economic impacts of implementation and scale-up on a healthy weight and body image intervention tested in a Type II translational research trial. Methods The Supporting Healthy Image, Nutrition and Exercise (SHINE) study is a cluster randomised controlled trial, aiming to deliver universal education about healthy nutrition, physical activity and wellbeing behaviours to adolescents in Australian secondary schools. Data on the cost of the intervention were collected alongside the trial using standard micro-costing techniques. Semi-structured interviews were conducted with key intervention stakeholders to explore the potential economic impacts of implementation and scale-up. Thematic content analysis was undertaken by two authors. Results Fifteen intervention group schools participated in the 8-week online intervention targeting students in 2019 (99 Grade 7 classes; 2,240 students). Booster sessions were delivered during one class session in Grades 8 and 9, in 2020 and 2021 respectively. Time costs of intervention delivery and co-ordination comprised the majority (90%) of intervention cost as per the trial, along with costs associated with travel for intervention training and equipment. Themes related to the benefit of the intervention emerged from interviews with six intervention stakeholders, including the potential for economies of scale afforded by online delivery. Contextual themes that may have an impact on intervention implementation and scale included acceptability across all school sectors, availability and reliability of IT infrastructure for intervention delivery and variations in population characteristics. A number of key alterations to the intervention program emerged as important in supporting and sustaining intervention scale-up. In addition, significant implementation costs were identified if the intervention was to be successfully implemented at scale. Conclusions The findings from this study provide important information relevant to decisions on progression to a Type III implementation trial, including budget allocation, and will inform modelled economic evaluation.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13754-0.
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Affiliation(s)
- Vicki Brown
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia.
| | - Huong Tran
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia
| | - Joanne Williams
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Rachel Laws
- Deakin University, Geelong, Institute for Physical Activity and Nutrition, Victoria, 3220, Australia
| | - Marj Moodie
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Victoria, 3220, Australia
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13
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Ezeofor V'S, Spencer LH, Rogers SN, Kanatas A, Lowe D, Semple CJ, Hanna JR, Yeo ST, Edwards RT. An Economic Evaluation Supported by Qualitative Data About the Patient Concerns Inventory (PCI) versus Standard Treatment Pathway in the Management of Patients with Head and Neck Cancer. PHARMACOECONOMICS - OPEN 2022; 6:389-403. [PMID: 35099783 PMCID: PMC8802252 DOI: 10.1007/s41669-021-00320-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The head and neck cancer (HNC) Patient Concerns Inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns to cancer consultants that otherwise might be overlooked. OBJECTIVE This is the first economic evaluation of the PCI in patients with HNC investigating the costs and effects to the health service of not prioritising certain treatment pathways in addition to the primary cancer pathway. Additional costs can be accrued due to delayed referral to other appropriate services, e.g. hospital dentist. Economic evidence could influence future policy direction in this area globally. METHODS Alongside a 3-year clustered randomised controlled trial, an economic evaluation was undertaken with Client Service Receipt Inventory data collected at three different time points (baseline and 6 and 12 months post-baseline). Patients were identified by a multidisciplinary team at the trial clinics. This economic analysis compared the PCI intervention versus the non-PCI treatment pathway. A deterministic and probabilistic sensitivity analysis was conducted to investigate the cost per quality-adjusted life-year (QALY) gain of the PCI versus non-PCI intervention treatment pathways. Qualitative data were also collected from seven consultants to triangulate findings from the economic evaluation. RESULTS The analysis used data from 191 patients (66% of the full trial sample). The PCI inventory was low cost, at just over £13 per participant. The PCI intervention was cost effective and also cost saving, with an incremental cost difference of £295.91 over the 12-month follow-up period. The QALY values were higher in the PCI intervention strategy, with a value of 0.79, whereas the non-PCI group had a value of 0.76, thus the PCI intervention was dominant. The sensitivity analysis showed that, at a willingness-to-pay threshold of £20,000 per QALY gained, the probability of being cost effective was 0.85 (95% confidence interval [CI] 0.80-0.83). Qualitative results showed that consultants using the PCI reported an enhanced awareness of patients' overall post-treatment needs. DISCUSSION The PCI provided an effective means to conduct clinical consultations by avoiding unnecessary healthcare costs and focussing on aspects of care most important to patients. The cost per QALY gain was within the National Institute for Health and Care Excellence guideline threshold. The economic evaluation showed that the PCI intervention strategy was dominant and therefore cost saving to the national health service (NHS) and was more effective in terms of treatment. CONCLUSION The PCI appears to be a low-cost intervention that generates a cost-effective benefit to patients from a NHS perspective if rolled out as part of routine care. Qualitative evidence has shown that the use of the PCI is supported by consultants in routine practice. TRIAL REGISTRATION Clinical Trials Identifier: NCT03086629.
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Affiliation(s)
- Victory 'Segun Ezeofor
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Medical and Health Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales, LL57 2PZ, UK.
| | - Llinos Haf Spencer
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Medical and Health Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales, LL57 2PZ, UK
| | - Simon N Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, L39 4QP, England
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, England, UK
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, England, UK
| | - Derek Lowe
- Astraglobe Ltd, 24 Trinity Place, Congleton, Cheshire, England, CW12 3JB, UK
| | - Cherith J Semple
- Institute of Nursing and Health Research, Ulster University, Belfast, Northen Ireland, BT37 0QB, UK
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, BT16 1RH, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Medical and Health Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales, LL57 2PZ, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Medical and Health Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales, LL57 2PZ, UK
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14
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Roberts G, Holmes J, Williams G, Chess J, Hartfiel N, Charles JM, McLauglin L, Noyes J, Edwards RT. Current costs of dialysis modalities: A comprehensive analysis within the United Kingdom. ARCH ESP UROL 2022; 42:578-584. [DOI: 10.1177/08968608211061126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Previous evidence suggests home-based dialysis to be more cost-effective than unit-based or hospital-based dialysis. However, previous analyses to quantify the costs of different dialysis modalities have used varied perspectives, different methods, and required assumptions due to lack of available data. The National Institute for Health and Care Excellence reports uncertainty about the differences in costs between home-based and unit-based dialysis. This uncertainty limits the ability of policy makers to make recommendations based on cost effectiveness, which also impacts on the ability of budget holders to model the impact of any service redesign and to understand which therapies deliver better value. The aim of our study was to use a combination of top-down and bottom-up costing methods to determine the direct medical costs of different dialysis modalities in one UK nation (Wales) from the perspective of the National Health Service (NHS). Methods: Detailed hybrid top-down and bottom-up micro-costing methods were applied to estimate the direct medical costs of dialysis modalities across Wales. Micro-costing data was obtained from commissioners of the service and from interviews with renal consultants, nurses, accountants, managers and allied health professionals. Top-down costing information was obtained from the Welsh Renal Clinical Network (who commission renal services across Wales) and the Welsh Ambulance Service Trust. Results: The annual direct cost per patient for home-based modalities was £16,395 for continuous ambulatory peritoneal dialysis (CAPD), £20,295 for automated peritoneal dialysis (APD) and £23,403 for home-based haemodialysis (HHD). The annual cost per patient for unit-based modalities depended on whether or not patients required ambulance transport. Excluding transport, the cost of dialysis was £19,990 for satellite units run in partnership with independent sector providers and £23,737 for hospital units managed and staffed by the NHS. When ambulance transport was included, the respective costs were £28,931 and £32,678, respectively. Conclusion: Our study is the most comprehensive analysis of the costs of dialysis undertaken thus far in the United Kingdom and clearly demonstrate that CAPD is less costly than other dialysis modalities. When ambulance transport costs are included, other home therapies (APD and HHD) are also less costly than unit-based dialysis. This detailed analysis of the components that contribute to dialysis costs will help inform future cost-effectiveness studies, inform healthcare policy and drive service redesign.
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Affiliation(s)
| | | | | | - James Chess
- Department of Nephrology, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation, School of Health Sciences, Bangor University, Bangor, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, School of Health Sciences, Bangor University, Bangor, UK
| | - Leah McLauglin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, School of Health Sciences, Bangor University, Bangor, UK
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15
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Pell B, Hawkins J, Cannings-John R, Charles JM, Hallingberg B, Moore G, Roberts J, van Sluijs E, Morgan K. CHoosing Active Role Models to INspire Girls (CHARMING): protocol for a cluster randomised feasibility trial of a school-based, community-linked programme to increase physical activity levels in 9-10-year-old girls. Pilot Feasibility Stud 2022; 8:2. [PMID: 34980254 PMCID: PMC8720937 DOI: 10.1186/s40814-021-00961-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background In the UK, there is evidence that girls’ physical activity tends to decline to a greater extent than boys as they enter adolescence. ‘Role models’ could play a vital role in inspiring girls to become or remain physically active. The CHARMING Programme is a primary school-based community linked role-model programme, co-developed in 2016, with children, parents, schools and wider stakeholders. It involves different types of physical activity delivered for 1-h each week by a community provider and peer role models (e.g. older girls from secondary schools) joining in with the sessions. The programme ultimately aims to increase and sustain physical activity levels among 9–10-year-old girls. This study aims to assess the feasibility and acceptability of the CHARMING Programme and of evaluating it using a randomised trial. Methods This study is a feasibility cluster randomised controlled trial, with embedded process evaluation and health economic evaluation. Approximately 90 Year 5 (i.e. 9–10-year-old) girls will be recruited across six primary schools in Mid-South Wales. Participating schools will be allocated to the programme: control on a 2:1 basis; four intervention schools will run the CHARMING Programme and two will continue with usual practice. A survey and accelerometer will be administered at baseline and repeated at 12 months. Interviews and focus groups will be conducted post-intervention delivery. The primary aim is to assess feasibility of a future randomised trial via the recruitment of schools, participants and role models; randomisation; retention; reach; data collection completion rates; programme adherence; and programme fidelity, views on intervention acceptability and programme barriers and facilitators. Secondary aims are to evaluate established physical activity outcome measures for children plus additional health economic outcomes for inclusion in a future full-scale trial. Discussion The results of this study will inform decisions on whether and how to proceed to a full-scale evaluation of the effectiveness and cost-effectiveness of the CHARMING Programme to improve or sustain physical activity. Trial registration ClinicalTrials.gov ISRCTN36223327. Registered March 29, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00961-6.
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Affiliation(s)
- Bethan Pell
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Jemma Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | | | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Normal Site, Holyhead Road, Bangor, Gwynedd, LL57 2PZ, UK
| | - Britt Hallingberg
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Joan Roberts
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Esther van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK.
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Cost-effectiveness of paediatric surgery: an economic evaluation of World Paediatric Project surgical interventions in St. Vincent and the Grenadines (2002–2019). BMJ Open 2021. [PMCID: PMC8719173 DOI: 10.1136/bmjopen-2021-050286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives The purpose of this study is to examine the cost-effectiveness of six types of surgical interventions as part of a sustained paediatric surgical programme in St.Vincent and the Grenadines from 2002 to 2019. Design In this economic model, six paediatric surgical interventions (ophthalmic, orthopaedic, plastic, general, urology, neurosurgery) were compared with no surgery in a deterministic cost-effectiveness model. We assessed health benefits as averted disability-adjusted life-years (DALYs). Costs were included from the programme perspective and measured using standard micro-costing methods. Incremental cost-effectiveness ratios (ICERs) were calculated for each type of surgical intervention. Interventions with ICERs of <50% of gross domestic product (GDP) per capita were considered cost-effective. Costs are reported in 2019 US$. Univariate sensitivity analyses were conducted to assess the effect of uncertainty. Results The average cost per procedure was US$16 685 (range: US$9791.78–US$72 845.76). The cumulative discounted 18-year health impact was 5815 DALYs averted with a cost per DALY averted of US$2622. Most paediatric surgical interventions were cost-effective, yielding cost per DALY estimates less than 50% of GDP per capita of St. Vincent and the Grenadines. When undiscounted, only orthopaedic surgeries had cost per DALY more than 50% GDP per capita. When considering discounting, orthopaedic and urology surgeries exceeded the adopted threshold for cost-effectiveness. Conclusions We found that short-term, recurrent surgical interventions could yield substantial economic benefits in this limited resource setting. This research indicates that investment in paediatric surgical interventions is cost-effective for the majority of specialties. These findings are of clinical significance given the large burden of disease attributable to surgically treatable diseases. This work demonstrates that scaling up dedicated surgical programmes for children is a cost-effective and essential component to improve paediatric health.
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Cidav Z, Marcus S, Mandell D, Hornbrook MC, Mo JJ, Sun V, Ercolano E, Wendel CS, Weinstein RS, Holcomb MJ, Grant M, Rock M, Krouse RS. Programmatic Costs of the Telehealth Ostomy Self-Management Training: An Application of Time-Driven Activity-Based Costing. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1245-1253. [PMID: 34452703 DOI: 10.1016/j.jval.2021.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/19/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Programmatic cost assessment of novel clinical interventions can inform their widespread dissemination and implementation. This study aimed to determine the programmatic costs of a telehealth Ostomy Self-Management Training (OSMT) intervention for cancer survivors using Time-Driven Activity-Based Costing (TDABC) methodology. METHODS We demonstrated a step-by-step application of TDABC based on a process map with core OSMT intervention activities and associated procedures and determined resource use and costs, per unit procedure. We also assessed per-patient costs from a payer perspective and provided estimates of total hours and costs by personnel, activity, and procedure. RESULTS The per-patient cost of the OSMT was $1758. Personnel time accounted for 91% of the total cost. Site supervisor and information technology technician time were the most expensive personnel resources. Telehealth technical and communication equipment accounted for 8% of the total cost. Intervention coordination and monitoring efforts represented most of the total time cost (62%), followed by the intervention delivery (35%). The procedures with the highest cost were communication via phone or virtual meetings (24%), email exchanges (18%), and telehealth session delivery (18%). CONCLUSIONS Future efforts to replicate, disseminate, and implement the OSMT intervention should anticipate funding for nonclinical components of the intervention, including coordination and monitoring, and consider how these activities can be performed most efficiently. For institutions without established telemedicine programs, selection of videoconferencing platforms and adequate staffing for participant technical support should be considered. Our step-by-step application of TDABC serves as a case study demonstrating how interventionists can gather data on resource use and costs of intervention activities concurrently with their collection of trial data.
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Affiliation(s)
- Zuleyha Cidav
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Steven Marcus
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Mandell
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Julia J Mo
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia Sun
- Division of Nursing Research and Education, City of Hope Medical Center, Duarte, CA, USA
| | | | | | | | | | - Marcia Grant
- Division of Nursing Research and Education, City of Hope Medical Center, Duarte, CA, USA
| | - Matthew Rock
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert S Krouse
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Disbeschl S, Surgey A, Roberts JL, Hendry A, Lewis R, Goulden N, Hoare Z, Williams N, Anthony BF, Edwards RT, Law RJ, Hiscock J, Carson-Stevens A, Neal RD, Wilkinson C. Protocol for a feasibility study incorporating a randomised pilot trial with an embedded process evaluation and feasibility economic analysis of ThinkCancer!: a primary care intervention to expedite cancer diagnosis in Wales. Pilot Feasibility Stud 2021; 7:100. [PMID: 33883033 PMCID: PMC8059131 DOI: 10.1186/s40814-021-00834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/07/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Compared to the rest of Europe, the UK has relatively poor cancer outcomes, with late diagnosis and a slow referral process being major contributors. General practitioners (GPs) are often faced with patients presenting with a multitude of non-specific symptoms that could be cancer. Safety netting can be used to manage diagnostic uncertainty by ensuring patients with vague symptoms are appropriately monitored, which is now even more crucial due to the ongoing COVID-19 pandemic and its major impact on cancer referrals. The ThinkCancer! workshop is an educational behaviour change intervention aimed at the whole general practice team, designed to improve primary care approaches to ensure timely diagnosis of cancer. The workshop will consist of teaching and awareness sessions, the appointment of a Safety Netting Champion and the development of a bespoke Safety Netting Plan and has been adapted so it can be delivered remotely. This study aims to assess the feasibility of the ThinkCancer! intervention for a future definitive randomised controlled trial. METHODS The ThinkCancer! study is a randomised, multisite feasibility trial, with an embedded process evaluation and feasibility economic analysis. Twenty-three to 30 general practices will be recruited across Wales, randomised in a ratio of 2:1 of intervention versus control who will follow usual care. The workshop will be delivered by a GP educator and will be adapted iteratively throughout the trial period. Baseline practice characteristics will be collected via questionnaire. We will also collect primary care intervals (PCI), 2-week wait (2WW) referral rates, conversion rates and detection rates at baseline and 6 months post-randomisation. Participant feedback, researcher reflections and economic costings will be collected following each workshop. A process evaluation will assess implementation using an adapted Normalisation Measure Development (NoMAD) questionnaire and qualitative interviews. An economic feasibility analysis will inform a future economic evaluation. DISCUSSION This study will allow us to test and further develop a novel evidenced-based complex intervention aimed at general practice teams to expedite the diagnosis of cancer in primary care. The results from this study will inform the future design of a full-scale definitive phase III trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04823559 .
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Affiliation(s)
- Stefanie Disbeschl
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Alun Surgey
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Jessica L Roberts
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Annie Hendry
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Nia Goulden
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, The Normal Site, Holyhead Road, Gwynedd, LL57 2PZ, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, The Normal Site, Holyhead Road, Gwynedd, LL57 2PZ, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, L69 3GL, UK
| | - Bethany Fern Anthony
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, The Normal Site, Holyhead Road, Gwynedd, LL57 2PZ, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, The Normal Site, Holyhead Road, Gwynedd, LL57 2PZ, UK
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK
| | - Richard D Neal
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research (NWCPCR), Bangor University, Cambrian 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK
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Brown V, Tan EJ, Hayes A, Baur L, Campbell K, Taylor R, Byrne R, Wen LM, Hesketh KD, Moodie M. Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years. Pediatr Obes 2020; 15:e12684. [PMID: 32558343 DOI: 10.1111/ijpo.12684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the absence of rigorous evidence of cost-effectiveness for early childhood obesity prevention interventions, the next-best option may be for decision-makers to consider the relevant costs of interventions when allocating resources. OBJECTIVES This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0-2 years, undertaken in research settings in Australia and New Zealand. METHODS A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro-costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. RESULTS Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77-$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059-$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. CONCLUSIONS An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS-based intervention had the lowest delivery cost in this study.
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Affiliation(s)
- Vicki Brown
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Eng J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Baur
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen Campbell
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rachael Taylor
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Rebecca Byrne
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,School of Exercise and Nutrition Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Li Ming Wen
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kylie D Hesketh
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Marjory Moodie
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, University of Sydney, Sydney, New South Wales, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Tan EJ, Taylor RW, Taylor BJ, Brown V, Hayes AJ. Cost-Effectiveness of a Novel Sleep Intervention in Infancy to Prevent Overweight in Childhood. Obesity (Silver Spring) 2020; 28:2201-2208. [PMID: 33012118 DOI: 10.1002/oby.22989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine, from a health funder perspective, whether a sleep intervention, delivered in infancy, either alone or in combination with food, activity, and breastfeeding advice was cost-effective compared with usual care. METHODS A cost-effectiveness analysis was conducted alongside the Prevention of Overweight in Infancy (POI) randomized controlled trial for outcomes at 5 years and cost-effectiveness was modeled to age 15 years using the Early Prevention of Obesity in Childhood microsimulation model. Intervention costs for the Sleep (n = 192), Combination (n = 196), and control (n = 209) groups were determined in 2018 Australian dollars. Incremental cost-effectiveness ratios (ICERs) were determined for BMI outcomes at 5 and 15 years, with the primary outcome being quality-adjusted life years (QALYs) modeled over 15 years. RESULTS The average costs of the Sleep and Combination interventions were $184 and $601 per child, respectively. The ICER for the Sleep intervention was $18,125 per QALY gained, with a 74% probability of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY. The ICER for the Combination intervention was $94,667 per QALY gained with a 23% probability of being cost-effective. CONCLUSIONS The POI Sleep intervention, without additional advice, was a low-cost and cost-effective approach to reducing childhood obesity. Sleep modification programs offer a very promising approach to obesity prevention in children.
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Affiliation(s)
- Eng Joo Tan
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barry J Taylor
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Alison J Hayes
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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21
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Khavjou O, Forehand R. Helping the Noncompliant Child: An Updated Assessment of Program Costs and Cost-Effectiveness. CHILDREN AND YOUTH SERVICES REVIEW 2020; 114:105050. [PMID: 32742049 PMCID: PMC7394389 DOI: 10.1016/j.childyouth.2020.105050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Behavior disorders (BD) in children can lead to delinquency, antisocial behavior, and mental disorders in adulthood. Evidence-based behavioral parent training (BPT) programs have been developed to treat early-onset BDs, yet cost analyses of BPT are deficient. We provide updated estimates of cost and cost-effectiveness of Helping the Noncompliant Child (HNC), a mastery-based BPT, delivered to low-income families. The cost of research-specific activities was $1,152 per family. HNC program delivery costs were $293 per family from a payer perspective, including the cost of therapist time ($275 per family) and non-labor resources, such as supplies and toys ($18 per family). It costs an average of $6 to improve the Eyberg Child Behavior Inventory intensity score by each additional point or $171 to improve it by one standard deviation. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs.
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Affiliation(s)
- Olga Khavjou
- Corresponding author: Olga Khavjou, RTI International, 3040 Cornwallis Rd, Durham, NC 27709, tel: 919-541-6689,
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22
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Cidav Z, Mandell D, Pyne J, Beidas R, Curran G, Marcus S. A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implement Sci 2020; 15:28. [PMID: 32370752 PMCID: PMC7201568 DOI: 10.1186/s13012-020-00993-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standardized costing methods that can be integrated into implementation effectiveness evaluation efforts. METHODS We present a pragmatic approach to systematically estimating detailed, specific resource use and costs of implementation strategies that combine time-driven activity-based costing (TDABC), a business accounting method based on process mapping and known for its practicality, with a leading implementation science framework developed by Proctor and colleagues, which guides specification and reporting of implementation strategies. We illustrate the application of this method using a case study with synthetic data. RESULTS This step-by-step method produces a clear map of the implementation process by specifying the names, actions, actors, and temporality of each implementation strategy; determining the frequency and duration of each action associated with individual strategies; and assigning a dollar value to the resources that each action consumes. The method provides transparent and granular cost estimation, allowing a cost comparison of different implementation strategies. The resulting data allow researchers and stakeholders to understand how specific components of an implementation strategy influence its overall cost. CONCLUSION TDABC can serve as a pragmatic method for estimating resource use and costs associated with distinct implementation strategies and their individual components. Our use of the Proctor framework for the process mapping stage of the TDABC provides a way to incorporate cost estimation into implementation evaluation and may reduce the burden associated with economic evaluations in implementation science.
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Affiliation(s)
- Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas, Little Rock, USA
- Veterans Healthcare System, North Little Rock, AR, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center, Leonard Davis Institute of Health Economics, Philadelphia, USA
| | - Geoffrey Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Steven Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Slade P, West H, Thomson G, Lane S, Spiby H, Edwards RT, Charles JM, Garrett C, Flanagan B, Treadwell M, Hayden E, Weeks A. STRAWB2 (Stress and Wellbeing After Childbirth): a randomised controlled trial of targeted self‐help materials to prevent post‐traumatic stress disorder following childbirth. BJOG 2020; 127:886-896. [DOI: 10.1111/1471-0528.16163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- P Slade
- Department of Psychological Sciences Institute of Health and Life Sciences University of Liverpool Liverpool UK
| | - H West
- Department of Psychological Sciences Institute of Health and Life Sciences University of Liverpool Liverpool UK
| | - G Thomson
- School of Community Health and Midwifery University of Central Lancashire Preston UK
| | - S Lane
- Centre for Medical Statistics and Health Evaluation University of Liverpool Liverpool UK
| | - H Spiby
- School of Health Sciences University of Nottingham Nottingham UK
| | - RT Edwards
- Centre for Health Economics and Medicines Evaluation Bangor University Gwynedd UK
| | - JM Charles
- Centre for Health Economics and Medicines Evaluation Bangor University Gwynedd UK
| | - C Garrett
- Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | - B Flanagan
- Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
| | | | - E Hayden
- Liverpool Women’s Hospital Foundation Trust Liverpool UK
| | - A Weeks
- Department of Women’s and Children’s Health University of Liverpool Liverpool UK
- Liverpool Women’s Hospital Foundation Trust and Liverpool Health Partners Liverpool UK
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24
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Doble B, Welbourn R, Carter N, Byrne J, Rogers CA, Blazeby JM, Wordsworth S. Multi-Centre Micro-Costing of Roux-En-Y Gastric Bypass, Sleeve Gastrectomy and Adjustable Gastric Banding Procedures for the Treatment of Severe, Complex Obesity. Obes Surg 2020; 29:474-484. [PMID: 30368646 DOI: 10.1007/s11695-018-3553-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a growing interest in comparing the effectiveness and costs of alternative forms of bariatric surgery. We aimed to examine the per-patient, procedural costs of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric banding (AGB) in the United Kingdom. METHODS Multi-centre (two National Health Service; NHS and one private hospital) micro-costing, using a time-and-motion study. Prospective collection of surgery times, staff quantities, equipment, instruments and consumables for 12 patients (four RYGB, five SG, three AGB) from patients' first surgeon interaction on the day of surgery to departure from the theatre recovery area. Costs were attached to quantities and mean costs compared. Sensitivity and scenario analyses assessed the impact of varying surgery inputs and consideration of additional plausible factors respectively on total costs. RESULTS Mean procedural costs were £5002 for RYGB, £4306 for SG and £2527 for AGB. Varying staff seniority or altering procedure times had small impacts on costs (± 4-6%). Reducing prices of consumables by 20% reduced costs by 10-13%. Accounting for differences in surgical technique by altering the number of staple reloads used impacted costs by ± 7-10%. Adjusted total costs from scenario analyses were similar to NHS tariffs for RYGB and SG (difference of £51 and -£119 respectively) but were much lower for AGB (difference of £1982). CONCLUSIONS These detailed costs will allow for more precise reimbursement of bariatric surgery and support comprehensive assessments of cost-effectiveness. Additional work to investigate costs of post-surgical care, re-operations and life-long support received by patients following surgery is required.
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Affiliation(s)
- Brett Doble
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Nicholas Carter
- Bariatric and Metabolic Surgery Department, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK
| | - James Byrne
- Southampton University Hospitals NHS Trust, Southampton, SO16 6YD, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Medical School, University of Bristol, Bristol, BS2 8HW, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
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25
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Chapel JM, Wang G. Understanding cost data collection tools to improve economic evaluations of health interventions. Stroke Vasc Neurol 2019; 4:214-222. [PMID: 32030205 PMCID: PMC6979867 DOI: 10.1136/svn-2019-000301] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 11/04/2022] Open
Abstract
Micro-costing data collection tools often used in literature include standardized comprehensive templates, targeted questionnaires, activity logs, on-site administrative databases, and direct observation. These tools are not mutually exclusive and are often used in combination. Each tool has unique merits and limitations, and some may be more applicable than others under different circumstances. Proper application of micro-costing tools can produce quality cost estimates and enhance the usefulness of economic evaluations to inform resource allocation decisions. A common method to derive both fixed and variable costs of an intervention involves collecting data from the bottom up for each resource consumed (micro-costing). We scanned economic evaluation literature published in 2008-2018 and identified micro-costing data collection tools used. We categorized the identified tools and discuss their practical applications in an example study of health interventions, including their potential strengths and weaknesses. Sound economic evaluations of health interventions provide valuable information for justifying resource allocation decisions, planning for implementation, and enhancing the sustainability of the interventions. However, the quality of intervention cost estimates is seldom addressed in the literature. Reliable cost data forms the foundation of economic evaluations, and without reliable estimates, evaluation results, such as cost-effectiveness measures, could be misleading. In this project, we identified data collection tools often used to obtain reliable data for estimating costs of interventions that prevent and manage chronic conditions and considered practical applications to promote their use.
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Affiliation(s)
- John M Chapel
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, USA
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Charles JM, Harrington DM, Davies MJ, Edwardson CL, Gorely T, Bodicoat DH, Khunti K, Sherar LB, Yates T, Edwards RT. Micro-costing and a cost-consequence analysis of the 'Girls Active' programme: A cluster randomised controlled trial. PLoS One 2019; 14:e0221276. [PMID: 31419257 PMCID: PMC6697369 DOI: 10.1371/journal.pone.0221276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the 'Girls Active' secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the 'Girls Active' programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, 'Girls Active' costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb 'Girls Active' strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the 'Girls Active' programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, ISRCTN10688342.
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Affiliation(s)
- Joanna M. Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | | | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Trish Gorely
- Department of Nursing, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, United Kingdom
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
- Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Lauren B. Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
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Clarkson S, Charles JM, Saville CWN, Bjornstad GJ, Hutchings J. Introducing KiVa school-based antibullying programme to the UK: A preliminary examination of effectiveness and programme cost. SCHOOL PSYCHOLOGY INTERNATIONAL 2019. [DOI: 10.1177/0143034319841099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bullying is an internationally recognized problem and school-based bullying is particularly pervasive. KiVa is a robustly evidenced school-based antibullying programme developed and evaluated at Turku University, Finland, and subsequently disseminated across Finland. Following a positive UK trial of Unit 2 (for 10- to 12-year-olds), further UK dissemination has taken place. This study presents (a) pupil self-reported levels of victimization and bullying prior to, and after, one year of KiVa implementation (Units 1 and 2) with 7- to 11-year-olds from 41 schools, and (b) programme training and delivery costs. Data from 41 primary schools were analysed using a linear mixed model effects analysis. Results revealed statistically significant reductions in victimization and bullying after one year of programme implementation. Ongoing costs were small, at £2.84 per Key Stage 2 pupil per annum. These promising results highlight the need for further more rigorous evaluation of KiVa in the UK, including the exploration of factors associated with effective implementation, and the importance for educators and policy makers of evaluating both impact and costs when implementing programmes to prevent and reduce bullying.
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Harrington DM, Davies MJ, Bodicoat D, Charles JM, Chudasama YV, Gorely T, Khunti K, Rowlands AV, Sherar LB, Tudor-Edwards R, Yates T, Edwardson CL. A school-based intervention (‘Girls Active’) to increase physical activity levels among 11- to 14-year-old girls: cluster RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BackgroundPhysical activity (PA) levels among adolescent girls in the UK are low. ‘Girls Active’, developed by the Youth Sport Trust (YST), has been designed to increase girls’ PA levels.ObjectiveTo understand the effectiveness and cost-effectiveness of the Girls Active programme.DesignA two-arm cluster randomised controlled trial.SettingState secondary schools in the Midlands, UK.ParticipantsGirls aged between 11 and 14 years.InterventionGirls Active involves teachers reviewing PA, sport and physical education provision, culture and practices in their school; attending training; creating action plans; and effectively working with girls as peer leaders to influence decision-making and to promote PA to their peers. Support from a hub school and the YST is offered.Main outcome measuresThe change in objectively measured moderate to vigorous intensity PA (MVPA) levels at 14 months. Secondary outcomes included changes in overall PA level (mean acceleration), light PA levels, sedentary time, body composition and psychosocial outcomes. Cost-effectiveness and process evaluation (qualitative and quantitative) data were collected.ResultsTwenty schools and 1752 pupils were recruited; 1211 participants provided complete primary outcome data at 14 months. No difference was found in mean MVPA level between groups at 14 months [1.7 minutes/day, 95% confidence interval (CI) –0.8 to 4.3 minutes/day], but there was a small difference in mean MVPA level at 7 months (2.4 minutes/day, 95% CI 0.1 to 4.7 minutes/day). Significant differences between groups were found at 7 months, but not at 14 months, in some of the objective secondary outcomes: overall PA level represented by average acceleration (1.39 mg, 95% CI 0.1 to 2.2 mg), after-school sedentary time (–4.7 minutes/day, 95% CI –8.9 to –0.6 minutes/day), overall light PA level (5.7 minutes/day, 95% CI 1.0 to 10.5 minutes/day) and light PA level on school days (4.5 minutes/day, 95% CI 0.25 to 8.75 minutes/day). Minor, yet statistically significant, differences in psychosocial measures at 7 months were found in favour of control schools. Significant differences in self-esteem and identified motivation in favour of intervention schools were found at 7 and 14 months, respectively. Subgroup analyses showed a significant effect of the intervention for those schools with higher numbers of pupils at 14 months. Girls Active was well received by teachers, and they reported that implemented strategies and activities were having a positive impact in schools. Barriers to implementation progress included lack of time, competing priorities and the programme flexibility. Implementation costs ranged from £2054 (£23/pupil) to £8545 (£95/pupil) per school. No differences were found between groups for health-related quality-of-life scores or frequencies, or for costs associated with general practitioner, school nurse and school counsellor use.ConclusionsGirls Active may not have had an effect on the random 90 girls per school included in the evaluation. Although we included a diverse sample of schools, the results may not be generalisable to all schools. Girls Active was viewed positively but teachers did not implement as many aspects of the programme as they wanted. The intervention was unlikely to have a wide impact and did not have an impact on MVPA level at 14 months. Capitalising on the opportunities of a flexible programme like this, while also learning from the stated barriers to and challenges of long-term implementation that teachers face, is a priority for research and practice.Trial registrationCurrent Controlled Trials ISRCTN10688342.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 5. See the NIHR Journals Library website for further project information. The YST funded the intervention. This study was undertaken in collaboration with the Leicester Clinical Trials Unit, a UK Clinical Research Collaboration-registered clinical trials unit in receipt of NIHR Clinical Trials Unit support funding. Neither the YST nor the NIHR Clinical Trials Unit had any involvement in the Trial Steering Committee, data analysis, data interpretation, data collection or writing of the report. The University of Leicester authors are supported by the NIHR Leicester–Loughborough Biomedical Research Unit (2012–17), the NIHR Leicester Biomedical Research Centre (2017–22) and the Collaboration for Leadership in Applied Health Research and Care East Midlands. These funders had no involvement in the Trial Steering Committee, the data analysis, data interpretation, data collection or writing of the report.
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Affiliation(s)
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Danielle Bodicoat
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Trish Gorely
- Department of Nursing, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
- Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
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Bywater T, Berry V, Blower SL, Cohen J, Gridley N, Kiernan K, Mandefield L, Mason-Jones A, McGilloway S, McKendrick K, Pickett K, Richardson G, Teare MD, Tracey L, Walker S, Whittaker K, Wright J. Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE): a study protocol of a community-based randomised controlled trial with process and economic evaluations of the incredible years infant and toddler parenting programmes, delivered in a proportionate universal model. BMJ Open 2018; 8:e026906. [PMID: 30573493 PMCID: PMC6303737 DOI: 10.1136/bmjopen-2018-026906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Behavioural and mental disorders have become a public health crisis and by 2020 may surpass physical illness as a major cause of disability. Early prevention is key. Two Incredible Years (IY) parent programmes that aim to enhance child well-being and development, IY Infant and IY Toddler, will be delivered and evaluated in a proportionate universal intervention model called Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE) Steps. The main research question is: Does E-SEE Steps enhance child social emotional well-being at 20 months when compared with services as usual? METHODS AND ANALYSIS E-SEE Steps will be delivered in community settings by Early Years Children's Services and/or Public Health staff across local authorities. Parents of children aged 8 weeks or less, identified by health visitors, children's centre staff or self-referral, are eligible for participation in the trial. The randomisation allocation ratio is 5:1 (intervention to control). All intervention parents will receive an Incredible Years Infant book (universal level), and may be offered the Infant and/or Toddler group-based programme/s-based on parent depression scores on the Patient Health Questionnaire or child social emotional well-being scores on the Ages and Stages Questionnaire: Social Emotional, Second Edition (ASQ:SE-2). Control group parents will receive services as usual. A process and economic evaluation are included. The primary outcome for the study is social emotional well-being, assessed at 20 months, using the ASQ:SE-2. Intention-to-treat and per protocol analyses will be conducted. Clustering and hierarchical effects will be accounted for using linear mixed models. ETHICS AND DISSEMINATION Ethical approvals have been obtained from the University of York Education Ethics Committee (ref: FC15/03, 10 August 2015) and UK NHS REC 5 (ref: 15/WA/0178, 22 May 2015. The current protocol is Version 9, 26 February 2018. The sponsor of the trial is the University of York. Dissemination of findings will be via peer-reviewed journals, conference presentations and public events. TRIAL REGISTRATION NUMBER ISRCTN11079129; Pre-results.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, University of York, York, UK
| | - Vashti Berry
- College of Medicine and Health, University of Exeter Medical School, Exeter, Devon, UK
| | | | - Judith Cohen
- Hull Health Trials Unit, University of Hull, Hull, UK
| | - Nicole Gridley
- Carnegie School of Education, Leeds Beckett University, Leeds, UK
| | - Kathleen Kiernan
- Department of Social Policy and Social Work, University of York, York, UK
| | - Laura Mandefield
- Clinical Trials Research Unit (CTRU), University of Sheffield, Sheffield, UK
| | | | - Sinead McGilloway
- Centre for Mental Health and Community Research, National University of Ireland, Maynooth, Ireland
| | - Kirsty McKendrick
- Clinical Trials Research Unit (CTRU), University of Sheffield, Sheffield, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | - M Dawn Teare
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Tracey
- Department of Education, University of York, York, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Jessica Wright
- Clinical Trials Research Unit (CTRU), University of Sheffield, Sheffield, UK
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Psaltikidis EM, Silva END, Moretti ML, Trabasso P, Stucchi RSB, Aoki FH, Cardoso LGDO, Höfling CC, Bachur LF, Ponchet DDF, Colombrini MRC, Tozzi CS, Ramos RF, Costa SMQ, Resende MR. Cost-utility analysis of outpatient parenteral antimicrobial therapy (OPAT) in the Brazilian national health system. Expert Rev Pharmacoecon Outcomes Res 2018; 19:341-352. [PMID: 30362845 DOI: 10.1080/14737167.2019.1541404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) has been used for decades in different countries to reduce hospitalization rates, with favorable clinical and economic outcomes. This study assesses the cost-utility of OPAT compared to inpatient parenteral antimicrobial therapy (IPAT) from the perspective of a public university hospital and the Brazilian National Health System (Unified Health System -SUS). METHODS Prospective study with adult patients undergoing OPAT at an infusion center, compared to IPAT. Clinical outcomes and quality-adjusted life year (QALY) were assessed, as well as a micro-costing. Cost-utility analysis from the hospital and SUS perspectives were conducted by means of a decision tree, within a 30-day horizon time. RESULTS Forty cases of OPAT (1112 days) were included and monitored, with a favorable outcome in 97.50%. OPAT compared to IPAT generated overall savings of 31.86% from the hospital perspective and 26.53% from the SUS perspective. The intervention reduced costs, with an incremental cost-utility ratio of -44,395.68/QALY for the hospital and -48,466.70/QALY for the SUS, with better cost-utility for treatment times greater than 14 days. Sensitivity analysis confirmed the stability of the model. CONCLUSION Our economic assessment demonstrated that, in the Brazilian context, OPAT is a cost-saving strategy both for hospitals and for the SUS.
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Affiliation(s)
- Eliane Molina Psaltikidis
- a Hospital Epidemiology Department and Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.,b School of Medical Sciences , State University of Campinas , Campinas , Brazil
| | | | - Maria Luiza Moretti
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil.,e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Plínio Trabasso
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil.,e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Raquel Silveira Bello Stucchi
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil.,f Day-Hospital , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Francisco Hideo Aoki
- d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil
| | | | - Christian Cruz Höfling
- e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Luis Felipe Bachur
- e Hospital Epidemiology Department , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | | | | | - Cíntia Soarez Tozzi
- f Day-Hospital , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | - Rosana Fins Ramos
- f Day-Hospital , Clinical Hospital of State University of Campinas , Campinas , Brazil
| | | | - Mariângela Ribeiro Resende
- a Hospital Epidemiology Department and Health Technology Assessment Department , Clinical Hospital of State University of Campinas , Campinas , Brazil.,d Division of Infectious Diseases, Internal Medicine Department, School of Medical Sciences , State University of Campinas , Campinas , Brazil
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Harrington DM, Davies MJ, Bodicoat DH, Charles JM, Chudasama YV, Gorely T, Khunti K, Plekhanova T, Rowlands AV, Sherar LB, Tudor Edwards R, Yates T, Edwardson CL. Effectiveness of the 'Girls Active' school-based physical activity programme: A cluster randomised controlled trial. Int J Behav Nutr Phys Act 2018; 15:40. [PMID: 29695250 PMCID: PMC5918764 DOI: 10.1186/s12966-018-0664-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, adolescent girls' physical activity (PA) levels are low. The 'Girls Active' secondary school-based programme, developed by the Youth Sport Trust, aims to increase PA in adolescent girls. This paper explores the effectiveness of the 'Girls Active' school-based PA programme. METHODS A random sample of girls aged 11-14 from 20 secondary schools (Midlands, UK) participated in a two-arm cluster randomised controlled trial. Ten schools received Girls Active and 10 continued with usual practice. Measurements were taken at baseline, seven- and 14-month follow-up. PRIMARY OUTCOME wrist-worn accelerometer measured moderate- to vigorous-intensity PA (MVPA). SECONDARY OUTCOMES overall PA, light PA, sedentary time, body composition, and psychosocial outcomes. Generalised estimating equations, adjusted for school cluster and potential confounders, were used and A priori subgroup analysis was undertaken. Micro-costing and cost-consequence analyses were conducted using bespoke collection methods on programme delivery information. Outcomes for the cost-consequence analysis were health related quality of life measured by the Child Health Utility-9D and service use. RESULTS Overall, 1752 pupils participated, 1211 (69.1%) provided valid 14-month accelerometer data. No difference in MVPA (mins/day; 95% confidence intervals) was found at 14 months (1.7; -0.8 to 4.3), there was at seven months (2.4; 0.1 to 4.7). Subgroup analyses showed significant intervention effects on 14-month in larger schools (3.9; 1.39 to 6.09) and in White Europeans (3.1; 0.60 to 6.02) and in early maturers (5.1; 1.69 to 8.48) at seven months. The control group did better in smaller schools at 14-months (-4.38; -7.34 to -1.41). Significant group differences were found in 14-month identified motivation (-0.09; -0.18 to -0.01) and at seven months in: overall PA (1.39 mg/day; 0.1 to 2.2), after-school sedentary time (-4.7; -8.9 to -0.6), whole day (5.7; 1.0 to 10.5) and school day (4.5; 0.25 to 8.75) light PA, self-esteem. Small, statistically significant, differences in some psychosocial variables favoured control schools. Micro-costing demonstrated that delivering the programme resulted in a range of time and financial costs at each school. Cost-consequence analysis demonstrated no effect of the programme for health related quality of life or service use. CONCLUSIONS Compared with usual practice, 'Girls Active' did not affect 14-month MVPA. TRIAL REGISTRATION ISRCTN10688342.
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Affiliation(s)
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | | | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Trish Gorely
- Department of Nursing, School of Health, Social Care and Life Sciences, University of the Highlands and Islands, Inverness, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK.,
| | | | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Lauren B Sherar
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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Duncan KM, MacGillivray S, Renfrew MJ. Costs and savings of parenting interventions: results of a systematic review. Child Care Health Dev 2017; 43:797-811. [PMID: 28557011 DOI: 10.1111/cch.12473] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND This systematic review of economic evaluations of universal preventative or targeted treatment parenting interventions that aim to enhance parent-infant interaction is primarily intended to inform decision makers who have to make difficult spending decisions, especially at a time of reduced spending allocations. A synthesis of available costs and savings about parenting interventions that set out to enhance parent-infant interaction is presented. This topic is important specifically in view of the UK Governments' emphasis on the equalities agenda and the early years. The benefits of positive early life experiences, which include good parent-infant interaction, are far reaching and may be positively correlated with improved educational, health and well-being outcomes and reduced criminality. METHODS A literature search was undertaken using on-line indexing databases between 2004 and 2014 that included the search terms 'parent', 'infant', 'interaction', 'cost benefit analysis' and their synonyms. RESULTS Despite existing economic studies generally focusing upon targeted short-run outcomes, significant savings were observed in the included studies. Parenting interventions could save the health service around £2.5k per family over 25 years and could save the criminal justice system over £145k per person over the life course. In light of the escalating costs of remedial services, these potential savings may provide the UK and other governments with a robust incentive to invest in early years parenting interventions. CONCLUSIONS Parenting interventions can be economically efficient and return savings on investment. Moreover, and one might argue as a moral imperative of democratic societies, population health can be improved and health inequalities reduced. An important debate is needed about early years policy, to include acknowledgement of the differences between UK and international healthcare systems and the potential savings from the synergistic and spin-off effects of early years interventions to inform decision-making to fund and implement appropriate action.
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Affiliation(s)
- K M Duncan
- Lecturer in Adult Nursing and Interprofessional Education, University of West London, London, UK
| | - S MacGillivray
- Lead of the Evidence, Synthesis Training and Research Group, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research, University of Dundee, Dundee, UK
| | - M J Renfrew
- Professor of Mother and Infant Health, Mother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research, University of Dundee, Dundee, UK
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TURRI JAO, DECIMONI TC, FERREIRA LA, DINIZ MA, HADDAD LBDP, CAMPOLINA AG. Higher MELD score increases the overall cost on the waiting list for liver transplantation: a micro-costing analysis based study. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:238-245. [DOI: 10.1590/s0004-2803.201700000-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/10/2017] [Indexed: 12/18/2022]
Abstract
ABSTRACT BACKGROUND: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS: The total expenditure of the 482 patients was US$ 6,064,986.51. Outpatient and impatient costs correspond to 32.4% of total cost (US$ 1,965,045.52) and 67.6% (US$ 4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31%), laboratorial tests and image exams (31.68%). Main cost drivers regarding hospitalizations were: medicines (35.20%), bed use in ward and ICU (26.38%) and laboratorial tests (13.72%). Patients with MELD score between 25-30 were the most expensive on the waiting list (US$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION: Total costs on the waiting list for liver transplantation increased according to the patient’s severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.
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Williams ME, Hastings R, Charles JM, Evans S, Hutchings J. Parenting for Autism, Language, And Communication Evaluation Study (PALACES): protocol for a pilot randomised controlled trial. BMJ Open 2017; 7:e014524. [PMID: 28209607 PMCID: PMC5318566 DOI: 10.1136/bmjopen-2016-014524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/26/2016] [Accepted: 01/17/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children with autistic spectrum disorder (ASD) often have associated behavioural difficulties that can present a challenge for parents and parenting. There are several effective social learning theory-based parenting programmes for dealing with behavioural difficulties, including the Incredible Years (IY) parent programmes. However, these programmes typically do not specifically target parents of children with ASD. Recently, a new addition to the IY suite of programmes known as the IY Autistic Spectrum and Language Delays (IY-ASLD) parent programme was developed. The main aims of the present study are to examine the feasibility of delivering this programme within child health services and to provide initial evidence for effectiveness and economic costs. METHODS AND ANALYSIS The Parenting for Autism, Language, And Communication Evaluation Study (PALACES) trial is a pragmatic, multicentre, pilot randomised controlled trial comparing the IY-ASLD programme with a wait-list control condition. 72 parents of children with ASD (aged 3-8 years) will be randomly allocated to either the intervention or control condition. Data will be collected prior to randomisation and 6 months postrandomisation for all families. Families in the intervention condition only will also be followed up at 12 and 18 months postrandomisation. This study will provide initial evidence of effectiveness for the newly developed IY-ASLD parenting programme. It will also add to the limited economic evidence for an intervention targeting parents of children with ASD and provide longer term data, an important component for evaluations of parenting programmes. ETHICS AND DISSEMINATION Approval for the study was granted by the Research Ethics Committee at the School of Psychology, Bangor University (reference number: 2016-15768) and the North Wales Research Ethics Committee, UK (reference number: 16/WA/0224). The findings will be disseminated through research conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN57070414; Pre-results.
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Affiliation(s)
| | - Richard Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Warwick, UK
| | - Joanna Mary Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Wales, UK
| | - Sue Evans
- Powys Teaching Health Board, Park Street Clinic, Newtown, Powys, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, Bangor University, Wales, UK
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Hutchings J, Griffith N, Bywater T, Williams ME. Evaluating the Incredible Years Toddler Parenting Programme with parents of toddlers in disadvantaged (Flying Start) areas of Wales. Child Care Health Dev 2017; 43:104-113. [PMID: 27704590 DOI: 10.1111/cch.12415] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/02/2016] [Accepted: 09/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early risk factors for poor child outcomes are well established, and some group parenting programmes have demonstrated good outcomes for children under 3 years of age. This randomized controlled trial evaluated the effectiveness of the Incredible Years® Toddler Parenting Programme with parents of 1-year-old and 2-year-old children recruited by staff in disadvantaged Flying Start areas across Wales. METHODS Eighty-nine families with a child aged between 12 and 36 months at baseline participated in a pragmatic community-based trial of the programme in eight Flying Start areas. Outcomes were measured at baseline, 6 months and 12 months using measures of parental mental health, competence, child behaviour, child development, home environment and blinded-observation of parent-child interactions. RESULTS Significant intervention group improvements were found in parental mental well-being and observed praise at 6 months. Significant improvements for the intervention group at 12 months included child development, home environment and parental depression. CONCLUSION The study provides preliminary evidence for programme attendance.
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Affiliation(s)
- J Hutchings
- Centre for Evidence Based Early Intervention, Bangor University, Bangor, Gwynedd, UK
| | - N Griffith
- School of Psychology, Bangor University, Bangor, Gwynedd, UK
| | - T Bywater
- Department of Health Sciences, University of York, York, UK
| | - M E Williams
- Centre for Evidence Based Early Intervention, Bangor University, Bangor, Gwynedd, UK
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Griffith GM, Jones R, Hastings RP, Crane RS, Roberts J, Williams J, Bryning L, Hoare Z, Edwards RT. Can a mindfulness-informed intervention reduce aggressive behaviour in people with intellectual disabilities? Protocol for a feasibility study. Pilot Feasibility Stud 2016; 2:58. [PMID: 27965874 PMCID: PMC5154058 DOI: 10.1186/s40814-016-0098-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 10-20 % of adults with intellectual disabilities engage in challenging behaviours such as aggression, destructiveness, and self-injury, which are often accompanied by feelings of anger. The inability to manage anger can reduce quality of life. For example, aggression is a strong predictor of out-of-area placements and is a risk variable for abuse. Recent research suggests that mindfulness-based therapies (specifically, Singh's Soles of the Feet meditation) can help people with intellectual disabilities manage angry emotions, with resultant reductions in challenging behaviour. However, previous research has been single-case design studies, and no group studies have been published with people with intellectual disabilities and aggressive behaviour. METHODS/DESIGN For this feasibility study, a UK protocol will be developed for use by health professionals within National Health Service (NHS) Intellectual Disability (ID) teams, based upon Singh's Soles of the Feet manual. Twenty adults with intellectual disabilities and identified problems with anger control will be recruited and six sessions will be delivered by a trained ID clinician. The study will monitor participant's aggressive behaviour, health-related quality of life, anxiety, depression, and use of support services (medication, hospital appointments etc.). These will be measured at three time points: (1) Baseline (within 2 weeks prior to the first session of the intervention), (2) 2 months post-baseline, and (3) 6 months post-baseline. Qualitative interviews will be conducted with participants, their carers, and the therapists who delivered the intervention. In order to help design an economic evaluation alongside a future full trial, we will cost the intervention and test the acceptability and validity of health economics measures to record resource use and health-related quality of life outcomes. DISCUSSION The data from this study will inform the feasibility of the project protocol and intervention, which will help develop future research and to determine whether a larger, randomised controlled trial with concurrent economic evaluation is feasible. TRIAL REGISTRATION UKCERN: 16743.
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Affiliation(s)
- Gemma Maria Griffith
- Centre for Mindfulness Research and Practice (CMRP), Bangor University, Bangor, UK
| | - Robert Jones
- School of Psychology, Bangor University, Brigantia Building, Penrhalt Road, Bangor, LL57 2AS UK
| | - Richard Patrick Hastings
- Centre for Educational Development, Appraisal and Research: (CEDAR) University of Warwick, Coventry, UK
| | - Rebecca S Crane
- Centre for Mindfulness Research and Practice (CMRP), Bangor University, Bangor, UK
| | - Judith Roberts
- School of Psychology, Bangor University, Brigantia Building, Penrhalt Road, Bangor, LL57 2AS UK
| | - Jonathan Williams
- Denbighshire Complex Disabilities Team, North Wales, North Wales, UK
| | - Lucy Bryning
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
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Ruger JP, Reiff M. A Checklist for the Conduct, Reporting, and Appraisal of Microcosting Studies in Health Care: Protocol Development. JMIR Res Protoc 2016; 5:e195. [PMID: 27707687 PMCID: PMC5071616 DOI: 10.2196/resprot.6263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/27/2022] Open
Abstract
Background Microcosting is a cost estimation method that requires the collection of detailed data on resources utilized, and the unit costs of those resources in order to identify actual resource use and economic costs. Microcosting findings reflect the true costs to health care systems and to society, and are able to provide transparent and consistent estimates. Many economic evaluations in health and medicine use charges, prices, or payments as a proxy for cost. However, using charges, prices, or payments rather than the true costs of resources can result in inaccurate estimates. There is currently no existing checklist or guideline for the conduct, reporting, or appraisal of microcosting studies in health care interventions. Objective The aim of this study is to create a checklist and guideline for the conduct, reporting, and appraisal of microcosting studies in health care interventions. Methods Appropriate potential domains and items will be identified through (1) a systematic review of all published microcosting studies of health and medical interventions, strategies, and programs; (2) review of published checklists and guidelines for economic evaluations of health interventions, and selection of items relevant for microcosting studies; and (3) theoretical analysis of economic concepts relevant for microcosting. Item selection, formulation, and reduction will be conducted by the research team in order to develop an initial pool of items for evaluation by an expert panel comprising individuals with expertise in microcosting and economic evaluation of health interventions. A modified Delphi process will be conducted to achieve consensus on the checklist. A pilot test will be conducted on a selection of the articles selected for the previous systematic review of published microcosting studies. Results The project is currently in progress. Conclusions Standardization of the methods used to conduct, report or appraise microcosting studies will enhance the consistency, transparency, and comparability of future microcosting studies. This will be the first checklist for microcosting studies to accomplish these goals and will be a timely and important contribution to the health economic and health policy literature. In addition to its usefulness to health economists and researchers, it will also benefit journal editors and decision-makers who require accurate cost estimates to deliver health care.
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Affiliation(s)
- Jennifer Prah Ruger
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, United States.
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Frew E. Economic Evaluation of Childhood Obesity Interventions: Reflections and Suggestions. PHARMACOECONOMICS 2016; 34:733-740. [PMID: 26968705 DOI: 10.1007/s40273-016-0398-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Rising levels of childhood obesity present a serious global public health problem amounting to 7 % of GDP in developed countries and affecting 14 % of children. As such, many countries are investing increasingly large quantities of resource towards treatment and prevention. Whilst it is important to demonstrate the clinical effectiveness of any intervention, it is equally as important to demonstrate cost effectiveness as policy makers strive to get the best value for money from increasingly limited public resources. Economic evaluation assists with making these investment decisions and whilst it can offer considerable support in many healthcare contexts, applying it to a childhood obesity context is not straightforward. Childhood obesity is a complex disease with interventions being multi-component in nature. Furthermore, the interventions are implemented in a variety of settings such as schools, the community, and the home, and have costs and benefits that fall outside the health sector. This paper provides a reflection from a UK perspective on the application of the conventional approach to economic evaluation to childhood obesity. It offers suggestions for how evaluations should be designed to fit better within this context, and to meet the needs of local decision makers. An excellent example is the need to report costs using a micro-costing format and for benefit measurement to go beyond a health focus. This is critical as the organisation and commissioning of childhood obesity services is done from a Local Authority setting and this presents further challenges for what is the most appropriate economic evaluation approach to use. Given that adult obesity is now of epidemic proportions, the accurate assessment of childhood obesity interventions to support public health decision making is critical.
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Affiliation(s)
- Emma Frew
- Health Economics Unit, University of Birmingham, Birmingham, UK.
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Clarkson S, Axford N, Berry V, Edwards RT, Bjornstad G, Wrigley Z, Charles J, Hoare Z, Ukoumunne OC, Matthews J, Hutchings J. Effectiveness and micro-costing of the KiVa school-based bullying prevention programme in Wales: study protocol for a pragmatic definitive parallel group cluster randomised controlled trial. BMC Public Health 2016; 16:104. [PMID: 26832736 PMCID: PMC4736131 DOI: 10.1186/s12889-016-2746-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bullying refers to verbal, physical or psychological aggression repeated over time that is intended to cause harm or distress to the victims who are unable to defend themselves. It is a key public health priority owing to its widespread prevalence in schools and harmful short- and long-term effects on victims' well-being. There is a need to strengthen the evidence base by testing innovative approaches to preventing bullying. KiVa is a school-based bullying prevention programme with universal and indicated elements and an emphasis on changing bystander behaviour. It achieved promising results in a large trial in Finland, and now requires testing in other countries. This paper describes the protocol for a cluster randomised controlled trial (RCT) of KiVa in Wales. METHODS/DESIGN The study uses a two-arm waitlist control pragmatic definitive parallel group cluster RCT design with an embedded process evaluation and calculation of unit cost. Participating schools will be randomised a using a 1:1 ratio to KiVa plus usual provision (intervention group) or usual provision only (control group). The trial has one primary outcome, child self-reported victimisation from bullying, dichotomised as 'victimised' (bullied at least twice a month in the last couple of months) versus 'not victimised'. Secondary outcomes are: bullying perpetration; aspects of child social and emotional well-being (including emotional problems, conduct, peer relations, prosocial behaviour); and school attendance. Follow-up is at 12 months post-baseline. Implementation fidelity is measured through teacher-completed lesson records and independent school-wide observation. A micro-costing analysis will determine the costs of implementing KiVa, including recurrent and non-recurrent unit costs. Factors related to the scalability of the programme will be examined in interviews with head teachers and focus groups with key stakeholders in the implementation of school-based bullying interventions. DISCUSSION The results from this trial will provide evidence on whether the KiVa programme is transportable from Finland to Wales in terms of effectiveness and implementation. It will provide information about the costs of delivery and generate insights into factors related to the scalability of the programme. TRIAL REGISTRATION Current Controlled Trials ISRCTN23999021 Date 10-6-13.
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Affiliation(s)
- Suzy Clarkson
- Centre for Evidence Based Early Intervention, School of Psychology, College of Health and Behavioural Sciences, Bangor University, Nantlle Building, Normal Site, Bangor, Gwynedd, LL57 2PX, Wales, United Kingdom.
| | - Nick Axford
- Dartington Social Research Unit, Lower Hood Barn, Dartington, TQ9 6AB, Devon, United Kingdom.
| | - Vashti Berry
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, Devon, EX1 2 LU, United Kingdom.
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Hall, Bangor, Gwynedd, LL57 2PZ, Wales, United Kingdom.
| | - Gretchen Bjornstad
- Dartington Social Research Unit, Lower Hood Barn, Dartington, TQ9 6AB, Devon, United Kingdom.
| | - Zoe Wrigley
- Dartington Social Research Unit, Lower Hood Barn, Dartington, TQ9 6AB, Devon, United Kingdom.
| | - Joanna Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Hall, Bangor, Gwynedd, LL57 2PZ, Wales, United Kingdom.
| | - Zoe Hoare
- NWORTH CTU - North Wales Organisation for Randomised Trials in Health, Bangor University, Y Wern, Normal Site, Holyhead Road, Bangor, Gwynedd, LL57 2PZ, Wales, United Kingdom.
| | - Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, Devon, EX1 2 LU, United Kingdom.
| | - Justin Matthews
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, Devon, EX1 2 LU, United Kingdom.
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, School of Psychology, College of Health and Behavioural Sciences, Bangor University, Nantlle Building, Normal Site, Bangor, Gwynedd, LL57 2PX, Wales, United Kingdom.
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Berry V, Axford N, Blower S, Taylor RS, Edwards RT, Tobin K, Jones C, Bywater T. The Effectiveness and Micro-costing Analysis of a Universal, School-Based, Social–Emotional Learning Programme in the UK: A Cluster-Randomised Controlled Trial. SCHOOL MENTAL HEALTH 2015. [DOI: 10.1007/s12310-015-9160-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dehbarez NT, Lynggaard V, May O, Søgaard R. Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial. BMC Health Serv Res 2015; 15:422. [PMID: 26412226 PMCID: PMC4586001 DOI: 10.1186/s12913-015-1072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/18/2015] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure. METHODS The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors. RESULTS An additional cost of DKK 6,043 (95% CI -5,697; 17,783) and a QALY gain of 0.005 (95% CI -0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29% for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62% over the threshold values. DISCUSSION The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn. CONCLUSION Future research should assess the LC strategies' long-term efficacy and cost-utility. TRIAL REGISTRATION NCT01668394.
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Affiliation(s)
- Nasrin Tayyari Dehbarez
- Health Economics, Public Health and Quality Improvement, Olof Palmes Alle 15, 8200, Aarhus N, Denmark. .,Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark.
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Ole May
- Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark. .,Department of Clinical Medicine, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark.
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Stanley N, Ellis J, Farrelly N, Hollinghurst S, Bailey S, Downe S. Preventing domestic abuse for children and young people (PEACH): a mixed knowledge scoping review. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundA range of interventions that aim to prevent domestic abuse has been developed for children and young people in the general population. While these have been widely implemented, few have been rigorously evaluated. This study aimed to discover what was known about these interventions for children and what worked for whom in which settings.Review methodsThis mixed knowledge review was informed by realist principles and comprised four overlapping phases: an online mapping survey to identify current provision; a systematic review of the existing literature; a review of the UK ‘grey’ literature; and consultation with young people and experts. Information from these four sources of evidence informed analysis of costs and benefits.ResultsThe evidence for interventions achieving changes in knowledge and attitudes was stronger than that for behavioural change. Shifting social norms in the peer group emerged as a key mechanism of change. Media campaigns act to influence the wider social climate within which more targeted interventions are received, and they are also a source for programme materials. While most interventions are delivered in secondary schools, they are increasingly targeted at younger children. The review emphasised the importance of a school’s ‘readiness’ to introduce preventative interventions which need to be supported across all aspects of school life. Involving young people in the design and delivery of programmes increases authenticity and this emerged as a key ingredient in achieving impact. Longer interventions delivered by appropriately trained staff appeared likely to be more effective. Teachers emerged as well placed to embed interventions in schools but they require training and support from those with specialist knowledge in domestic abuse. There was evidence that small groups of students who were at higher risk might have accounted for some results regarding effectiveness and that programme effectiveness may vary for certain subgroups. Increasingly, boys are being identified as a target for change. The study identified a need for interventions for disabled children and children and young people from black, Asian, minority ethnic and refugee groups and a particular lack of materials designed for lesbian, gay, bisexual and transgender young people.LimitationsVery little evidence was identified on costs and cost-effectiveness. Few studies showed an effect at the level of significance set for the review. Where it did exist, the effect size was small, except in respect of improved knowledge. The inability to calculate a response rate for the mapping survey, which used a snowballing approach, limits the ability to generalise from it.ConclusionsWhile it is appropriate to continue to deliver interventions to whole populations of children and young people, effectiveness appeared to be influenced by high-risk children and young people, who should be directed to additional support. Programmes also need to make provision to manage any resulting disclosures. Interventions appear to be context specific, and so those already being widely delivered in the UK and which are likely to be acceptable should be robustly tested.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Nicky Stanley
- School of Social Work, University of Central Lancashire, Preston, UK
| | - Jane Ellis
- School of Social Work, University of Central Lancashire, Preston, UK
| | - Nicola Farrelly
- School of Social Work, University of Central Lancashire, Preston, UK
| | | | - Sue Bailey
- Gardener Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
- Royal College of Psychiatrists, London, UK
| | - Soo Downe
- School of Health, University of Central Lancashire, Preston, UK
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Sach TH, Desborough J, Houghton J, Holland R. Applying micro-costing methods to estimate the costs of pharmacy interventions: an illustration using multi-professional clinical medication reviews in care homes for older people. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:237-247. [PMID: 25377218 DOI: 10.1111/ijpp.12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Economic methods are underutilised within pharmacy research resulting in a lack of quality evidence to support funding decisions for pharmacy interventions. The aim of this study is to illustrate the methods of micro-costing within the pharmacy context in order to raise awareness and use of this approach in pharmacy research. METHODS Micro-costing methods are particularly useful where a new service or intervention is being evaluated and for which no previous estimates of the costs of providing the service exist. This paper describes the rationale for undertaking a micro-costing study before detailing and illustrating the process involved. The illustration relates to a recently completed trial of multi-professional medication reviews as an intervention provided in care homes. All costs are presented in UK£2012. KEY FINDINGS In general, costing methods involve three broad steps (identification, measurement and valuation); when using micro-costing, closer attention to detail is required within all three stages of this process. The mean (standard deviation; 95% confidence interval (CI) ) cost per resident of the multi-professional medication review intervention was £104.80 (50.91; 98.72 to 109.45), such that the overall cost of providing the intervention to all intervention home residents was £36,221.29 (95% CI, 32 810.81 to 39 631.77). CONCLUSIONS This study has demonstrated that micro-costing can be a useful method, not only for estimating the cost of a pharmacy intervention to feed into a pharmacy economic evaluation, but also as a source of information to help inform those designing pharmacy services about the potential time and costs involved in delivering such services.
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Affiliation(s)
- Tracey H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Julie Houghton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, UK
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Edwards RT, Bryning L, Crane R. Design of Economic Evaluations of Mindfulness-Based Interventions: Ten Methodological Questions of Which to Be Mindful. Mindfulness (N Y) 2014; 6:490-500. [PMID: 26000063 PMCID: PMC4432017 DOI: 10.1007/s12671-014-0282-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mindfulness-based interventions (MBIs) are being increasingly applied in a variety of settings. A growing body of evidence to support the effectiveness of these interventions exists and there are a few published cost-effectiveness studies. With limited resources available within public sectors (health care, social care, and education), it is necessary to build in concurrent economic evaluations alongside trials in order to inform service commissioning and policy. If future research studies are well-designed, they have strong potential to investigate the economic impact of MBIs. The particular challenge to the health economist is how best to capture the ways that MBIs help people adjust to or build resilience to difficult life circumstances, and to disseminate effectively to enable policy makers to judge the value of the contribution that MBIs can make within the context of the limited resourcing of public services. In anticipation of more research worldwide evaluating MBIs in various settings, this article suggests ten health economics methodological design questions that researchers may want to consider prior to conducting MBI research. These questions draw on both published standards of good methodological practice in economic evaluation of medical interventions, and on the authors’ knowledge and experience of mindfulness-based practice. We argue that it is helpful to view MBIs as both complex interventions and as public health prevention initiatives. Our suggestions for well-designed economic evaluations of MBIs in health and other settings, mirror current thinking on the challenges and opportunities of public health economics.
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Affiliation(s)
- Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), IMSCaR, Bangor University, Bangor, LL57 2PZ UK
| | - Lucy Bryning
- Centre for Health Economics and Medicines Evaluation (CHEME), IMSCaR, Bangor University, Bangor, LL57 2PZ UK
| | - Rebecca Crane
- Centre for Mindfulness Research and Practice (CMRP), School of Psychology, Bangor University, Bangor, LL57 1UT UK
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Acevedo-Polakovich ID, Niec LN, Barnet ML, Bell KM. Incorporating Natural Helpers to Address Service Disparities for Young Children with Conduct Problems. CHILDREN AND YOUTH SERVICES REVIEW 2013; 35:1463-1467. [PMID: 24729649 PMCID: PMC3979433 DOI: 10.1016/j.childyouth.2013.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In response to the high levels of unmet need among historically underserved young children with conduct problems, this paper outlines some of the key issues involved in incorporating natural helpers into the delivery of parenting interventions for the treatment of conduct problems among historically underserved children. Strategies for the selection and training of natural helpers are discussed along with challenges that might be encountered in these processes. Directions for future research are also highlighted. With appropriate selection and training procedures in place, natural helpers may increase the accessibility of services for children and families and foster the reduction of service disparities.
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Affiliation(s)
| | - Larissa N Niec
- Central Michigan University Center for Children, Families and Communities
| | - Miya L Barnet
- Central Michigan University Center for Children, Families and Communities
| | - Katrina M Bell
- Central Michigan University Center for Children, Families and Communities
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