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García-Álvarez D, Sempere-Rubio N, Faubel YR. Evaluaciones económicas en promoción de la actividad física: una revisión sistemática. Glob Health Promot 2024:17579759241245413. [PMID: 39086317 DOI: 10.1177/17579759241245413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- David García-Álvarez
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Núria Sempere-Rubio
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Y Raquel Faubel
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
- Unidad de Investigación Conjunta en Ingeniería Biomédica, IIS La Fe-Universitat Politècnica de València, Valencia, España
- PTinMOTION, Fisioterapia en movimiento, Grupo de Investigación Multiespecialidad, Departamento de Fisioterapia, Universitat de València, Valencia, España
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Taylor R, Sullivan D, Reeves P, Kerr N, Sawyer A, Schwartzkoff E, Bailey A, Williams C, Hure A. A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6139. [PMID: 37372726 DOI: 10.3390/ijerph20126139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
The Australian National Preventive Health Strategy 2021-2030 recommended the establishment of evidence-based frameworks to enable local public health services to identify strategies and interventions that deliver value for money. This study aimed to review the cost-effectiveness of preventive health strategies to inform the reorientation of local public health services towards preventive health interventions that are financially sustainable. Four electronic databases were searched for reviews published between 2005 and February 2022. Reviews that met the following criteria were included: population: human studies, any age or sex; concept 1: primary and/or secondary prevention interventions; concept 2: full economic evaluation; context: local public health services as the provider of concept 1. The search identified 472 articles; 26 were included. Focus health areas included mental health (n = 3 reviews), obesity (n = 1), type 2 diabetes (n = 3), dental caries (n = 2), public health (n = 4), chronic disease (n = 5), sexual health (n = 1), immunisation (n = 1), smoking cessation (n = 3), reducing alcohol (n = 1), and fractures (n = 2). Interventions that targeted obesity, type 2 diabetes, smoking cessation, and fractures were deemed cost-effective, however, more studies are needed, especially those that consider equity in priority populations.
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Affiliation(s)
- Rachael Taylor
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Deborah Sullivan
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Penny Reeves
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicola Kerr
- Health Promotion, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Amy Sawyer
- Health Promotion, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Emma Schwartzkoff
- Health Promotion, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Andrew Bailey
- Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Christopher Williams
- Research and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
- University Centre for Rural Health, School of Health Sciences, University of Sydney, 61 Uralba Street, Lismore, NSW 2480, Australia
| | - Alexis Hure
- Health Economics and Impact, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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Melariri HI, Kalinda C, Chimbari MJ. Patients' views on health promotion and disease prevention services provided by healthcare workers in a South African tertiary hospital. BMC Health Serv Res 2023; 23:368. [PMID: 37061700 PMCID: PMC10105350 DOI: 10.1186/s12913-023-09351-5] [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: 01/11/2022] [Accepted: 05/13/2022] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Patients' views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied. AIM This study assessed the views of patients on HP and DP services provided by various categories of HCWs. SETTING The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa. METHOD An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted. RESULTS In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27-0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW. CONCLUSION Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients' experience from all HCW groups and phases of patient care.
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Affiliation(s)
- Herbert I Melariri
- College of Health Sciences, Disipline of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4041, South Africa.
- Eastern Cape Department of Health, Port Elizabeth Provincial Hospital, Buckingham Rd, Mount Croix, Gqeberha, 6001, South Africa.
| | - Chester Kalinda
- College of Health Sciences, Disipline of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4041, South Africa
- University of Global Health Equity (UGHE), Bill and Joyce Cummings Institute of Global Health, PO Box 6955, Kigali, 20093, Rwanda
| | - Moses J Chimbari
- College of Health Sciences, Disipline of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4041, South Africa
- Great Zimbabwe University, PO Box 1235, Masvingo, Zimbabwe
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Lange O. Health economic evaluation of preventive digital public health interventions using decision-analytic modelling: a systematized review. BMC Health Serv Res 2023; 23:268. [PMID: 36932436 PMCID: PMC10024449 DOI: 10.1186/s12913-023-09280-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Digital public health (DiPH) provides novel approaches for prevention, potentially leading to long-term health benefits in resource-limited health systems. However, cost-effectiveness of DiPH interventions is unclear. This systematized review investigates the use of decision-analytic modelling in health economic evaluations of DiPH primary prevention and health promotion interventions, focusing on intervention's design, methods used, results, and reporting quality. METHODS PubMed, CINAHL, and Web of Science were searched for studies of decision-analytic economic evaluations of digital interventions in primary prevention or health promotion, published up to June 2022. Intervention characteristics and selected items were extracted based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratios (ICERs) were then extracted and price-adjusted to compare the economic evaluation results. Finally, the included studies' reporting quality was assessed by building a score using CHEERS. RESULTS The database search (including search update) produced 2,273 hits. After removing duplicates, 1,434 titles and abstracts were screened. Of the 89 studies meeting the full-text search criteria, 14 were ultimately reviewed. The most common targets were physical activity (five studies) and weight loss (four). Digital applications include text messages, web-based inventions, app-based interventions, e-learning devices, and the promotion of smartphone apps. The mean ICER of the 12 studies using quality-adjusted life years (QALYs) is €20,955 per QALY (min. - €3,949; max. €114,211). The mean of reported CHEERS items per study is 81% (min. 59%; max. 91%). CONCLUSIONS This review only includes primary prevention and health promotion, and thus excludes other DiPH fields (e.g. secondary prevention). It also focuses on decision-analytic models, excluding study-based economic evaluations. Standard methods of economic evaluation could be adapted more to the specifics of DiPH by measuring the effectiveness of more current technologies through alternative methods, incorporating a societal perspective, and more clearly defining comparators. Nevertheless, the review demonstrates using common thresholds that the new field of DiPH shows potential for cost-effective preventive interventions.
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Affiliation(s)
- Oliver Lange
- Department of Health Care Management, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany.
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Huter K, Krick T, Rothgang H. Health economic evaluation of digital nursing technologies: a review of methodological recommendations. HEALTH ECONOMICS REVIEW 2022; 12:35. [PMID: 35792960 PMCID: PMC9258051 DOI: 10.1186/s13561-022-00378-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Health economic evaluation of digital nursing technologies (DNT) is important to provide information that helps avoid undesirable developments and implementations as well as increase the chances of success of developed applications. At the same time, studies and evidence on cost-effectiveness are still very rare in this field. Review studies in related technology areas such as telemedicine frequently criticise the quality and comparability of health economic evaluations conducted in this field. Based on a content analysis of methodological literature on the economic evaluation of innovative (digital) technologies in health and nursing, this article aims to identify specific challenges in this research area and offers recommendations on how to address these challenges to promote more sound health economic evaluations in the future. METHODS A rapid review was conducted, consisting of a systematic search in the Pubmed database as well as Google Scholar. In addition, the literature lists of the analysed texts were scoured for additional texts to be included. Methodological literature, single studies, and reviews were included. A total of 536 studies were screened, of which 29 were included in the full text analysis. RESULTS Based on the systematic content analysis of the studies under consideration, 10 specific methodological challenges are identified, and the methodological recommendations were examined for consideration. A particular focus was given to whether specific methodological approaches might be needed in the context of evaluating the efficiency of DNT. CONCLUSION Many of the challenges identified for the health economic evaluations of digital nursing technologies are comparable to those of other complex health care interventions. The recommendations discussed can help to alleviate those challenges. Future research should focus on alternative approaches to assessing causality in different phases of technology development while maintaining high evidence standards. High-evidence economic assessment of technologies in nursing care should be carried out in routine use, especially if they are intended to be reimbursed by the social insurance.
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Affiliation(s)
- Kai Huter
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359, Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Tobias Krick
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359, Bremen, Germany.
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany.
| | - Heinz Rothgang
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 3, 28359, Bremen, Germany
- High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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Kwon J, Squires H, Franklin M, Lee Y, Young T. Economic evaluation of community-based falls prevention interventions for older populations: a systematic methodological overview of systematic reviews. BMC Health Serv Res 2022; 22:401. [PMID: 35346185 PMCID: PMC8962024 DOI: 10.1186/s12913-022-07764-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Falls impose significant health and economic burdens on older people. The volume of falls prevention economic evaluations has increased, the findings from which have been synthesised by systematic reviews (SRs). Such SRs can inform commissioning and design of future evaluations; however, their findings can be misleading and incomplete, dependent on their pre-specified criteria. This study aims to conduct a systematic overview (SO) to: (1) systematically identify SRs of community-based falls prevention economic evaluations; (2) describe the methodology and findings of SRs; (3) critically appraise the methodology of SRs; and (4) suggest commissioning recommendations based on SO findings. Methods The SO followed the PRISMA guideline and the Cochrane guideline on SO, covering 12 databases and grey literature for the period 2003–2020. Eligible studies were SRs with 50% or more included studies that were economic evaluations of community-based falls prevention (against any comparator) for older persons (aged 60 +) or high-risk individuals aged 50–59. Identified SRs’ aims, search strategies and results, extracted data fields, quality assessment methods/results, and commissioning and research recommendations were synthesised. The comprehensiveness of previous SRs’ data synthesis was judged against criteria drawn from literature on falls prevention/public health economic evaluation. Outcomes of general population, lifetime decision models were re-analysed to inform commissioning recommendations. The SO protocol is registered in the Prospective Register of Systematic Reviews (CRD42021234379). Results Seven SRs were identified, which extracted 8 to 33 data fields from 44 economic evaluations. Four economic evaluation methodological/reporting quality checklists were used; three SRs narratively synthesised methodological features to varying extent and focus. SRs generally did not appraise decision modelling features, including methods for characterising dynamic complexity of falls risk and intervention need. Their commissioning recommendations were based mainly on cost-per-unit ratios (e.g., incremental cost-effectiveness ratios) and neglected aggregate impact. There is model-based evidence of multifactorial and environmental interventions, home assessment and modification and Tai Chi being cost-effective but also the risk that they exacerbate social inequities of health. Conclusions Current SRs of falls prevention economic evaluations do not holistically inform commissioning and evaluation. Accounting for broader decisional factors and methodological nuances of economic evaluations, particularly decision models, is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07764-2.
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Kwon J, Squires H, Franklin M, Lee Y, Young T. Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations. BMC Health Serv Res 2022; 22:316. [PMID: 35255898 PMCID: PMC8902781 DOI: 10.1186/s12913-022-07647-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Falls impose significant health and economic burdens among older populations, making their prevention a priority. Health economic models can inform whether the falls prevention intervention represents a cost-effective use of resources and/or meet additional objectives such as reducing social inequities of health. This study aims to conduct a systematic review (SR) of community-based falls prevention economic models to: (i) systematically identify such models; (ii) synthesise and critically appraise modelling methods/results; and (iii) formulate methodological and commissioning recommendations. METHODS The SR followed PRISMA 2021 guideline, covering the period 2003-2020, 12 academic databases and grey literature. A study was included if it: targeted community-dwelling persons aged 60 and over and/or aged 50-59 at high falls risk; evaluated intervention(s) designed to reduce falls or fall-related injuries; against any comparator(s); reported outcomes of economic evaluation; used decision modelling; and had English full text. Extracted data fields were grouped by: (A) model and evaluation overview; (B) falls epidemiology features; (C) falls prevention intervention features; and (D) evaluation methods and outcomes. A checklist for falls prevention economic evaluations was used to assess reporting/methodological quality. Extracted fields were narratively synthesised and critically appraised to inform methodological and commissioning recommendations. The SR protocol is registered in the Prospective Register of Systematic Reviews (CRD42021232147). RESULTS Forty-six models were identified. The most prevalent issue according to the checklist was non-incorporation of all-cause care costs. Based on general population, lifetime models conducting cost-utility analyses, seven interventions produced favourable ICERs relative to no intervention under the cost-effectiveness threshold of US$41,900 (£30,000) per QALY gained; of these, results for (1) combined multifactorial and environmental intervention, (2) physical activity promotion for women, and (3) targeted vitamin D supplementation were from validated models. Decision-makers should explore the transferability and reaches of interventions in their local settings. There was some evidence that exercise and home modification exacerbate existing social inequities of health. Sixteen methodological recommendations were formulated. CONCLUSION There is significant methodological heterogeneity across falls prevention models. This SR's appraisals of modelling methods should facilitate the conceptualisation of future falls prevention models. Its synthesis of evaluation outcomes, though limited to published evidence, could inform commissioning.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
| | - Matthew Franklin
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
| | - Yujin Lee
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL England
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA England
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Seleznova Y, Alayli A, Stock S, Müller D. Methodological issues in economic evaluations of disease prevention and health promotion: an overview of systematic and scoping reviews. BMC Public Health 2021; 21:2130. [PMID: 34801013 PMCID: PMC8605499 DOI: 10.1186/s12889-021-12174-w] [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: 03/16/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to provide a comprehensive overview of methodological challenges in economic evaluations of disease prevention and health promotion (DPHP)-measures. Methods We conducted an overview of reviews searching MEDLINE, EMBASE, NHS Economic Evaluation Database, Database of Promoting Health Effectiveness Reviews, Cochrane Database of Systematic Reviews (CDSR) and Database of Promoting Health Effectiveness Reviews (DOPHER) (from their inception to October 2021). We included both systematic and scoping reviews of economic evaluations in DPHP addressing following methodological aspects: (i) attribution of effects, (ii) outcomes, (iii) inter-sectoral (accruing to non-health sectors of society) costs and consequences and (iv) equity. Data were extracted according to the associated sub-criteria of the four methodological aspects including study design economic evaluation (e.g. model-based), type/scope of the outcomes (e.g. outcomes beyond health), perspective, cost categories related to non-health sectors of society, and consideration of equity (method of inclusion). Two reviewers independently screened all citations, full-text articles, and extracted data. A narrative synthesis without a meta-analysis or other statistical synthesis methods was conducted. Results The reviewing process resulted in ten systematic and one scoping review summarizing 494 health economic evaluations. A lifelong time horizon was adopted in about 23% of DPHP evaluations, while 64% of trial-based evaluations had a time horizon up to 2 years. Preference-based outcomes (36%) and non-health outcomes (8%) were only applied in a minority of studies. Although the inclusion of inter-sectoral costs (i.e. costs accruing to non-health sectors of society) has increased in recent years, these were often neglected (between 6 and 23% depending on the cost category). Consideration to equity was barely given in economic evaluations, and only addressed in six of the eleven reviews. Conclusions Economic evaluations of DPHP measures give only little attention to the specific methodological challenges related to this area. For future economic DPHP evaluations a tool with structured guidance should be developed. This overview of reviews was not registered and a published protocol does not exist. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12174-w.
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Affiliation(s)
- Yana Seleznova
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany.
| | - Adrienne Alayli
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
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Gottschalk S, König HH, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, Dams J. Cost-Effectiveness of a Group vs Individually Delivered Exercise Program in Community-Dwelling Persons Aged ≥70 Years. J Am Med Dir Assoc 2021; 23:736-742.e6. [PMID: 34626579 DOI: 10.1016/j.jamda.2021.08.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Interventions aimed at reducing falls and physical inactivity could alleviate the economic burden attributable to these factors. The study aimed to analyze the cost-effectiveness of a group-delivered version of the Lifestyle-integrated Functional Exercise Program compared with an individually delivered program version. DESIGN An economic evaluation conducted alongside the LiFE-is-LiFE randomized non-inferiority trial. INTERVENTIONS Group and individually delivered version of a program consisting of strength and balance exercises integrated into everyday activities to prevent falls. SETTING AND PARTICIPANTS 309 community-dwelling older adults (aged ≥70 years) at risk of falling recruited around Heidelberg and Stuttgart (Germany). METHODS Cost-effectiveness of the group program was assessed over 6 months using different effect measures [quality-adjusted life years (QALYs, EQ-5D-5L), physical activity (mean number of steps/day), and falls] and cost perspectives (societal and payer's). Incremental cost-effectiveness ratios were determined, and cost-effectiveness acceptability curves were constructed. RESULTS From a societal perspective, mean costs, the number of falls, and the number of steps/day were somewhat higher in the group program, whereas QALYs were almost identical between the 2 interventions. From the payer's perspective, the incremental cost-effectiveness ratio for the group compared to the individual program were €56,733 per QALY and €4755 per fall prevented. Based on the cost-effectiveness acceptability curves, the cost-effectiveness of the group program had to be rated as uncertain for both effect measures and perspectives. In contrast, it demonstrated cost-effectiveness for increasing physical activity at willingness-to-pay values per additional 1000 steps/day of €1600 (societal perspective) or €600 (payer's perspective). CONCLUSIONS AND IMPLICATIONS Compared to the individual program, the group program might be cost-effective for increasing physical activity in older adults but was unlikely to be cost-effective with regard to QALY or for preventing falls. The cost-effectiveness should be evaluated long-term and compared to a regular care group.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Network Aging Research, Heidelberg University, Heidelberg, Germany; Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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Kwon J, Lee Y, Young T, Squires H, Harris J. Qualitative research to inform economic modelling: a case study in older people's views on implementing the NICE falls prevention guideline. BMC Health Serv Res 2021; 21:1020. [PMID: 34583685 PMCID: PMC8479997 DOI: 10.1186/s12913-021-07056-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background High prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation to ensure cost-effective use of healthcare resources. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in the local area of Sheffield. Methods Focus group and interview participants (n = 27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible non-users of varying falls risks. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake and adherence. Views on other topics concerning falls prevention were also invited. Framework analysis was applied for data analysis, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) facilitators and barriers to implementing the NICE-recommended pathway and contextual factors; (2) intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand; and (3) methodological and evaluative challenges for public health economic modelling. Results Two cross-component factors were identified: health motives of older persons; and professional competence. Participants highlighted the need for intersectoral approaches and prioritising the vulnerable groups. The local commissioning strategy should consider the socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider, organisation, funding and policy (including intersectoral) and health and non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses. Conclusions Holistic qualitative research can inform how commissioned falls prevention pathways can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions. This would improve the structural validity of quantitative models used to inform geriatric public health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07056-1.
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Affiliation(s)
- Joseph Kwon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA.
| | - Yujin Lee
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, England, CV4 7AL
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
| | - Hazel Squires
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
| | - Janet Harris
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, England, S1 4DA
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Besor O, Manor O, Paltiel O, Donchin M, Rauch O, Kaufman-Shriqui V. A city-wide health promotion programme evaluation using EQUIHP: Jerusalem Community-Academic Partnership (J-CAP). Eur J Public Health 2021; 30:455-461. [PMID: 31539039 DOI: 10.1093/eurpub/ckz154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While health promotion initiatives are common, too little is known about their quality, impact and sustainability. Fragmentation between sectors exists and programme evaluation initiatives lack consistency, making comparison of outcomes challenging. METHODS We used a 'snowball' methodology to detect health promotion programmes (HPPs) in the Municipality of Jerusalem, excluding those in schools. The European Quality Instrument for Health Promotion (EQUIHP) was adapted and used to examine programme quality. The tool was pre-tested among stakeholders, and translated into Hebrew and Arabic between March and December 2017. Trained research assistants collected information on four domains using in-person interviews: (i) compliance with international principles of HPPs, (ii) development and implementation, (iii) project management and (iv) sustainability of programmes. RESULTS Overall, 93 programmes, including 33 670 participants, were ascertained and evaluated. The majority of HPPs (54.8%) addressed nutrition and physical activity, with 58.1% targeting the non-orthodox Jewish population and 68.8% aimed at both sexes. Cronbach's alpha scores were 0.968 for the entire EQUIHP tool and 0.802, 0.959, 0.918 and 0.718 for the subdomains of Framework, Project Development, Project Management and Sustainability, respectively. Median domain scores were 0.83, 0.61, 0.76 and 0.75. Median score of the entire tool was 0.67. HPPs operated by the Municipality scored lower than those of non-governmental organizations and health providers/organizations in every domain except for Project Management. CONCLUSION A systematic city-wide evaluation of HPPs is feasible and uncovers strengths and weaknesses, including sustainability and variability by programme provider. Academic-community partnerships may assist planning and improving HPPs in the city.
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Affiliation(s)
- Omri Besor
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Milka Donchin
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Orly Rauch
- Braun School of Public Health & Community Medicine, The Hebrew University - Hadassah, Jerusalem, Israel
| | - Vered Kaufman-Shriqui
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel.,Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, Toronto, Canada
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12
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Hult M, Halminen O, Linna M, Suominen S, Kangasniemi M. Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review. Eur J Public Health 2021; 31:997-1003. [PMID: 33970246 PMCID: PMC8546878 DOI: 10.1093/eurpub/ckab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety. Methods Our systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis. Results The searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used. Conclusion This review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.
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Affiliation(s)
- Marja Hult
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Olli Halminen
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Espoo, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, Institute of Healthcare Engineering, Management and Architecture (HEMA), Aalto University, Espoo, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland.,Department of Public Health, Turku University Hospital, Turku, Finland.,Department of Public Health, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
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The Role of Prevention in Reducing the Economic Impact of ME/CFS in Europe: A Report from the Socioeconomics Working Group of the European Network on ME/CFS (EUROMENE). ACTA ACUST UNITED AC 2021; 57:medicina57040388. [PMID: 33923830 PMCID: PMC8073750 DOI: 10.3390/medicina57040388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023]
Abstract
This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such programmes. We consider the economic case for prevention programmes, whether there is scope for preventive programmes for ME/CFS, and what are the health and economic benefits to be derived from the implementation of such programmes. We conclude that there is little scope for primary prevention programmes, given that ME/CFS is attributable to a combination of host and environmental risk factors, with host factors appearing to be most prominent, and that there are few identified modifiable risk factors that could be the focus of such programmes. The exception is in the use of agricultural chemicals, particularly organophosphates, where there is scope for intervention, and where Europe-wide programmes of health education to encourage safe use would be beneficial. There is a need for more research on risk factors for ME/CFS to establish a basis for the development of primary prevention programmes, particularly in respect of occupational risk factors. Secondary prevention offers the greatest scope for intervention, to minimise diagnostic delays associated with prolonged illness, increased severity, and increased costs.
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14
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Domagała A, Golinowska S. Good practices in health promotion for older people - Significance for evidence in health policy. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:404-415. [PMID: 32697009 DOI: 10.1111/hsc.13100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
This article is devoted to convincing policy makers to use good practices in encouraging older people to pursue adequate and effective health policies. Long-term scientific research focused on the effects of health promotion programmes is rarely undertaken, although its scope is still expanding. At the same time, it is strongly desirable to form health policy based on scientific evidence. In this situation, an indication of good practices characterised by precisely defined features and their systematic evaluation could be an alternative to an insufficient number of empirical studies. The first step of the methodology was a literature review on health promotion for older people, aimed at defining good practices and criteria used for their selection. The authors searched the following databases: PubMED, Embase and Cochrane Library, as well as international databases dedicated to health promotion programmes for older people (e.g. Age-friendly World (https://extranet.who.int/agefriendlyworld/age-friendly-practice-database-launched); HealthProElderly (www.healthproelderly.com/database/index.php?id=16); JA-CHRODIS (www.chrodis.eu); EuroHealthNet (www.eurohealthnet.eu) and ProFouND; (www.profound.eu.com). As relevant health policy information is usually available in national languages, the authors then approached national experts in 10 European countries, who filled in a dedicated survey on health promotion programmes for older people and indicated examples of good practices from their countries. Practical evidence, based on real implemented programmes, is valuable as inspiration for health promotion programmes, their planning and management. Selecting good practices from among implemented and evaluated actions makes it possible to establish their value. The significance of good practices in health promotion is to deliver real benefits and health effects for a target group, which, in the case of evident benefits, renders the practices credible and worthy of further dissemination. The EU already successfully shares good practices in migrant health and environmental protection. Creating databases on good practices helps policy makers promote the sustainability of already implemented activities and enhances their applicability by other organisations and in different settings.
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Affiliation(s)
- Alicja Domagała
- Department of Health Policy and Management, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisława Golinowska
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Bajraktari S, Sandlund M, Zingmark M. Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context. ACTA ACUST UNITED AC 2020; 78:97. [PMID: 33072316 PMCID: PMC7556574 DOI: 10.1186/s13690-020-00480-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023]
Abstract
Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.
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Affiliation(s)
- Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.,Department of Epidemiology and Public Health, Umeå University, Umeå, Sweden
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16
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Ribeiro I, Batel Marques F, Alves D, Alves C. An analysis of the effectiveness outcomes of economic studies evaluating ophthalmic drugs: a systematic review. Acta Ophthalmol 2020; 98:237-243. [PMID: 32003153 DOI: 10.1111/aos.14362] [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: 05/13/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To characterize the effectiveness measures of cost-effectiveness studies (CES) of ophthalmic drugs. METHODS A systematic review was conducted in PubMed/Embase until October 2019. Cost-effectiveness studies (CES) evaluating ophthalmic drugs were included. Sources of effectiveness measures were extracted. Data on study design and study outcomes were extracted from sources of effectiveness measures. The adequacy of the sample size of the clinical studies used as sources of effectiveness measures was assessed. If CES have retrieved effectiveness data from multiple sources, the appropriateness of the method to combine the results was analysed. RESULTS Forty-five CES were included. Thirty-one (68.9%) retrieved their effectiveness measures from experimental studies, five (11.1%) from observational studies and nine (20%) from other type of data sources. Eight (17.8%) CES used data from a primary outcome of a study as an effectiveness measure, eight (17.8%) used data from secondary outcomes, seven (15.6%) used data from the both primary and secondary outcomes and for 22 (48.9%) it was not possible to identify the outcomes used. From the 23 (51.1%) CES based on a single clinical study, three (6.7%) included data from clinical studies which had an adequate sample size to detect significant differences in the clinical outcomes used as effectiveness measures. From the 17 (37.8%) CES based on multiple clinical studies, only one (2.2%) used and/or reported an adequate method of quantitative synthesis (meta-analysis). CONCLUSION A considerable number of CES in ophthalmology were not based on clinical studies with adequate sample sizes and report results from effectiveness measures not assessed as primary outcomes.
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Affiliation(s)
- Inês Ribeiro
- AIBILI – Association for Innovation and Biomedical Research on Light and Image CHAD – Centre for Health Technology Assessment and Drug Research Azinhaga Santa Comba Coimbra Portugal
- Faculty of Pharmacy Azinhaga Santa Comba University of Coimbra Coimbra Portugal
| | - Francisco Batel Marques
- AIBILI – Association for Innovation and Biomedical Research on Light and Image CHAD – Centre for Health Technology Assessment and Drug Research Azinhaga Santa Comba Coimbra Portugal
- Laboratory of Social Pharmacy and Public Health School of Pharmacy Azinhaga Santa Comba University of Coimbra Coimbra Portugal
| | - Dalila Alves
- AIBILI – Association for Innovation and Biomedical Research on Light and Image CHAD – Centre for Health Technology Assessment and Drug Research Azinhaga Santa Comba Coimbra Portugal
| | - Carlos Alves
- AIBILI – Association for Innovation and Biomedical Research on Light and Image CHAD – Centre for Health Technology Assessment and Drug Research Azinhaga Santa Comba Coimbra Portugal
- Laboratory of Social Pharmacy and Public Health School of Pharmacy Azinhaga Santa Comba University of Coimbra Coimbra Portugal
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17
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Pettigrew S, Jongenelis MI, Jackson B, Warburton J, Newton RU. A randomized controlled trial and pragmatic analysis of the effects of volunteering on the health and well-being of older people. Aging Clin Exp Res 2020; 32:711-721. [PMID: 31201669 DOI: 10.1007/s40520-019-01241-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Volunteering among older people has the potential to deliver health benefits to the individual, along with economic and social benefits to society. However, it is not clear whether healthier people are more likely to engage in volunteering, whether volunteering improves health, or the extent to which the relationship may be reciprocal. There is an identified need for longitudinal work, especially in the form of randomized controlled trials, to establish causality. AIMS To assess the effects of commencing volunteering among older non-volunteers utilizing a randomized controlled trial approach involving per-protocol and pragmatic analyses. METHODS Of the 445 Australians aged 60 + years who participated in the study, 201 were assigned to an intervention arm that required them to participate in a minimum of 1 h/week of formal volunteering in a position of their choice. The remaining participants were assigned to a control condition and asked to continue their lives as usual, but were not discouraged from commencing volunteering. RESULTS Across the assessed physical, psychological, and social variables, a significant difference in sit-to-stand scores was found in both the per-protocol and pragmatic analyses, and a further significant difference in the fast pace walk was identified in the pragmatic analyses. CONCLUSION The results provide some support for policies and programs designed to encourage older people to engage in volunteering to maintain or improve their health. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12615000091505.
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Affiliation(s)
- Simone Pettigrew
- School of Psychology, Curtin University, Kent St, Bentley, WA, 6102, Australia.
| | | | - Ben Jackson
- School of Human Sciences (Exercise and Sports Science), University of Western Australia, Perth, Australia
| | - Jeni Warburton
- La Trobe Rural Health School, La Trobe University, Melbourne, Australia
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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18
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Ribeiro IS, Batel Marques FJ, Alves DG, Alves CMC. A systematic review of the methodological quality of economic studies evaluating ophthalmic drugs. Expert Rev Pharmacoecon Outcomes Res 2019; 19:421-430. [PMID: 30722711 DOI: 10.1080/14737167.2019.1579646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Innovative drugs have been approved in ophthalmology. Thus, the number and importance of economic evaluation studies of ophthalmic drugs have been growing. This study aims to assess the methodological quality of pharmacoeconomic studies of ophthalmic drugs. AREAS COVERED A systematic search was conducted in Pubmed/Embase until November 2018 to identify full pharmacoeconomic studies evaluating ophthalmic drugs. The quality of studies was evaluated using the British Medical Journal (BMJ) checklist. Quality indicators were evaluated by Fisher's exact test. Ninety-five studies were included, 50 (52.6%) cost-utility analysis, 28 (29.5%) cost-effectiveness and 17 (17.9%) cost-effectiveness/cost-utility. All studies presented, at least, three methodological limitations. Cost-utility studies, studies conducted from a health system perspective, with time horizons longer than one-year and that rely on observational or observational and experimental data simultaneously are associated with higher quality. Only eight (8.4%) studies considered two eyes in the economic analysis and only 13 (13.7%) considered the natural history of the disease when extrapolating results for long-term analysis. EXPERT OPINION The majority of the pharmacoeconomic studies were assessed as having good methodological quality, however, the methodological quality scores were sensitive to several indicators. Therefore, improving the quality of studies would enhance their usefulness in the decision-making processes.
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Affiliation(s)
- Inês Souto Ribeiro
- a CHAD - Centre for Health Technology Assessment and Drug Research , AIBILI - Association for Innovation and Biomedical Research on Light and Image , Coimbra , Portugal
- b Faculty of Pharmacy , University of Coimbra , Coimbra , Portugal
| | - Francisco Jorge Batel Marques
- a CHAD - Centre for Health Technology Assessment and Drug Research , AIBILI - Association for Innovation and Biomedical Research on Light and Image , Coimbra , Portugal
- c Laboratory of Social Pharmacy and Public Health, School of Pharmacy , University of Coimbra , Coimbra , Portugal
| | - Dalila Gil Alves
- a CHAD - Centre for Health Technology Assessment and Drug Research , AIBILI - Association for Innovation and Biomedical Research on Light and Image , Coimbra , Portugal
| | - Carlos Miguel Costa Alves
- a CHAD - Centre for Health Technology Assessment and Drug Research , AIBILI - Association for Innovation and Biomedical Research on Light and Image , Coimbra , Portugal
- c Laboratory of Social Pharmacy and Public Health, School of Pharmacy , University of Coimbra , Coimbra , Portugal
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Money AG, Atwal A, Boyce E, Gaber S, Windeatt S, Alexandrou K. Falls Sensei: a serious 3D exploration game to enable the detection of extrinsic home fall hazards for older adults. BMC Med Inform Decis Mak 2019; 19:85. [PMID: 30992072 PMCID: PMC6469143 DOI: 10.1186/s12911-019-0808-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background Falls are the main cause of death and injury for older adults in the UK. Many of these falls occur within the home as a result of extrinsic falls risk factors such as poor lighting, loose/uneven flooring, and clutter. Falls education plays an important role in self-management education about extrinsic hazards and is typically delivered via information leaflets, falls apps, and educational booklets. Serious games have the potential of delivering an engaging and informative alternative to traditional methods but almost exclusively, these are currently delivered as exergaming applications that focus solely on intrinsic falls risk factors. This study presents ‘Falls Sensei’ a first-person 3D exploration game that aims to educate older adults about extrinsic falls risk factors within the home environment. After presenting Falls Sensei, game usability and older adults’ perceptions and attitudes towards using the game in practice are explored. Methods This study involved 15 community dwelling older adults. After playing the Falls Sensei game, participants completed a Systems Usability Scale (SUS) questionnaire and post task interview, and follow-up interviews three weeks later. Inductive and deductive thematic template analysis, informed by the Unified Theory of Acceptance and Use of Technology model, was used to analyse the think-aloud, post-task and follow-up interview transcripts. Descriptive statistical analysis and one-sampled t-tests were used to analyse log-file data and SUS responses. Results Three high-level themes emerged from the analysis of transcriptions: Performance Expectancy; Effort Expectancy; Social Influence. The SUS score was 77.5/100 which indicates ‘Good’ levels of usability. Interestingly, reported usability of the game increased with participant age. Participants were positive about the usability of the game (p < = 0.05 for 9/10 items). The most memorable fall hazards were those most commonly encountered in the game or those most challenging to participants. Conclusions The results support the use of serious games as an engaging tool for educating older adults about extrinsic falls risk factors. Awareness of home hazard detection was raised by the game, and some older adults became more aware for the need to adapt their own homes after gameplay. Further research would be needed to draw comparisons with established interventions.
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Affiliation(s)
- Arthur G Money
- Department of Computer Science, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Anita Atwal
- Faculty of Health and Social Care, London South Bank University, London, SE1 0AA, UK
| | - Emily Boyce
- North London Forensic Service, Barnet, Enfield and Haringey Mental Health NHS Trust, Enfield, EN2 8JL, UK
| | - Sophie Gaber
- Department of Neurobiology, Care Sciences & Society, Division of Occupational Therapy, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Susan Windeatt
- CIS Westminster Rehabilitation Service, Gordon Hospital London, CNWL NHS Foundation Trust, SW1V 2RH, London, UK
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Zingmark M, Norström F, Lindholm L, Dahlin-Ivanoff S, Gustafsson S. Modelling long-term cost-effectiveness of health promotion for community-dwelling older people. Eur J Ageing 2019; 16:395-404. [PMID: 31798365 PMCID: PMC6857142 DOI: 10.1007/s10433-019-00505-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.
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Affiliation(s)
- Magnus Zingmark
- Health and Social Care Administration, Municipality of Östersund, 83182 Östersund, Sweden.,2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Fredrik Norström
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Lars Lindholm
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Synneve Dahlin-Ivanoff
- 3Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,4University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden
| | - Susanne Gustafsson
- 3Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,4University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden
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Ippoliti R, Allievi I, Falavigna G, Giuliano P, Montani F, Obbia P, Rizzi S, Moda G. The sustainability of a community nurses programme aimed at supporting active ageing in mountain areas. Int J Health Plann Manage 2018; 33:e1100-e1111. [PMID: 30052282 DOI: 10.1002/hpm.2591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/24/2018] [Accepted: 06/29/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Community Nurse Supporting Elderly iN a changing SOciety is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship, and this work highlights the necessary conditions for the existence of these entrepreneurial initiatives on the market, with community nurses' services purchased by the public health care system. METHODS The authors propose a sustainability framework for this project based on three relevant dimensions (ie, health, organisation, and context), highlighting the necessary conditions for continued provision of health services beyond project conclusion. Then, considering the Piedmont Region and those aged 65 or older as target population, health outcomes are analysed, proposing a break-even analysis to calculate expected levels. RESULTS According to our results, in order to care for 191 977 elderly people for 3 years, a successful pro-active approach is needed to prevent 1657 falls with hip fracture, reducing the prevalence of this adverse outcome by 36%. These are the expected health outcome levels for the existence of a social market, which can be achieved through the successful involvement of local public health organisations and stakeholders. CONCLUSIONS Policy makers need clear information on the economic impact of extending this new intervention to the whole target population and on the required preconditions for its financial sustainability in terms of health outcomes. However, a participatory process involving all relevant local stakeholders and organisations is crucial to extend current achievements beyond project conclusion.
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Huter K, Dubas-Jakóbczyk K, Kocot E, Kissimova-Skarbek K, Rothgang H. Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:14. [PMID: 29686540 PMCID: PMC5902889 DOI: 10.1186/s12962-018-0100-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. METHODS Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. RESULTS Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. CONCLUSION There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.
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Affiliation(s)
- Kai Huter
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Katarzyna Dubas-Jakóbczyk
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Kissimova-Skarbek
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Heinz Rothgang
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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Kocot E. The impact of aging on different types of health care: The example of the Polish health insurance system. Int J Health Plann Manage 2018; 33:e557-e568. [PMID: 29469209 DOI: 10.1002/hpm.2498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 11/10/2022] Open
Abstract
The aging phenomenon, which is being observed all over the world, can strongly affect health policy and a planning in the health care sector. However, the impact of demographic changes on different parts of it can be varied. The main objective of this study was to check the possible impact of aging on health expenditure (HE) regarding different types of health care and to evaluate whether this impact is significant for all analyzed areas. To show a relationship between age and HE a special indicator (old-age sensitivity) was defined, showing a difference between the standardized value of HE per capita in the age group 65+ and in the group 20 to 64 (defined as the reference group). Then a simple prognosis of expenditure was prepared. Both analyses were done separately for 11 types of health care services and 2 types of goods reimbursement. The results show that while sensitivity varies between the different types of care, however, it is strong in most of them. Because of the prognosis, the expenditure will be increasing for the 9 types of care and decreasing for 4 of them. While in the case of the low values of sensitivity the HE is actually decreasing, the high value of sensitivity does not result in a growing tendency. Our main conclusion is that it is very important for health policy and planning to take into account the diversity of the types of health care and the different influences of changes in the size and structure of population on them.
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Affiliation(s)
- Ewa Kocot
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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