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Herkama S, Larose MP, Harjuniemi I, Pöyhönen V, Yanagida T, Kankaanpää E, Rissanen E, Salmivalli C. Improving the implementation of KiVa antibullying program with tailored support: Study protocol for a cluster randomized controlled trial. Contemp Clin Trials 2024; 137:107407. [PMID: 38104858 DOI: 10.1016/j.cct.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There are no evidence-based models to support the implementation of school-based bullying prevention programs. Our primary objective is to examine the impact of tailored support on the implementation of the KiVa antibullying program. Our second objective is to evaluate whether the offered support influences student outcomes (e.g., victimization, bullying perpetration). We also assess the cost-effectiveness of the provided support and conduct a process evaluation. METHODS In a cluster randomized control trial (cRCT), we compare program fidelity between schools that receive implementation support and those that do not. Twenty-four (N = 24) schools in Finland were randomized to either the IMPRES condition (receiving support, n = 12) or the control group (KiVa as usual, n = 12). In the IMPRES condition, pre-assessment and staff training were organized, and a selected team of staff members received four mentoring sessions during one academic year. Staff and students answer questionnaires at the end of school year 0, at post-intervention (year 1) and again at the 1-year follow-up (year 2). Our primary outcomes concern two main program components - universal and indicated actions - reflecting program fidelity. As secondary outcomes, we examine the level of bullying victimization and perpetration as well as students' perception of several program fidelity indicators. Finally, we assess several tertiary outcomes, collect resource data and conduct qualitative interviews to perform additional analyses. CONCLUSION This trial will inform us of whether implementation support can boost program fidelity and have a distal impact on bullying prevalence. TRIAL REGISTRATION ISRCTN15558617 https://doi.org/10.1186/ISRCTN15558617.
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Vasiliadis HM, Lamoureux-Lamarche C, Chapdelaine A, Provencher MD, Norton PJ, Berbiche D, Roberge P. Cost-Effectiveness of Group Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders in Primary Care Settings: Economic Evaluation From the Healthcare System Perspective Over a 1-Year Time Horizon. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:43-53. [PMID: 37461378 PMCID: PMC10867409 DOI: 10.1177/07067437231187459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
AIM To assess the incremental cost-effectiveness ratio (ICER) of group transdiagnostic cognitive-behavioural therapy (tCBT) added to treatment as usual (TAU) for anxiety disorders compared to TAU only from the healthcare system perspective over a 1-year time horizon. METHODS Data from a pragmatic multisite randomized controlled trial where adults (18-65 years) with an anxiety disorder were randomized to tCBT + TAU (n = 117) or TAU (n = 114). Group tCBT is a 12-week (2h weekly sessions) community-based intervention. Health service utilization and related costs were captured from medico-administrative data and included those for the intervention, ambulatory visits, hospitalizations and medications. Effectiveness was based on quality-adjusted life years (QALYs). The study included measures at baseline, 4, 8, and 12 months. Intention-to-treat and complete case analyses were carried out. Missing data were imputed using multiple imputation analyses. Seemingly unrelated regression analyses were used to assess the effect of the intervention on total costs and QALYs while also adjusting for baseline confounders. The probability of cost-effectiveness of the intervention was assessed according to different willingness-to-pay (WTP) thresholds using the net benefit regression method. RESULTS The ICER of tCBT + TAU as compared to TAU in the intention-to-treat analysis was $6,581/QALY. Complete case analyses showed a similar ICER of $6,642/QALY. The probability at a WTP threshold of $20,000 and $40,000 that tCBT + TAU as compared to TAU is cost-effective is 93.0% and 99.9%. CONCLUSION tCBT added to TAU appears to be cost-effective from the healthcare system perspective for treating adult patients with anxiety disorders. Larger trials including young and older adults as well as a range of anxiety disorders are needed to further investigate the cost-effectiveness of tCBT in different patient populations.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Catherine Lamoureux-Lamarche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Alexandra Chapdelaine
- PRIMUS Research Group, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Djamal Berbiche
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d’urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Ben ÂJ, van Dongen JM, El Alili M, Esser JL, Broulíková HM, Bosmans JE. Conducting Trial-Based Economic Evaluations Using R: A Tutorial. PHARMACOECONOMICS 2023; 41:1403-1413. [PMID: 37458913 PMCID: PMC10570221 DOI: 10.1007/s40273-023-01301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 10/13/2023]
Abstract
Trial-based economic evaluations are increasingly being conducted to support healthcare decision-making. When analysing trial-based economic evaluation data, different methodological challenges may be encountered, including (i) missing data, (ii) correlated costs and effects, (iii) baseline imbalances and (iv) skewness of costs and/or effects. Despite the broad range of methods available to account for these methodological challenges in effectiveness studies, they may not always be directly applicable in trial-based economic evaluations where costs and effects are analysed jointly, and more than one methodological challenge typically needs to be addressed simultaneously. The use of inappropriate methods can bias results and conclusions regarding the cost-effectiveness of healthcare interventions. Eventually, such low-quality evidence can hamper healthcare decision-making, which may in turn result in a waste of already scarce healthcare resources. Therefore, this tutorial aims to provide step-by-step guidance on how to combine appropriate statistical methods for handling the abovementioned methodological challenges using a ready-to-use R script. The theoretical background of the described methods is provided, and their application is illustrated using a simulated trial-based economic evaluation.
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Affiliation(s)
- Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Jonas L Esser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Hana Marie Broulíková
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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4
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Chapdelaine A, Vasiliadis HM, Provencher MD, Norton PJ, Roberge P. Moderators of the cost-effectiveness of transdiagnostic CBT for anxiety disorders over an 8-month time horizon using a net-benefit regression framework. BMC Health Serv Res 2023; 23:596. [PMID: 37291599 DOI: 10.1186/s12913-023-09468-7] [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: 02/15/2022] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Access to evidence-based psychological treatment is a concern in many parts of the globe due to government-level financial constraints and patient-level barriers. Transdiagnostic cognitive behavioural therapy (tCBT) is an effective treatment approach that uses a single protocol for anxiety disorders which could enhance the dissemination of evidence-based psychotherapy. In a context of limited resources, the study of treatment moderators can allow to identify subgroups for which the cost-effectiveness of an intervention differs, information that could impact decision-making. So far, there has been no economic evaluation of tCBT for different subpopulations. The objectives of this study, using the net-benefit regression framework, were to explore clinical and sociodemographic factors as potential moderators of the cost-effectiveness of tCBT compared to treatment-as-usual (TAU). METHODS This is a secondary data analysis of a pragmatic randomized controlled trial opposing tCBT added to TAU (n = 117) to TAU only (n = 114). Data on costs from the health system and the limited societal perspectives, as well as anxiety-free days, an effectiveness measure based on the Beck Anxiety Inventory, were collected over an 8-month time horizon and used to derive individual net-benefits. The net-benefit regression framework was used to assess moderators of the cost-effectiveness of tCBT + TAU as opposed to TAU alone. Variables of sociodemographic and clinical nature were assessed. RESULTS Results showed that the number of comorbid anxiety disorders significantly moderated the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. CONCLUSIONS The number of comorbid anxiety disorders was identified as a moderator affecting the cost-effectiveness of tCBT + TAU compared to TAU from the limited societal perspective. More research is needed to strengthen the case of tCBT from an economic standpoint for large-scale dissemination. TRIAL REGISTRATION ClinicalTrials.gov: NCT02811458, 23/06/2016.
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Affiliation(s)
- Alexandra Chapdelaine
- PRIMUS Research Group, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus de Longueuil, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Martin D Provencher
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 All. des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Peter J Norton
- The Cairnmillar Institute, 391-393 Tooronga Road, Hawthorn East, Victoria, VIC, 3123, Australia
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001 12e Avenue N, Sherbrooke, Québec, J1H 5N4, Canada
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5
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Vos JAM, El Alili M, Duineveld LAM, Wieldraaijer T, Wind J, Sert E, Donkervoort SC, Govaert MJPM, van Geloven NAW, van de Ven AWH, Heuff G, van Weert HCPM, Bosmans JE, van Asselt KM. Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial. J Cancer Surviv 2023:10.1007/s11764-023-01383-4. [PMID: 37097550 DOI: 10.1007/s11764-023-01383-4] [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: 02/09/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE The aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective. METHODS We performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I-III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping. RESULTS Total societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of - €3895; 95% CI - €6113; - €1712). Lost productivity was the main contributor to the difference in societal costs (- €3305; 95% CI - €5028; - €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI - 0.049; 3.15). The ICER for QLQ-C30 was - 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was - 0.021 (95% CI - 0.083; 0.040) resulting in an ICER of 129,164. CONCLUSIONS GP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL. IMPLICATIONS FOR CANCER SURVIVORS With a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.
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Affiliation(s)
- Julien A M Vos
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Mohamed El Alili
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Van Der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Laura A M Duineveld
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Thijs Wieldraaijer
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jan Wind
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Edanur Sert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Sandra C Donkervoort
- Department of Surgery, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands
| | - Marc J P M Govaert
- Department of Surgery, Dijklander Hospital, Maelsonstraat 3, 1624 NP, Hoorn, the Netherlands
| | - Nanette A W van Geloven
- Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, the Netherlands
| | - Anthony W H van de Ven
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands
| | - Gijsbert Heuff
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Van Der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Kristel M van Asselt
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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6
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Hartman L, El Alili M, Cutolo M, Opris D, Da Silva JAP, Szekanecz Z, Buttgereit F, Masaryk P, Bos R, Kok MR, Paolino S, Coupé VMH, Lems WF, Boers M. Cost-effectiveness and cost-utility of add-on, low-dose prednisolone in patients with rheumatoid arthritis aged 65+: The pragmatic, multicenter, placebo-controlled GLORIA trial. Semin Arthritis Rheum 2022; 57:152109. [DOI: 10.1016/j.semarthrit.2022.152109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
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7
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Regier DA, Pollard S, McPhail M, Bubela T, Hanna TP, Ho C, Lim HJ, Chan K, Peacock SJ, Weymann D. A perspective on life-cycle health technology assessment and real-world evidence for precision oncology in Canada. NPJ Precis Oncol 2022; 6:76. [PMID: 36284134 PMCID: PMC9596463 DOI: 10.1038/s41698-022-00316-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
Health technology assessment (HTA) can be used to make healthcare systems more equitable and efficient. Advances in precision oncology are challenging conventional thinking about HTA. Precision oncology advances are rapid, involve small patient groups, and are frequently evaluated without a randomized comparison group. In light of these challenges, mechanisms to manage precision oncology uncertainties are critical. We propose a life-cycle HTA framework and outline supporting criteria to manage uncertainties based on real world data collected from learning healthcare systems. If appropriately designed, we argue that life-cycle HTA is the driver of real world evidence generation and furthers our understanding of comparative effectiveness and value. We conclude that life-cycle HTA deliberation processes must be embedded into healthcare systems for an agile response to the constantly changing landscape of precision oncology innovation. We encourage further research outlining the core requirements, infrastructure, and checklists needed to achieve the goal of learning healthcare supporting life-cycle HTA.
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Affiliation(s)
- Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Melanie McPhail
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Science, Queen's University, Kingston, ON, Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Howard J Lim
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kelvin Chan
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control (ARCC), Cancer Control Research, BC Cancer, Vancouver, BC, Canada.
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8
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Smith DH, O'Keeffe-Rosetti M, Leo MC, Mayhew M, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, McMullen C, Owen-Smith A, Trinacty CM, Vollmer WM, DeBar L. Economic Evaluation: A Randomized Pragmatic Trial of a Primary Care-based Cognitive Behavioral Intervention for Adults Receiving Long-term Opioids for Chronic Pain. Med Care 2022; 60:423-431. [PMID: 35352703 PMCID: PMC9106895 DOI: 10.1097/mlr.0000000000001713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic pain is prevalent and costly; cost-effective nonpharmacological approaches that reduce pain and improve patient functioning are needed. OBJECTIVE Report the incremental cost-effectiveness ratio (ICER), compared with usual care, of cognitive behavioral therapy aimed at improving functioning and pain among patients with chronic pain on long-term opioid treatment. DESIGN Economic evaluation conducted alongside a pragmatic cluster randomized trial. SUBJECTS Adults with chronic pain on long-term opioid treatment (N=814). INTERVENTION A cognitive behavioral therapy intervention teaching pain self-management skills in 12 weekly, 90-minute groups delivered by an interdisciplinary team (behaviorists, nurses) with additional support from physical therapists, and pharmacists. OUTCOME MEASURES Cost per quality adjusted life year (QALY) gained, and cost per additional responder (≥30% improvement on standard scale assessment of Pain, Enjoyment, General Activity, and Sleep). Costs were estimated as-delivered, and replication. RESULTS Per patient intervention replication costs were $2145 ($2574 as-delivered). Those costs were completely offset by lower medical care costs; inclusive of the intervention, total medical care over follow-up was $1841 lower for intervention patients. Intervention group patients also had greater QALY and responder gains than did controls. Supplemental analyses using pain-related medical care costs revealed ICERs of $35,000, and $53,000 per QALY (for replication, and as-delivered intervention costs, respectively); the ICER when excluding patients with outlier follow-up costs was $106,000. LIMITATIONS Limited to 1-year follow-up; identification of pain-related utilization potentially incomplete. CONCLUSION The intervention was the optimal choice at commonly accepted levels of willingness-to-pay for QALY gains; this finding was robust to sensitivity analyses.
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Affiliation(s)
- David H. Smith
- Kaiser Permanente Center for Health Research, Portland
OR
| | | | - Michael C. Leo
- Kaiser Permanente Center for Health Research, Portland
OR
| | - Meghan Mayhew
- Kaiser Permanente Center for Health Research, Portland
OR
| | - Lindsay Benes
- Kaiser Permanente Center for Health Research, Portland
OR
- Montana State University College of Nursing, Missoula,
MT
| | | | - Richard A. Deyo
- Oregon Health and Science University, School of Medicine,
Portland, OR
| | | | | | | | - Ashli Owen-Smith
- Georgia State University, School of Public Health, Atlanta
GA
- Kaiser Permanente Center for Clinical and Outcomes
Research, Atlanta GA
| | | | | | - Lynn DeBar
- Kaiser Permanente Washington Health Research Institute,
Seattle WA
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Arsham A, Bebu I, Mathew T. A Bivariate Regression-Based Cost-Effectiveness Analysis. JOURNAL OF STATISTICAL THEORY AND PRACTICE 2022. [DOI: 10.1007/s42519-022-00255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Makki A, Thomsen JB, Gunnarsson GL, Hölmich PLR, Sørensen PJA, Rindom MB. A cost-effectiveness analysis of delayed breast reconstruction with pedicled flaps from the back. J Plast Reconstr Aesthet Surg 2022; 75:2211-2218. [PMID: 35365412 DOI: 10.1016/j.bjps.2022.02.034] [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: 08/08/2021] [Revised: 02/05/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Variability in breast reconstruction methods provides an opportunity to investigate whether a method is superior to another with regard to cost, quality, or both. We performed a cost-effectiveness analysis (CEA) study based on tertiary endpoint data from a randomized clinical trial to compare the cost-effectiveness of delayed breast reconstruction by either a latissimus dorsi flap (LD) or a thoracodorsal artery perforator flap (TAP). MATERIAL & METHODS A total of 50 women were included for unilateral delayed breast reconstruction and were randomized to reconstruction by either the LD flap (n = 18) or the TAP flap (n = 22). The CEA was based on differences in shoulder function after the reconstruction. Direct and indirect costs relating to the two procedures were assessed by the Danish Diagnosis-Related Groups tariffs. RESULTS Our analysis showed a significant positive effect of introducing the TAP flap on the total shoulder score with an additional cost of $2779. The incremental cost-effectiveness ratio was $4481 and based on a willingness to pay (WTP) $500, we found an estimated net benefit of $519, which was statistically significant (p = 0.0375). The cost-effectiveness acceptability curve indicated that there is a 96.3% probability for the TAP flap being cost-effective to the LD flap at a WTP threshold of $500. CONCLUSION From a societal perspective, our cost-effective analysis demonstrated that the TAP flap is the more cost-effective method of breast reconstruction compared to the LD flap with respect to patient-reported shoulder-related disability.
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Affiliation(s)
- Ahmad Makki
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.
| | - Jørn B Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark; Research Unit for Plastic Surgery, Odense University Hospital, University of Southern, Odense, Denmark
| | | | - Professor Lisbet R Hölmich
- Department of Plastic Surgery, Herlev & Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Professor Jens A Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark; Research Unit for Plastic Surgery, Odense University Hospital, University of Southern, Odense, Denmark
| | - Mikkel B Rindom
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Denmark
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11
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Bagepally BS, Chaikledkaew U, Chaiyakunapruk N, Attia J, Thakkinstian A. Meta-analysis of economic evaluation studies: data harmonisation and methodological issues. BMC Health Serv Res 2022; 22:202. [PMID: 35168619 PMCID: PMC8845252 DOI: 10.1186/s12913-022-07595-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In the context of ever-growing health expenditure and limited resources, economic evaluations aid in making evidence-informed policy decisions. Cost-utility analysis (CUA) is often used, and CUA data synthesis is also desirable, but methodological issues are challenged. Hence, we aim to provide a step-by-step process to prepare the CUA data for meta-analysis. METHODS Data harmonisation methods were constructed specifically considering CUA methodology, including inconsistent reports, economic parameters, heterogeneity (i.e., country's income, time horizon, perspective, modelling approaches, currency, willingness to pay). An incremental net benefit (INB) and its variance were estimated and pooled across studies using a basic meta-analysis by COMER. RESULTS Five scenarios show how to obtain INB and variance with various reported data: Study reports the mean and variance (Scenario 1) or 95% confidence interval (Scenario 2) of ΔC, ΔE, and ICER for INB/variance calculations. Scenario 3: ΔC, ΔE, and variances are available, but not for the ICER; a Monte Carlo was used to simulate ΔC and ΔE data, variance and covariance can be then estimated leading INB calculation. Scenario-4: Only the CE plane was available, ΔC and ΔE data can be extracted; means of ΔC, ΔE, and variance/covariance can be estimated accordingly, leading to INB/variance estimates. Scenario-5: Only mean cost/outcomes and ICER are available but not for variance and the CE-plane. A variance INB can be borrowed from other studies which are similar characteristics, including country income, ICERs, intervention-comparator, time period, country region, and model type and inputs (i.e., discounting, time horizon). CONCLUSION Out data harmonisation and meta-analytic methods should be useful for researchers for the synthesis of economic evidence to aid policymakers in decision making.
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Affiliation(s)
- Bhavani Shankara Bagepally
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.,ICMR-National Institute of Epidemiology, Chennai, India
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.,Social Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - John Attia
- Centre for Clinical Epidemiology & Biostatistics, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton, NSW, Australia
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand. .,Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
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Zanganeh M, Adab P, Li B, Pallan M, Liu WJ, Hemming K, Lin R, Liu W, Martin J, Cheng KK, Frew E. Cost-Effectiveness of a School-and Family-Based Childhood Obesity Prevention Programme in China: The "CHIRPY DRAGON" Cluster-Randomised Controlled Trial. Int J Public Health 2021; 66:1604025. [PMID: 34531712 PMCID: PMC8439195 DOI: 10.3389/ijph.2021.1604025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023] Open
Abstract
Objectives: Rapid socioeconomic and nutrition transitions in Chinese populations have contributed to the growth in childhood obesity. This study presents a cost-effectiveness analysis of a school- and family-based childhood obesity prevention programme in China. Methods: A trial-based economic evaluation assessed cost-effectiveness at 12 months. Forty schools with 1,641 children were randomised to either receive the multi-component (diet and physical activity) intervention or to continue with usual activities. Both public sector and societal perspectives were adopted. Costs and benefits in the form of quality-adjusted life years (QALYs) were compared and uncertainty was assessed using established UK and US thresholds. Results: The intervention cost was 35.53 Yuan (£7.04/US$10.01) per child from a public sector perspective and 536.95 Yuan (£106/US$151) from a societal perspective. The incremental cost-effectiveness ratio (ICER) was 272.7 Yuan (£54/US$77)/BMI z-score change. The ICER was 8,888 Yuan (£1,760/US$2,502) and 73,831 Yuan (£14,620/US$20,796) per QALY from a public sector and societal perspective, respectively and was cost-effective using UK (£20,000) and US (US$50,000) per QALY thresholds. Conclusion: A multi-component school-based prevention programme is a cost-effective means of preventing childhood obesity in China.
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Affiliation(s)
- Mandana Zanganeh
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peymane Adab
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Bai Li
- School for Public Studies, University of Bristol, Bristol, United Kingdom
| | - Miranda Pallan
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Wei Jia Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Karla Hemming
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Rong Lin
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wei Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - James Martin
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kar Keung Cheng
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Frew
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Cost-effectiveness of physical activity intervention in children - results based on the Physical Activity and Nutrition in Children (PANIC) study. Int J Behav Nutr Phys Act 2021; 18:116. [PMID: 34488794 PMCID: PMC8419957 DOI: 10.1186/s12966-021-01181-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background We assessed the cost-effectiveness of a 2-year physical activity (PA) intervention combining family-based PA counselling and after-school exercise clubs in primary-school children compared to no intervention from an extended service payer’s perspective. Methods The participants included 506 children (245 girls, 261 boys) allocated to an intervention group (306 children, 60 %) and a control group (200 children, 40 %). The children and their parents in the intervention group had six PA counselling visits, and the children also had the opportunity to participate in after-school exercise clubs. The control group received verbal and written advice on health-improving PA at baseline. A change in total PA over two years was used as the outcome measure. Intervention costs included those related to the family-based PA counselling, the after-school exercise clubs, and the parents’ taking time off to travel to and participate in the counselling. The cost-effectiveness analyses were performed using the intention-to-treat principle. The costs per increased PA hour (incremental cost-effectiveness ratio, ICER) were based on net monetary benefit (NMB) regression adjusted for baseline PA and background variables. The results are presented with NMB and cost-effectiveness acceptability curves. Results Over two years, total PA increased on average by 108 h in the intervention group (95 % confidence interval [CI] from 95 to 121, p < 0.001) and decreased by 65.5 h (95 % CI from 81.7 to 48.3, p < 0.001) in the control group, the difference being 173.7 h. the incremental effectiveness was 87 (173/2) hours. For two years, the intervention costs were €619 without parents’ time use costs and €860 with these costs. The costs per increased PA hour were €6.21 without and €8.62 with these costs. The willingness to pay required for 95 % probability of cost-effectiveness was €14 and €19 with these costs. The sensitivity analyses revealed that the ICER without assuming this linear change in PA were €3.10 and €4.31. Conclusions The PA intervention would be cost-effective compared to no intervention among children if the service payer’s willingness-to-pay for a 1-hour increase in PA is €8.62 with parents’ time costs. Trial registration ClinicalTrials.gov: NCT01803776. Registered 4 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=01803776&cntry=&state=&city=&dist=. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01181-0.
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The statistical approach in trial-based economic evaluations matters: get your statistics together! BMC Health Serv Res 2021; 21:475. [PMID: 34011337 PMCID: PMC8135982 DOI: 10.1186/s12913-021-06513-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Baseline imbalances, skewed costs, the correlation between costs and effects, and missing data are statistical challenges that are often not adequately accounted for in the analysis of cost-effectiveness data. This study aims to illustrate the impact of accounting for these statistical challenges in trial-based economic evaluations. Methods Data from two trial-based economic evaluations, the REALISE and HypoAware studies, were used. In total, 14 full cost-effectiveness analyses were performed per study, in which the four statistical challenges in trial-based economic evaluations were taken into account step-by-step. Statistical approaches were compared in terms of the resulting cost and effect differences, ICERs, and probabilities of cost-effectiveness. Results In the REALISE study and HypoAware study, the ICER ranged from 636,744€/QALY and 90,989€/QALY when ignoring all statistical challenges to − 7502€/QALY and 46,592€/QALY when accounting for all statistical challenges, respectively. The probabilities of the intervention being cost-effective at 0€/ QALY gained were 0.67 and 0.59 when ignoring all statistical challenges, and 0.54 and 0.27 when all of the statistical challenges were taken into account for the REALISE study and HypoAware study, respectively. Conclusions Not accounting for baseline imbalances, skewed costs, correlated costs and effects, and missing data in trial-based economic evaluations may notably impact results. Therefore, when conducting trial-based economic evaluations, it is important to align the statistical approach with the identified statistical challenges in cost-effectiveness data. To facilitate researchers in handling statistical challenges in trial-based economic evaluations, software code is provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06513-1.
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Adding the Coping Power Programme to parent management training: the cost-effectiveness of stacking interventions for children with disruptive behaviour disorders. Eur Child Adolesc Psychiatry 2021; 30:1603-1614. [PMID: 32924086 PMCID: PMC8505382 DOI: 10.1007/s00787-020-01638-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8-12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015.
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El Alili M, van Dongen JM, Goldfeld KS, Heymans MW, van Tulder MW, Bosmans JE. Taking the Analysis of Trial-Based Economic Evaluations to the Next Level: The Importance of Accounting for Clustering. PHARMACOECONOMICS 2020; 38:1247-1261. [PMID: 32729091 PMCID: PMC7546992 DOI: 10.1007/s40273-020-00946-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES The aim of this study was to assess the performance and impact of multilevel modelling (MLM) compared with ordinary least squares (OLS) regression in trial-based economic evaluations with clustered data. METHODS Three thousand datasets with balanced and unbalanced clusters were simulated with correlation coefficients between costs and effects of - 0.5, 0, and 0.5, and intraclass correlation coefficients (ICCs) varying between 0.05 and 0.30. Each scenario was analyzed using both MLM and OLS. Statistical uncertainty around MLM and OLS estimates was estimated using bootstrapping. Performance measures were estimated and compared between approaches, including bias, root mean squared error (RMSE) and coverage probability. Cost and effect differences, and their corresponding confidence intervals and standard errors, incremental cost-effectiveness ratios, incremental net-monetary benefits and cost-effectiveness acceptability curves were compared. RESULTS Cost-effectiveness outcomes were similar between OLS and MLM. MLM produced larger statistical uncertainty and coverage probabilities closer to nominal levels than OLS. The higher the ICC, the larger the effect on statistical uncertainty between MLM and OLS. Significant cost-effectiveness outcomes as estimated by OLS became non-significant when estimated by MLM. At all ICCs, MLM resulted in lower probabilities of cost effectiveness than OLS, and this difference became larger with increasing ICCs. Performance measures and cost-effectiveness outcomes were similar across scenarios with varying correlation coefficients between costs and effects. CONCLUSIONS Although OLS produced similar cost-effectiveness outcomes, it substantially underestimated the amount of variation in the data compared with MLM. To prevent suboptimal conclusions and a possible waste of scarce resources, it is important to use MLM in trial-based economic evaluations when data are clustered.
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Affiliation(s)
- Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Johanna M. van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Keith S. Goldfeld
- Department of Population Health, NYU School of Medicine, New York, NY USA
| | - Martijn W. Heymans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VU, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Bagepally BS, Chaikledkaew U, Gurav YK, Anothaisintawee T, Youngkong S, Chaiyakunapruk N, McEvoy M, Attia J, Thakkinstian A. Glucagon-like peptide 1 agonists for treatment of patients with type 2 diabetes who fail metformin monotherapy: systematic review and meta-analysis of economic evaluation studies. BMJ Open Diabetes Res Care 2020; 8:8/1/e001020. [PMID: 32690574 PMCID: PMC7371226 DOI: 10.1136/bmjdrc-2019-001020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/26/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis and to pool the incremental net benefits (INBs) of glucagon-like peptide 1 (GLP1) compared with other therapies in type 2 diabetes mellitus (T2DM) after metformin monotherapy failure. RESEARCH DESIGN AND METHODS The study design is a systematic review and meta-analysis. We searched MEDLINE (via PubMed), Scopus and Tufts Registry for eligible cost-utility studies up to June 2018, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We conducted a systematic review and pooled the INBs of GLP1s compared with other therapies in T2DM after metformin monotherapy failure. Various monetary units were converted to purchasing power parity, adjusted to 2017 US$. The INBs were calculated and then pooled across studies, stratified by level of country income; a random-effects model was used if heterogeneity was present, and a fixed-effects model if it was absent. Heterogeneity was assessed using Q test and I2 statistic. RESULTS A total of 56 studies were eligible, mainly from high-income countries (HICs). The pooled INBs of GLP1s compared with dipeptidyl peptidase-4 inhibitor (DPP4i) (n=10), sulfonylureas (n=6), thiazolidinedione (TZD) (n=3), and insulin (n=23) from HICs were US$4012.21 (95% CI US$-571.43 to US$8595.84, I2=0%), US$3857.34 (95% CI US$-7293.93 to US$15 008.61, I2=45.9%), US$37 577.74 (95% CI US$-649.02 to US$75 804.50, I2=92.4%) and US$14 062.42 (95% CI US$8168.69 to US$19 956.15, I2=86.4%), respectively. GLP1s were statistically significantly cost-effective compared with insulins, but not compared with DPP4i, sulfonylureas, and TZDs. Among GLP1s, liraglutide was more cost-effective compared with lixisenatide, but not compared with exenatide, with corresponding pooled INBs of US$4555.09 (95% CI US$3992.60 to US$5117.59, I2=0) and US$728.46 (95% CI US$-1436.14 to US$2893.07, I2=0), respectively. CONCLUSION GLP1 agonists are a cost-effective choice compared with insulins, but not compared with DPP4i, sulfonylureas and TZDs. PROSPERO REGISTRATION NUMBER CRD42018105193.
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Affiliation(s)
- Bhavani Shankara Bagepally
- Non-Communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Yogesh Krishnarao Gurav
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Epidemiology Group, ICMR-National Institute of Virology, Pune, India
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - Mark McEvoy
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, New Lambton, New South Wales, Australia
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, New Lambton, New South Wales, Australia
- Division of Medicine, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Breheny K, Passmore S, Adab P, Martin J, Hemming K, Lancashire ER, Frew E. Effectiveness and cost-effectiveness of The Daily Mile on childhood weight outcomes and wellbeing: a cluster randomised controlled trial. Int J Obes (Lond) 2020; 44:812-822. [PMID: 31988481 PMCID: PMC7101281 DOI: 10.1038/s41366-019-0511-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND The Daily Mile is designed to increase physical activity levels with children running or walking around school grounds for 15-min daily. It has been adopted by schools worldwide and endorsed as a solution to tackle obesity, despite no robust evidence of its benefits. We conducted a cluster randomised controlled trial to determine its clinical and cost-effectiveness. METHODS Forty schools were randomly assigned (1:1) to either the Daily Mile intervention or control group in which only the usual school health and wellbeing activities were implemented. The primary outcome was BMI z-score (BMIz) at 12 months follow-up from baseline, with planned subgroup analysis to examine differential effects. Primary economic analysis outcome was incremental cost per Quality-Adjusted-Life-Year (QALY) gained. RESULTS Using a constrained randomisation approach, balanced on school size, baseline BMIz and proportion of pupils eligible for free school meals, 20 schools were allocated to intervention (n = 1,153 participants) and 20 to control (n = 1,127); 3 schools withdrew (2 intervention, 1 control). At 12 months, BMIz data were available for 18 intervention schools (n = 850) and 19 control schools (n = 820 participants). Using intention-to-treat analysis the adjusted mean difference (MD) in BMIz (intervention - control) was -0.036 (95% CI: -0.085 to 0.013, p = 0.146). Pre-specified subgroup analysis showed a significant interaction with sex (p = 0.001) suggesting a moderate size benefit of The Daily Mile in girls (MD -0.097, 95% CI -0.156 to -0.037). This was consistent with the exploratory economic results that showed The Daily Mile to be highly cost-effective in girls (£2,492 per QALY), but not in boys, and overall to have a 76% chance of cost-effectiveness for the whole sample, at the commonly applied UK threshold of £20,000 per QALY. CONCLUSIONS Overall the Daily Mile had a small but non-significant effect on BMIz, however, it had a greater effect in girls suggesting that it might be considered as a cost-effective component of a system-wide approach to childhood obesity prevention.
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Affiliation(s)
- Katie Breheny
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
- Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | | | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Emma R Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
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Bagepally BS, Gurav YK, Anothaisintawee T, Youngkong S, Chaikledkaew U, Thakkinstian A. Cost Utility of Sodium-Glucose Cotransporter 2 Inhibitors in the Treatment of Metformin Monotherapy Failed Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1458-1469. [PMID: 31806203 DOI: 10.1016/j.jval.2019.09.2750] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) and associated ailments are leading economic burdens to society. Sodium glucose cotransporter-2 (SGLT2) inhibitors are recent antidiabetic medications with beneficial clinical efficacy. This meta-analysis was conducted to quantitatively pool the incremental net benefit of SGLT2 inhibitors in T2DM patients who failed metformin monotherapy. METHODS Relevant economic evaluation studies of T2DM patients were identified from PubMed, Scopus, ProQuest, the Cochrane Library, and the Tufts Cost-Effective Analysis Registry until June 2018. Studies were eligible if they studied T2DM patients who failed metformin monotherapy and assessed the cost-effectiveness/utility between SGLT2 inhibitors and other treatments. Details of the study characteristics, economic model inputs, costs, and outcomes were extracted. Risk of bias was assessed using the biases in economic studies (ECOBIAS) checklist. The incremental net benefit was calculated with monetary units adjusting for purchasing power parity for 2017 US dollars. This was then pooled across studies stratified by the country's level of income using a random-effect model if heterogeneity was present and with a fixed-effect model otherwise. Heterogeneity was assessed using the Q test and I2 statistic. RESULTS A total of 13 studies with 22 comparisons, mainly from high-income countries, were eligible. Six and 4 studies compared SGLT2 with dipeptidyl peptidase-4 inhibitors (DPP4i) and sulfonylureas, respectively. The pooled incremental net benefits (95% confidence interval) for these corresponding comparisons were $164.95 (-$534.71 to $864.61; I2 = 0%) and $3675.09 ($1656.46-$5693.71; I2 = 85.4%), respectively. These results indicate that SGLT2s were cost-effective in comparison with sulfonylureas but not DPP4i. CONCLUSION SGLT2s were cost-effective as compared with sulfonylureas but not DPP4i. Most of the evidence was from high-income countries with few comparative drug groups, and the results might not be representative of the actual global scenario. Further studies from middle and lower economies and other comparators are still required.
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Affiliation(s)
- Bhavani Shankara Bagepally
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; ICMR-National Institute of Epidemiology, Chennai, India
| | - Yogesh Krishnarao Gurav
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; ICMR-National Institute of Virology, Pune, India
| | - Thunyarat Anothaisintawee
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Department of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Economic Evaluation of Occupational Safety and Health Interventions From the Employer Perspective: A Systematic Review. J Occup Environ Med 2019; 60:147-166. [PMID: 29112631 PMCID: PMC5794237 DOI: 10.1097/jom.0000000000001224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: The aim of this systematic review was to evaluate the cost-effectiveness of occupational safety and health interventions from the employer perspective. Methods: A comprehensive literature search (2005 to 2016) in five electronic databases was conducted. Pre-2005 studies were identified from the reference lists of previous studies and systematic reviews, which have similar objective to those of this search. Results: A total of 19 randomized controlled trials and quasi-experimental studies were included, targeting diverse health problems in a number of settings. Few studies included organizational-level interventions. When viewed in relation to the methodological quality and the sufficiency of economic evidence, five of 11 cost-effective occupational safety and health (OSH) interventions appear to be promising. Conclusion: The present systematic review highlights the need for high-quality economic evidence to evaluate the cost-effectiveness of OSH interventions, especially at organizational-level, in all areas of worker health.
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Canaway A, Frew E, Lancashire E, Pallan M, Hemming K, Adab P. Economic evaluation of a childhood obesity prevention programme for children: Results from the WAVES cluster randomised controlled trial conducted in schools. PLoS One 2019; 14:e0219500. [PMID: 31291330 PMCID: PMC6619792 DOI: 10.1371/journal.pone.0219500] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/21/2019] [Indexed: 01/22/2023] Open
Abstract
Background Childhood obesity is a serious public health challenge and schools have been identified as an ideal place to implement prevention interventions. The aim of this study was to measure the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6–7 years when compared to ‘usual activities’. Methods A cluster randomised controlled trial in 54 schools across the West Midlands (UK) was conducted. The 12-month intervention aimed to increase physical activity by 30 minutes per day and encourage healthy eating. Costs were captured from a public sector perspective and utility-based health related outcomes measured using the CHU-9D. Multiple imputation using chained equations was used to address missing data. The cost effectiveness was measured at 30 months from baseline using a hierarchical net-benefit regression framework, that controlled for clustering and prespecified covariates. Any uncertainty in the results was characterised using cost-effectiveness acceptability curves. Results At 30 months, the total adjusted incremental mean cost of the intervention was £155 (95% confidence interval [CI]: £139, £171), and the incremental mean QALYs gained was 0.006 (95% CI: -0.024, 0.036), per child. The incremental cost-effectiveness at 30 months was £26,815 per QALY and using a standard willingness to pay threshold of £30,000 per QALY, there was a 52% chance that the intervention was cost-effective. Conclusions The cost-effectiveness of the school-based WAVES intervention was subject to substantial uncertainty. We therefore recommend more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention. Trial registration This paper uses data collected by the WAVES trial: Controlled trials ISRCTN97000586 (registered May 2010).
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Affiliation(s)
- Alastair Canaway
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Hoch JS, Hay A, Isaranuwatchai W, Thavorn K, Leighl NB, Tu D, Trenaman L, Dewa CS, O'Callaghan C, Pater J, Jonker D, Chen BE, Mittmann N. Advantages of the net benefit regression framework for trial-based economic evaluations of cancer treatments: an example from the Canadian Cancer Trials Group CO.17 trial. BMC Cancer 2019; 19:552. [PMID: 31174497 PMCID: PMC6555934 DOI: 10.1186/s12885-019-5779-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background Economic evaluations commonly accompany trials of new treatments or interventions; however, regression methods and their corresponding advantages for the analysis of cost-effectiveness data are not widely appreciated. Methods To illustrate regression-based economic evaluation, we review a cost-effectiveness analysis conducted by the Canadian Cancer Trials Group’s Committee on Economic Analysis and implement net benefit regression. Results Net benefit regression offers a simple option for cost-effectiveness analyses of person-level data. By placing economic evaluation in a regression framework, regression-based techniques can facilitate the analysis and provide simple solutions to commonly encountered challenges (e.g., the need to adjust for potential confounders, identify key patient subgroups, and/or summarize “challenging” findings, like when a more effective regimen has the potential to be cost-saving). Conclusions Economic evaluations of patient-level data (e.g., from a clinical trial) can use net benefit regression to facilitate analysis and enhance results.
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Affiliation(s)
- Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA.
| | - Annette Hay
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Wanrudee Isaranuwatchai
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Kednapa Thavorn
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Natasha B Leighl
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Dongsheng Tu
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Logan Trenaman
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Carolyn S Dewa
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Chris O'Callaghan
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Joseph Pater
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Derek Jonker
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Bingshu E Chen
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Nicole Mittmann
- Division of Health Policy and Management, Department of Public Health Sciences and Associate Director, Center for Healthcare Policy and Research, 2103 Stockton Blvd, Sacramento, CA, 95817, USA
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Burm R, Thewes B, Rodwell L, Kievit W, Speckens A, van de Wal M, Prins J. Long-term efficacy and cost-effectiveness of blended cognitive behavior therapy for high fear of recurrence in breast, prostate and colorectal Cancer survivors: follow-up of the SWORD randomized controlled trial. BMC Cancer 2019; 19:462. [PMID: 31096934 PMCID: PMC6524293 DOI: 10.1186/s12885-019-5615-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Blended cognitive behaviour therapy (bCBT) is an effective treatment for fear of cancer recurrence (FCR) in curatively-treated breast, colorectal and prostate cancer survivors with high FCR. However, long-term outcomes are unknown. This study investigated the long-term efficacy and cost-effectiveness of bCBT compared with care as usual (CAU). METHODS Eighty-eight cancer survivors with high FCR (Cancer Worry Scale ≥14) were randomly assigned to bCBT (n = 45) or CAU (n = 43). Data were collected at baseline and at three, nine and fifteen months from baseline and analysed by modified intention-to-treat. Efficacy was investigated with linear mixed-effects models. Cost-effectiveness was investigated from a societal perspective by comparing costs with quality-adjusted life-years (QALYs). RESULTS Participants who received bCBT reported significantly lower FCR compared with CAU (mean difference of - 1.787 [95% CI -3.251 to - 0.323, p = 0.017] at 15 months follow-up), and proportionally greater self-rated and clinically significant improvement at each follow-up measurement. Total QALYs were non-significantly different between conditions when adjusted for utility score baseline differences (0.984 compared to 0.957, p = 0.385), while total costs were €631 lower (95% CI -1737 to 2794, p = 0.587). Intervention costs of bCBT were €466. The incremental cost-effectiveness ratio amounted to an additional €2049 per QALY gained, with a 62% probability that bCBT is cost-effective at a willingness to pay (WTP) threshold of €20,000 per QALY. Results were confirmed in sensitivity analyses. CONCLUSIONS bCBT for cancer survivors with FCR is clinically and statistically more effective than CAU on the long-term. In addition, bCBT is a relatively inexpensive intervention with similar costs and QALYs as CAU. TRIAL REGISTRATION The RCT was registered in the Dutch National Trial Register ( NTR4423 ) on 12-Feb-2014. This abstract was previously presented at the International Psycho-Oncology Society conference of 2018 and published online. (Psycho-oncology, 27(S3):8-55; 2018).
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Affiliation(s)
- Rens Burm
- Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. .,MedValue, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Belinda Thewes
- Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department for Health Evidence, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marieke van de Wal
- Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Maxima Medical Center, Department of Medical Psychology, Eindhoven/Veldhoven, The Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Abstract
OBJECTIVE A comparative assessment of treatment alternatives for T1N0 anal canal cancer has never been conducted. We compared the outcomes associated with the treatment alternatives-chemoradiotherapy (CRT), radiotherapy (RT), and surgery or ablation techniques (surgery/ablation)-for T1N0 anal canal cancer. MATERIALS AND METHODS This retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER) registries linked with Medicare longitudinal data (SEER-Medicare database). Analysis included 190 patients who were treated for T1N0 anal canal cancer using surgery/ablation (n=44), RT (n=50), or CRT (n=96). The outcomes were reported in terms of survival and hazards ratios using Kaplan-Meier and Cox proportional hazards modeling, respectively; lifetime costs; and cost-effectiveness measured in terms of incremental cost-effectiveness ratio, that is, the ratio of the difference in costs between the 2 alternatives to the difference in effectiveness between the same 2 alternatives. RESULTS There was no significant difference in the survival duration between the treatment groups as predicted by the Kaplan-Meier curves. After adjusting for patient characteristics and propensity score, the hazard ratio of death for the patients who received CRT compared with surgery/ablation was 1.742 (95% confidence interval, 0.793-3.829) and RT was 2.170 (95% confidence interval, 0.923-5.101); however, the relationship did not reach statistical significance. Surgery/ablation resulted in lower lifetime cost than RT or CRT. The incremental cost-effectiveness ratio associated with CRT compared with surgery/ablation was $142,883 per life year gained. CONCLUSIONS There was no statistically significant difference in survival among the treatment alternatives for T1N0 anal canal cancer. Given that surgery/ablation costs less than RT or CRT and might be cost-effective compared with RT and CRT, it is crucial to explore this finding further in this era of limited health care resources.
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Adab P, Barrett T, Bhopal R, Cade JE, Canaway A, Cheng KK, Clarke J, Daley A, Deeks J, Duda J, Ekelund U, Frew E, Gill P, Griffin T, Hemming K, Hurley K, Lancashire ER, Martin J, McGee E, Pallan MJ, Parry J, Passmore S. The West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study: a cluster randomised controlled trial testing the clinical effectiveness and cost-effectiveness of a multifaceted obesity prevention intervention programme targeted at children aged 6-7 years. Health Technol Assess 2019; 22:1-608. [PMID: 29436364 DOI: 10.3310/hta22080] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Systematic reviews suggest that school-based interventions can be effective in preventing childhood obesity, but better-designed trials are needed that consider costs, process, equity, potential harms and longer-term outcomes. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of the WAVES (West Midlands ActiVe lifestyle and healthy Eating in School children) study intervention, compared with usual practice, in preventing obesity among primary school children. DESIGN A cluster randomised controlled trial, split across two groups, which were randomised using a blocked balancing algorithm. Schools/participants could not be blinded to trial arm. Measurement staff were blind to allocation arm as far as possible. SETTING Primary schools, West Midlands, UK. PARTICIPANTS Schools within a 35-mile radius of the study centre and all year 1 pupils (aged 5-6 years) were eligible. Schools with a higher proportion of pupils from minority ethnic populations were oversampled to enable subgroup analyses. INTERVENTIONS The 12-month intervention encouraged healthy eating/physical activity (PA) by (1) helping teachers to provide 30 minutes of additional daily PA, (2) promoting 'Villa Vitality' (interactive healthy lifestyles learning, in an inspirational setting), (3) running school-based healthy cooking skills/education workshops for parents and children and (4) highlighting information to families with regard to local PA opportunities. MAIN OUTCOME MEASURES The primary outcomes were the difference in body mass index z-scores (BMI-zs) between arms (adjusted for baseline body mass index) at 3 and 18 months post intervention (clinical outcome), and cost per quality-adjusted life-year (QALY) (cost-effectiveness outcome). The secondary outcomes were further anthropometric, dietary, PA and psychological measurements, and the difference in BMI-z between arms at 27 months post intervention in a subset of schools. RESULTS Two groups of schools were randomised: 27 in 2011 (n = 650 pupils) [group 1 (G1)] and another 27 in 2012 (n = 817 pupils) [group 2 (G2)]. Primary outcome data were available at first follow-up (n = 1249 pupils) and second follow-up (n = 1145 pupils) from 53 schools. The mean difference (MD) in BMI-z between the control and intervention arms was -0.075 [95% confidence interval (CI) -0.183 to 0.033] and -0.027 (95% CI -0.137 to 0.083) at 3 and 18 months post intervention, respectively. The main analyses showed no evidence of between-arm differences for any secondary outcomes. Third follow-up included data on 467 pupils from 27 G1 schools, and showed a statistically significant difference in BMI-z (MD -0.20, 95% CI -0.40 to -0.01). The mean cost of the intervention was £266.35 per consented child (£155.53 per child receiving the intervention). The incremental cost-effectiveness ratio associated with the base case was £46,083 per QALY (best case £26,804 per QALY), suggesting that the intervention was not cost-effective. LIMITATIONS The presence of baseline primary outcome imbalance between the arms, and interschool variation in fidelity of intervention delivery. CONCLUSIONS The primary analyses show no evidence of clinical effectiveness or cost-effectiveness of the WAVES study intervention. A post hoc analysis, driven by findings at third follow-up, suggests a possible intervention effect, which could have been attenuated by baseline imbalances. There was no evidence of an intervention effect on measures of diet or PA and no evidence of harm. FUTURE WORK A realist evidence synthesis could provide insights into contextual factors and strategies for future interventions. School-based interventions need to be integrated within a wider societal framework and supported by upstream interventions. TRIAL REGISTRATION Current Controlled Trials ISRCTN97000586. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Raj Bhopal
- Edinburgh Migration, Ethnicity and Health Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Janet E Cade
- Faculty of Mathematics and Physical Sciences, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ulf Ekelund
- Medical Research Council (MRC) Epidemiology Unit, Cambridge, UK.,Norwegian School of Sport Sciences, Oslo, Norway
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma R Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Miranda J Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Canaway A, Pincus T, Underwood M, Shapiro Y, Chodick G, Ben-Ami N. Is an enhanced behaviour change intervention cost-effective compared with physiotherapy for patients with chronic low back pain? Results from a multicentre trial in Israel. BMJ Open 2018; 8:e019928. [PMID: 29643158 PMCID: PMC5898302 DOI: 10.1136/bmjopen-2017-019928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of an enhanced transtheoretical model of behaviour change in conjunction with physiotherapy compared with standard care (physiotherapy) in patients with chronic lower back pain (CLBP). DESIGN Cost-utility and cost-effectiveness analyses alongside a multicentre controlled trial from a healthcare perspective with a 1-year time horizon. SETTING The trial was conducted in eight centres within the Sharon district in Israel. PARTICIPANTS 220 participants aged between 25 and 55 years who suffered from CLBP for a minimum of 3 months were recruited. INTERVENTIONS The intervention used a model of behaviour change that sought to increase the adherence and implementation of physical activity in conjunction with physiotherapy. The control arm received standard care in the form of physiotherapy. PRIMARY AND SECONDARY MEASURES The primary outcome was the incremental cost per quality-adjusted life year (QALY) of the intervention arm compared with standard care. The secondary outcome was the incremental cost per Roland-Morris Disability Questionnaire point. RESULTS The cost per QALY point estimate was 10 645 New Israeli shekels (NIS) (£1737.11). There was an 88% chance the intervention was cost-effective at NIS50 000 per QALY threshold. Excluding training costs, the intervention dominated the control arm, resulting in fewer physiotherapy and physician visits while improving outcomes. CONCLUSIONS The enhanced transtheoretical model intervention appears to be a very cost-effective intervention leading to improved outcomes for low cost. Given limitations within this study, there is justification for examining the intervention within a larger, long-term randomised controlled trial. TRIAL REGISTRATION NUMBER NCT01631344; Pre-results.
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Affiliation(s)
- Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Yair Shapiro
- Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Gabriel Chodick
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Noa Ben-Ami
- Faculty of Health Sciences, Ariel University, Ariel, Israel
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27
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Kaur A, Isaranuwatchai W, Jaffer A, Ferguson G, Abi-Jaoude A, Johnson A, Hollenberg E, Wiljer D. A Web- and Mobile-Based Map of Mental Health Resources for Postsecondary Students (Thought Spot): Protocol for an Economic Evaluation. JMIR Res Protoc 2018; 7:e83. [PMID: 29599106 PMCID: PMC5897622 DOI: 10.2196/resprot.9478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Youth demonstrate a low propensity to seek help for mental health issues and exhibit low use of health services despite the high prevalence of mental health challenges in this population. Research has found that delivering interventions via the internet and mobile devices is an effective way to reach youth. Thought Spot, a Web- and mobile-based map, was developed to help transition-aged youth in postsecondary settings overcome barriers to help-seeking, thereby reducing the economic burden associated with untreated mental health issues. Objective This paper presents the protocol for an economic evaluation that will be conducted in conjunction with a randomized controlled trial (RCT) to evaluate the effectiveness and cost of Thought Spot compared with usual care in terms of self-efficacy for mental health help-seeking among postsecondary students. Methods A partially blinded RCT will be conducted to assess the impact of Thought Spot on the self-efficacy of students for mental health help-seeking. Students from 3 postsecondary institutions in Ontario, Canada will be randomly allocated to 1 of 2 intervention groups (resource pamphlet or Thought Spot) for 6 months. The economic evaluation will focus on the perspective of postsecondary institutions or other organizations interested in using Thought Spot. Costs and resources for operating and maintaining the platform will be reported and compared with the costs and resource needs associated with usual care. The primary outcome will be change in help-seeking intentions, measured using the General Help-Seeking Questionnaire. The cost-effectiveness of the intervention will be determined by calculating the incremental cost-effectiveness ratio, which will then be compared with willingness to pay. Results The RCT is scheduled to begin in February 2018 and will run for 6 months, after which the economic evaluation will be completed. Conclusions We expect to demonstrate that Thought Spot is a cost-effective way to improve help-seeking intentions and encourage help-seeking behavior among postsecondary students. The findings of this study will help inform postsecondary institutions when they are allocating resources for mental health initiatives. Trial Registration ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 (Archived at WebCite at http://www.webcitation.org/6xy5lWpnZ)
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Affiliation(s)
- Amandeep Kaur
- The Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research, St. Micheal's Hospital, Toronto, ON, Canada
| | - Aliya Jaffer
- Centre for Excellence in Economic Analysis Research, St. Micheal's Hospital, Toronto, ON, Canada
| | - Genevieve Ferguson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoude
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Education, Technology and Innovation, University Health Network, Toronto, ON, Canada
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A randomised controlled trial assessing the severity and duration of depressive symptoms associated with a clinically significant response to sertraline versus placebo, in people presenting to primary care with depression (PANDA trial): study protocol for a randomised controlled trial. Trials 2017; 18:496. [PMID: 29065916 PMCID: PMC5655852 DOI: 10.1186/s13063-017-2253-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/22/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Depressive symptoms are usually managed within primary care and antidepressant medication constitutes the first-line treatment. It remains unclear at present which people are more likely to benefit from antidepressant medication. This paper describes the protocol for a randomised controlled trial (PANDA) to investigate the severity and duration of depressive symptoms that are associated with a clinically significant response to sertraline compared to placebo, in people presenting to primary care with depression. METHODS/DESIGN PANDA is a randomised, double blind, placebo controlled trial in which participants are individually randomised to sertraline or placebo. Eligible participants are those who are between the ages of 18 to 74; have presented to primary care with depression or low mood during the past 2 years; have not received antidepressant or anti-anxiety medication in the 8 weeks prior to enrolment in the trial and there is clinical equipoise about the benefits of selective serotonin reuptake inhibitor (SSRI) medication. Participants who consent to participate in the trial are randomised to receive either sertraline or matching placebo, starting at 50 mg daily for 1 week, increasing to 100 mg daily for up to 11 weeks (with the option of increasing to 150 mg if required). Participants, general practitioners (GPs) and the research team will be blind to treatment allocation. The primary outcome will be depressive symptoms measured by the Patient Health Questionnaire-9 (PHQ-9) at 6 weeks post randomisation, measured as a continuous outcome. Secondary outcomes include depressive symptoms measured with the PHQ-9 at 2 and 12 weeks as a continuous outcome and at 2, 6 and 12 weeks as a binary outcome; follow-up scores on depressive symptoms measured with the Beck Depression Inventory-II, anxiety symptoms measured by the Generalized Anxiety Disorder-7 and quality of life measured with the Euroqol-5D-5L and Short Form-12; emotional processing task scores measured at baseline, 2 and 6 weeks; and costs associated with healthcare use, time off work and personal costs. DISCUSSION The PANDA trial uses a simple self-administered measure to establish the severity and duration of depressive symptoms associated with a clinically significant response to sertraline. The evidence from the trial will inform primary care prescribing practice by identifying which patients are more likely to benefit from antidepressants. TRIAL REGISTRATION Controlled Trials ISRCTN Registry, ISRCTN84544741 . Registered on 20 March 2014. EudraCT Number: 2013-003440-22; Protocol Number: 13/0413 (version 6.1).
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Shamu S, Rusakaniko S, Hongoro C. Prioritizing health system and disease burden factors: an evaluation of the net benefit of transferring health technology interventions to different districts in Zimbabwe. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:695-705. [PMID: 27920564 PMCID: PMC5125992 DOI: 10.2147/ceor.s95037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Health-care technologies (HCTs) play an important role in any country's health-care system. Zimbabwe's health-care system uses a lot of HCTs developed in other countries. However, a number of local factors have affected the absorption and use of these technologies. We therefore set out to test the hypothesis that the net benefit regression framework (NBRF) could be a helpful benefit testing model that enables assessment of intra-national variables in HCT transfer. METHOD We used an NBRF model to assess the benefits of transferring cost-effective technologies to different jurisdictions. We used the country's 57 administrative districts to proxy different jurisdictions. For the dependent variable, we combined the cost and effectiveness ratios with the districts' per capita health expenditure. The cost and effectiveness ratios were obtained from HIV/AIDS and malaria randomized controlled trials, which did either a prospective or retrospective cost-effectiveness analysis. The independent variables were district demographic and socioeconomic determinants of health. RESULTS The study showed that intra-national variation resulted in different net benefits of the same health technology intervention if implemented in different districts in Zimbabwe. The study showed that population data, health data, infrastructure, demographic and health-seeking behavior had significant effects on the net margin benefit for the different districts. The net benefits also differed in terms of magnitude as a result of the local factors. CONCLUSION Net benefit testing using local data is a very useful tool for assessing the transferability and further adoption of HCTs developed elsewhere. However, adopting interventions with a positive net benefit should also not be an end in itself. Information on positive or negative net benefit could also be used to ascertain either the level of future savings that a technology can realize or the level of investment needed for the particular technology to become beneficial.
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Affiliation(s)
- Shepherd Shamu
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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