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Cunich M, Barakat-Johnson M, Lai M, Arora S, Church J, Basjarahil S, Campbell JL, Disher G, Geering S, Ko N, Leahy C, Leong T, McClure E, O'Grady M, Walsh J, White K, Coyer F. The costs, health outcomes and cost-effectiveness of interventions for the prevention and treatment of incontinence-associated dermatitis: A systematic review. Int J Nurs Stud 2022; 129:104216. [PMID: 35364428 DOI: 10.1016/j.ijnurstu.2022.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Incontinence-associated dermatitis is a common, under-recognized painful skin condition associated with poorer quality of life, increased nurse workloads, and costs. OBJECTIVE To systematically review economic evidence for the prevention and treatment of incontinence-associated dermatitis. DESIGN Systematic review of quantitative research. DATA SOURCES PubMed, MEDLINE, EMBASE, Cochrane Library, York Centre for Reviews and Dissemination database, Econlit, Tufts' Cost-Effectiveness Analysis Registry, and Web of Science. REVIEW METHODS A comprehensive search for studies on resource use (costs), health outcomes, and cost-effectiveness of interventions for incontinence-associated dermatitis was conducted. Screening, data extraction, and initial quality assessment were conducted independently by two reviewers, with disagreements/queries regarding quality settled through consensus with the larger team. Quality evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist and results narratively arranged. FINDINGS Seventeen studies (10 for prevention, one for treatment and six for both prevention and treatment) included. All studies measured resource use from a healthcare provider perspective; 14 quantified resources in monetary terms. Considerable variation existed in the resource use data primarily due to differences in the type of resources counted, selected time horizons, valuation methods, and reporting approaches. Ten studies provided evidence of their intervention to be cost saving (or at least cost avoiding). Five studies on barrier products provided evidence to be cost saving: three for prevention, one for treatment, and one for both prevention and treatment. Two studies of cleanser and barrier products provided evidence to be cost saving for the prevention and treatment of incontinence-associated dermatitis. One study found a cleanser to be a cost saving preventative intervention. One bowel management system was found to be cost saving over time only, and one nurse education intervention was found to be cost saving for preventing and treating incontinence-associated dermatitis. One barrier product was found to be cost-effective for preventing and treating the condition. Finally, one study found a cleanser and barrier product was time saving for prevention. None of the studies incorporated a multi-attribute quality of life measure; however, two studies included person-reported outcome measures for pain. A narrow range of resources (mainly products) were considered, and there was limited information on how they were counted and valued. Analyses relating to heterogeneity among patients/hospital wards or health facilities and uncertainty were lacking. CONCLUSIONS Barrier products are possibly a more cost-effective treatment than others; however, this evidence lacks certainty. Structured health economic evaluations are required for a reliable evidence-base on the interventions for incontinence-associated dermatitis. TWEETABLE ABSTRACT Most incontinence-associated dermatitis studies lack person-reported outcomes, costs beyond product/staff time, and economic evaluation.
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Affiliation(s)
- Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, New South Wales, Australia; Sydney Institute for Women, Children and their Families, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; The ANZAC Research Institute, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Sydney Health Economics Collaborative, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia.
| | - Michelle Barakat-Johnson
- Nursing and Midwifery Executive Services, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Michelle Lai
- Nursing and Midwifery Executive Services, Sydney Local Health District (SLHD), Sydney, New South Wales, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Jody Church
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Shifa Basjarahil
- Nursing and Midwifery Services, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Jayne L Campbell
- Nursing and Midwifery Services, Hunter New England Local Health District, New South Wales, Australia.
| | - Gary Disher
- Strategic Reform and Planning Branch, New South Wales Ministry of Health, Sydney, New South Wales, Australia.
| | - Samara Geering
- Nursing and Midwifery Services, South Western Sydney Local Health District, New South Wales, Australia.
| | - Natalie Ko
- Nursing and Midwifery Services, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Catherine Leahy
- Quality, Clinical Safety and Nursing, Western New South Wales Local Health District, New South Wales, Australia.
| | - Thomas Leong
- Nursing and Midwifery Services, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Eve McClure
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Melissa O'Grady
- Aged and Chronic Care and Rehabilitation Services, Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Joan Walsh
- Nursing and Midwifery Services, The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Cancer Care Research Unit, Sydney Local Health District, Sydney, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, New South Wales, Australia.
| | - Fiona Coyer
- Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
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Bright S, Gore-Langton GR, Fatima P, Dewan F, Yesmin A, Makins A. A non-inferiority analysis of hemoglobin levels in postpartum IUD users in Bangladesh. Int J Gynaecol Obstet 2022; 159:136-144. [PMID: 35157319 PMCID: PMC9543526 DOI: 10.1002/ijgo.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/16/2022] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to compare postpartum hemoglobin (Hb) between postpartum intrauterine device (PPIUD) and non-PPIUD users. METHODS A sample of 3697 postpartum women (475 PPIUD users, 3222 non-PPIUD users) from 5 tertiary referral hospitals in Bangladesh were assessed at multiple time points between 6 weeks and 12 months postpartum. Non-inferiority linear regression analysis compared changes in Hb levels at 29-52 weeks postpartum between the two groups. Non-inferiority was declared if the lower 95% confidence interval of the estimated difference in Hb change since delivery between PPIUD and non-PPIUD users was greater than -0.05 g/dL. RESULTS At approximately 9 months postpartum, 276 women in the PPIUD group (58.1%) and 1086 women in the comparison group (33.7%) attended follow-up. In total, 57.9% of PPIUD users and 61.0% of non-PPIUD users had taken iron supplementation. Change in Hb was 0.02 g/dL (95% CI: -0.16, 0.19) higher in the PPIUD users than the comparison group. The lower limit of the 95% CI was greater than -0.05g/dl, providing good evidence that PPIUD users were non-inferior to the comparison group in their Hb levels. CONCLUSION In the presence of offering iron supplementation, and an uptake of just over 60%, no difference in anemia was observed between the PPIUD and control group.
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Affiliation(s)
- Suzanna Bright
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
| | | | - Parveen Fatima
- Obstetric and Gynecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
| | - Farhana Dewan
- Obstetric and Gynecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
| | - Afroja Yesmin
- Obstetric and Gynecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
| | - Anita Makins
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
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Lewandowska M, De Abreu Lourenco R, Haas M, Watson CJ, Black KI, Taft A, Lucke J, McGeechan K, McNamee K, Peipert JF, Mazza D. Cost-effectiveness of a complex intervention in general practice to increase uptake of long-acting reversible contraceptives in Australia. AUST HEALTH REV 2021; 45:728-734. [PMID: 34903325 DOI: 10.1071/ah20282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial results were extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancy-related healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. What is known about the topic? The uptake of long-active reversible contraceptives (LARC) in Australia is low. The ACCORd trial assessed the efficacy of providing structured training to general practitioners (GPs) on LARC counselling, together with access to rapid referral to insertion clinics. What does this paper add? This study is the first to assess the cost-effectiveness of a complex intervention in the general practice setting aimed at increasing the uptake of LARC in Australia. What are the implications for practitioners? The results show that implementing a complex intervention in general practice involving GP education and the availability of rapid referral to LARC insertion clinics is a cost-effective approach to increase LARC use and its attending efficacy. If the majority of Australian GPs were able to deliver effectiveness-based contraceptive counselling and either insert LARC or use a rapid referral process to a LARC insertion clinic, the additional cost associated with the purchase of LARC products and their insertion would be offset by reductions to health system costs as a result of fewer UPB and abortions. Moreover, the benefits to women's physical and psychological health of avoiding such events is substantial.
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Affiliation(s)
- Milena Lewandowska
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and Corresponding author.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ;
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and School of Public Health, University of Sydney, NSW, Australia.
| | - Cathy J Watson
- Department of General Practice, Monash University, Melbourne, Vic., Australia. ;
| | - Kirsten I Black
- Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia.
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia.
| | - Kevin McGeechan
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia. ; ; and School of Public Health, University of Sydney, NSW, Australia.
| | - Kathleen McNamee
- Family Planning Victoria, Vic., Australia. ; and Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Vic., Australia
| | - Jeffrey F Peipert
- Department of Obstetrics and Gynaecology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Vic., Australia. ;
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Eva G, Gold J, Makins A, Bright S, Dean K, Tunnacliffe EA, Fatima P, Yesmin A, Muganyizi P, Kimario GF, Dalziel K. Economic Evaluation of Provision of Postpartum Intrauterine Device Services in Bangladesh and Tanzania. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:107-122. [PMID: 33795364 PMCID: PMC8087427 DOI: 10.9745/ghsp-d-20-00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Postpartum family planning is an effective means of achieving improved health outcomes for women and children, especially in low- and middle-income settings. We assessed the cost-effectiveness of an immediate postpartum intrauterine device (PPIUD) initiative compared with standard practice in Bangladesh and Tanzania (which is no immediate postpartum family planning counseling or service provision) to inform resource allocation decisions for governments and donors. METHODS A decision analysis was constructed to compare the PPIUD program with standard practice. The analysis was based on the number of PPIUD insertions, which were then modeled using the Impact 2 tool to produce estimates of cost per couple-years of protection (CYP) and cost per disability-adjusted life years (DALYs) averted. A micro-costing approach was used to estimate the costs of conducting the program, and downstream cost savings were generated by the Impact 2 tool. Results are presented first for the program as evaluated, and second, based on a hypothetical national scale-up scenario. One-way sensitivity analyses were conducted. RESULTS Compared to standard practice, the PPIUD program resulted in an incremental cost-effectiveness ratio (ICER) of US$14.60 per CYP and US$91.13 per DALY averted in Bangladesh, and US$54.57 per CYP and US$67.67 per DALY averted in Tanzania. When incorporating estimated direct health care costs saved, the results for Bangladesh were dominant (PPIUD is cheaper and more effective versus standard practice). For Tanzania, the PPIUD initiative was highly cost-effective, with the ICER (incorporating direct health care costs saved) estimated at US$15.20 per CYP and US$18.90 per DALY averted compared to standard practice. For the national scale-up model, the results were dominant in both countries.Conclusions/implications: The PPIUD initiative was highly cost-effective in Bangladesh and Tanzania, and national scale-up of PPIUD could produce long-term savings in direct health care costs in both countries. These analyses provide a compelling case for national governments and international donors to invest in PPIUD as part of their family planning strategies.
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Affiliation(s)
- Gillian Eva
- Independent consultant, Washington, DC, USA.
| | - Judy Gold
- Independent consultant, Melbourne, Australia
| | - Anita Makins
- International Federation of Gynecology and Obstetrics, London, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department Women's and Reproductive Health, Oxford University, Oxford, UK
| | - Suzanna Bright
- International Federation of Gynecology and Obstetrics, London, UK
| | - Katherine Dean
- International Federation of Gynecology and Obstetrics, London, UK
| | | | - Parveen Fatima
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | - Afroja Yesmin
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | | | | | - Kim Dalziel
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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White A, Srinivasan M, Wingate LM, Peasah S, Fleming M. Development of a pharmacoeconomic registry: an example using hormonal contraceptives. HEALTH ECONOMICS REVIEW 2021; 11:10. [PMID: 33745016 PMCID: PMC7981865 DOI: 10.1186/s13561-021-00309-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Disease-specific registries, documenting costs and probabilities from pharmacoeconomic studies along with health state utility values from quality-of-life studies could serve as a resource to guide researchers in evaluating the published literature and in the conduct of future economic evaluations for their own research. Registries cataloging economic evaluations currently exist, however they are restricted by the type of economic evaluations they include. There is a need for intervention-specific registries, that document all types of complete and partial economic evaluations and auxiliary information such as quality of life studies. The objective of this study is to describe the development of a pharmacoeconomic registry and provide best practices using an example of hormonal contraceptives. METHODS An expert panel consisting of researchers with expertise in pharmacoeconomics and outcomes research was convened and the clinical focus of the registry was finalized after extensive discussion. A list of key continuous, categorical and descriptive variables was developed to capture all relevant data with each variable defined in a data dictionary. A web-based data collection tool was designed to capture and store the resulting metadata. A keyword based search strategy was developed to retrieve the published sources of literature. Finally, articles were screened for relevancy and data was extracted to populate the registry. Expert opinions were taken from the panel at each stage to arrive at consensus and ensure validity of the registry. RESULTS The registry focused on economic evaluation literature of hormonal contraceptives used for contraception. The registry consisted of 65 articles comprising of 22 cost-effectiveness analyses, 9 cost-utility analyses, 7 cost-benefit analyses, 1 cost-minimization, 14 cost analyses, 10 cost of illness studies and 2 quality of life studies. The best practices followed in the development of the registry were summarized as recommendations. The completed registry, data dictionary and associated data files can be accessed in the supplementary information files. CONCLUSION This registry is a comprehensive database of economic evaluations, including costs, clinical probabilities and health-state utility estimates. The collated data captured from published information in this registry can be used to identify trends in the literature, conduct systematic reviews and meta-analysis and develop novel pharmacoeconomic models.
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Affiliation(s)
- Annesha White
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
- Department of Pharmacotherapy, UNT System College of Pharmacy, 3500 Camp Bowie Blvd, IREB 211, Fort Worth, TX 76107 USA
| | - Meenakshi Srinivasan
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
| | | | - Samuel Peasah
- Mercer University College of Pharmacy, Atlanta, GA 30341 USA
| | - Marc Fleming
- University of North Texas System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107 USA
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Joshi B, Moray KV, Sachin O, Chaurasia H, Begum S. Cost Effectiveness of Introducing Etonorgestrel Contraceptive Implant into India's Current Family Welfare Programme. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:267-277. [PMID: 32776166 DOI: 10.1007/s40258-020-00605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to provide evidence to policy makers on cost effectiveness and budget impact for the introduction of the etonorgestrel implant into the Indian public health system. METHODS An economic evaluation was conducted to ascertain the potential costs and outcomes of adding the etonorgestrel implant to the public health system of India as compared to the current scenario. A decision analytical model (Markov cohort) was conceptualized from a societal perspective, where a hypothetical population of 15-year-old females was followed until menopause. The primary outcome was incremental cost-utility ratio (ICUR). Sources for model inputs included country-level secondary data analysis, government reports, an observational primary costing study, a systematic review of etonorgestrel implant and targeted literature reviews. One-way and probabilistic sensitivity analyses (OWSA and PSA) were performed to account for uncertainty. The impact of etonorgestrel implant introduction on the annual Indian health budget was also analysed. RESULTS The base-case ICUR was 16,475 Indian rupees (INR) (USD 232) per quality-adjusted life-year gained, which showed the etonorgestrel implant to be very cost effective (ICUR below willingness-to-pay threshold of INR 137,945 [USD 1943]). OWSA showed that discount rate, percentage of people who do not use contraceptives and costs of managing side effects were the important parameters that affected ICUR. PSA showed that ICUR values of all 1000 Monte Carlo simulations were cost effective. Budget impact analysis showed that introduction of the implant would account for < 1% of the total annual health budget of India, even if acceptance of the implant varied between 0.2 and 4%. CONCLUSION Adding the etonorgestrel implant to the public health system would be cost effective for India, with a feasible budgetary allocation.
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Affiliation(s)
- Beena Joshi
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
| | - Kusum V Moray
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Oshima Sachin
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Himanshu Chaurasia
- Health Technology Assessment Resource Hub, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Shahina Begum
- Biostatistics Department, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
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Han L, Ma S, Zhao L, Liu Y, Wang Y, Feng X, Zhang K, Wang L, Wang L, Yin P, Liang D, Hou H, Shi G, Li Q. Clinical Evaluation of Li Brush Endometrial Samplers for Diagnosing Endometrial Lesions in Women With Intrauterine Devices. Front Med (Lausanne) 2020; 7:598689. [PMID: 33330563 PMCID: PMC7734192 DOI: 10.3389/fmed.2020.598689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: For women with intrauterine devices (IUDs), it is difficult to sample the endometrium when abnormal uterine bleeding occurs or when regular screening of endometrial cancer is proposed. The purpose of this study is to evaluate the validity of endometrial sampling using Li Brush in IUD users. Methods: This study was a prospective cohort study and conducted in two parts. Part I was to assess the impact of Li Brush on the position of IUDs. Transvaginal ultrasound was used to locate IUDs before and after sampling. Part II was to explore the diagnostic accuracy of Li Brush in detecting endometrial lesions. IUD users with irregular uterine bleeding were recruited in the IUD group and IUD non-users who arranged for dilatation and curettage (D&C) were recruited in the control group. The endometrium was sampled by Li Brush for cells and by D&C for tissues in both groups. The satisfactoriness of sampling and validity of Li Brush were evaluated. Results: Seventeen cases in part I confirmed no significant difference in the position of IUDs before and after sampling (p = 0.20). 112 IUD users and 139 IUD non-users were recruited in part II. Li Brush achieved 94.64 and 92.09% satisfactory sampling rates in the IUD group and control group, respectively, without statistically significant difference between the two groups (p = 0.42). The Sensitivity and specificity of Li Brush for detection of endometrial lesions in IUD group were 95.35 and 87.76% respectively. Conclusions: Li Brush used for endometrial biopsy did not affect the position of IUDs and had high yield of satisfactory samples and good validity for endometrial diagnoses. It was feasible to screen endometrial lesions by Li Brush for women with IUDs.
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Affiliation(s)
- Lu Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sijia Ma
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lanbo Zhao
- Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Yu Liu
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiran Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xue Feng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kailu Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Panyue Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dongxin Liang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huilian Hou
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guizhi Shi
- Aviation General Hospital of Beijing, Medical University & Beijing Institute of Translational Medicine, University of Chinese Academy of Sciences, Beijing, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Mazza D, Amos N, Watson CJ, McGeechan K, Haas M, Peipert JF, Lucke J, Taft A, McNamee K, Black KI. Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial longitudinal follow-up protocol. BMJ Open 2020; 10:e035895. [PMID: 32963063 PMCID: PMC7509957 DOI: 10.1136/bmjopen-2019-035895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/30/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Through addressing main barriers to the uptake of long-acting reversible contraceptives (LARCs) among Australian women, the Australian Contraceptive ChOice pRoject (ACCORd) trialled an educational intervention targeting general practitioners (GPs) and provided those in the intervention group with a rapid referral service for quick insertion. The cluster randomised controlled trial resulted in greater uptake of LARC in the intervention group. This protocol paper describes a longitudinal follow-up to the ACCORd Study to assess the long-term efficacy and cost-effectiveness of the intervention. METHODS AND ANALYSIS Women participants (patients of ACCORd GPs) completed a baseline, 6-month and 12-month survey. These participants will be invited to complete an additional follow-up survey 3 years post completion of their baseline interview. Based on the original ACCORd Study tools, the online survey will address long-term outcomes including contraceptive continuation rates and reproductive history, any unintended pregnancies, satisfaction and concerns with their current contraceptive method, and an assessment of quality of life. We will analyse data using binary regression models with generalised estimating equations and robust standard errors to account for clustering. DISCUSSION Demonstration of sustained use, effectiveness at reducing unwanted pregnancies and cost-effectiveness of this strategy among this cohort of Australian primary care patients, will strengthen the policy and programme urgency of addressing wider dissemination of these strategies and replicating the study elsewhere. ETHICS AND DISSEMINATION The ACCORd Study received approval from the Monash University Human Research Ethics Committee: CF16/188-201000080. Additionally, an amendment to conduct this 3-year longitudinal follow-up survey has been approved. The trial follow-up outcomes will be disseminated through formal academic pathways, including journal articles, national and international conferences and reports as well as using more 'mainstream' strategies such as seminars, workshops and media engagement. Additionally, outcomes will be communicated through policy briefs to Australian state and federal governments. TRAIL REGISTRATION NUMBER This trial is registered with the Australian and New Zealand Trials Registry ACTRN12615001346561. Recruitment and data collection have been completed for the baseline, 6-month and 12-month surveys. Data collection for the 3-year survey commenced in August 2019.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Natalie Amos
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Cathy J Watson
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Kevin McGeechan
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marion Haas
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jeffrey F Peipert
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jayne Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Angela Taft
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | | | - Kirsten I Black
- Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
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Wall KM, Ingabire R, Allen S, Karita E. Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda. Gates Open Res 2020; 2:39. [PMID: 32328566 PMCID: PMC7163922 DOI: 10.12688/gatesopenres.12858.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented postpartum intrauterine device (PPIUD) and postpartum (PP) implant promotional counseling and service delivery procedures between May-July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. The goal of the present analysis is to detail implementation expenditures and estimate incremental costs per insertion and couple years of protection (CYP) for PPIUD and PP implant users. Methods: We detail the incremental costs during the implementation from the health system perspective (including both the implementation costs and the cost of contraceptive methods) and use of standard methods to estimate the cost per insertion and CYP for PPIUD and PP implant users. In addition to the incremental costs of labor and supplies, the costs of promotional activities are included. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $6/PPIUDs and $21/PP implant. Conclusion: Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.
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Affiliation(s)
- Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
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10
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Wall KM, Ingabire R, Allen S, Karita E. Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda. Gates Open Res 2019; 2:39. [PMID: 32328566 PMCID: PMC7163922 DOI: 10.12688/gatesopenres.12858.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 11/05/2023] Open
Abstract
Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented postpartum intrauterine device (PPIUD) and postpartum (PP) implant promotional counseling and service delivery procedures between May-July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. The goal of the present analysis is to detail implementation expenditures and estimate incremental costs per insertion and couple years of protection (CYP) for PPIUD and PP implant users. Methods: We detail the incremental costs during the implementation from the health system perspective (including both the implementation costs and the cost of contraceptive methods) and use of standard methods to estimate the cost per insertion and CYP for PPIUD and PP implant users. In addition to the incremental costs of labor and supplies, the costs of promotional activities are included. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.
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Affiliation(s)
- Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
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Wall KM, Ingabire R, Allen S, Karita E. Cost per insertion and couple year of protection for postpartum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda. Gates Open Res 2019; 2:39. [PMID: 32328566 PMCID: PMC7163922 DOI: 10.12688/gatesopenres.12858.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 11/05/2023] Open
Abstract
Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented postpartum intrauterine device (PPIUD) and postpartum (PP) implant promotional counseling and service delivery procedures between May-July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. The goal of the present analysis is to detail implementation expenditures and estimate incremental costs per insertion and couple years of protection (CYP) for PPIUD and PP implant users. Methods: We detail the incremental costs during the implementation from the health system perspective (including both the implementation costs and the cost of contraceptive methods) and use of standard methods to estimate the cost per insertion and CYP for PPIUD and PP implant users. In addition to the incremental costs of labor and supplies, the costs of promotional activities are included. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.
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Affiliation(s)
- Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
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Wall KM, Ingabire R, Allen S, Karita E. Cost per insertion and couple year of protection for post-partum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda. Gates Open Res 2018; 2:39. [PMID: 32328566 PMCID: PMC7163922 DOI: 10.12688/gatesopenres.12858.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented post-partum intrauterine device (PPIUD) and post-partum (PP) implant promotions and service delivery procedures between May and July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. Methods: Here, we detail the expenditures during the implementation from the payer perspective (including both the implementation costs and the cost of contraceptive methods) and estimate the cost per PPIUD insertion, PP implant insertion, and couple years of protection (CYP) for PPIUD and PP implant users. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: The PPIUD/PP implant service implementation provided services at a low cost per insertion and CYP. Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.
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Affiliation(s)
- Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
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