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Evaluating the patient experience of an emergency burns assessment service in a UK burn unit using a service user evaluation questionnaire and process mapping. Burns 2020; 46:1066-1072. [DOI: 10.1016/j.burns.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/10/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022]
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Allison R, Lecky DM, Town K, Rugman C, Ricketts EJ, Ockendon-Powell N, Folkard KA, Dunbar JK, McNulty CAM. Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model. BMC FAMILY PRACTICE 2017; 18:43. [PMID: 28327096 PMCID: PMC5361828 DOI: 10.1186/s12875-017-0618-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15-24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims: a) Explore why the modified intervention did not increase screening across all general practices. b) Suggest recommendations for future intervention implementation. METHODS Phone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model. RESULTS Participants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers. CONCLUSION Not adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.
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Affiliation(s)
- R Allison
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK.
| | - D M Lecky
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - K Town
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C Rugman
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, GL1 3NN, UK
| | - E J Ricketts
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Derriford Hospital, Derriford Road, Plymouth, UK
| | - N Ockendon-Powell
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Biotechnology and Biological Sciences Research Council (BBSRC), Polaris House, North Star Avenue, Swindon, UK
| | - K A Folkard
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - J K Dunbar
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C A M McNulty
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
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Estcourt C, Sutcliffe L, Mercer CH, Copas A, Saunders J, Roberts TE, Fuller SS, Jackson LJ, Sutton AJ, White PJ, Birger R, Rait G, Johnson A, Hart G, Muniina P, Cassell J. The Ballseye programme: a mixed-methods programme of research in traditional sexual health and alternative community settings to improve the sexual health of men in the UK. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundSexually transmitted infection (STI) diagnoses are increasing and efforts to reduce transmission have failed. There are major uncertainties in the evidence base surrounding the delivery of STI care for men.AimTo improve the sexual health of young men in the UK by determining optimal strategies for STI testing and careObjectivesTo develop an evidence-based clinical algorithm for STI testing in asymptomatic men; model mathematically the epidemiological and economic impact of removing microscopy from routine STI testing in asymptomatic men; conduct a pilot randomised controlled trial (RCT) of accelerated partner therapy (APT; new models of partner notification to rapidly treat male sex partners of people with STIs) in primary care; explore the acceptability of diverse venues for STI screening in men; and determine optimal models for the delivery of screening.DesignSystematic review of the clinical consequences of asymptomatic non-chlamydial, non-gonococcal urethritis (NCNGU); case–control study of factors associated with NCNGU; mathematical modelling of the epidemiological and economic impact of removing microscopy from asymptomatic screening and cost-effectiveness analysis; pilot RCT of APT for male sex partners of women diagnosed withChlamydia trachomatisinfection in primary care; stratified random probability sample survey of UK young men; qualitative study of men’s views on accessing STI testing; SPORTSMART pilot cluster RCT of two STI screening interventions in amateur football clubs; and anonymous questionnaire survey of STI risk and previous testing behaviour in men in football clubs.SettingsGeneral population, genitourinary medicine clinic attenders, general practice and community contraception and sexual health clinic attenders and amateur football clubs.ParticipantsMen and women.InterventionsPartner notification interventions: APTHotline [telephone assessment of partner(s)] and APTPharmacy [community pharmacist assessment of partner(s)]. SPORTSMART interventions: football captain-led and health adviser-led promotion of urine-based STI screening.Main outcome measuresFor the APT pilot RCT, the primary outcome, determined for each contactable partner, was whether or not they were considered to have been treated within 6 weeks of index diagnosis. For the SPORTSMART pilot RCT, the primary outcome was the proportion of eligible men accepting screening.ResultsNon-chlamydial, non-gonococcal urethritis is not associated with significant clinical consequences for men or their sexual partners but study quality is poor (systematic review). Men with symptomatic and asymptomatic NCNGU and healthy men share similar demographic, behavioural and clinical variables (case–control study). Removal of urethral microscopy from routine asymptomatic screening is likely to lead to a small rise in pelvic inflammatory disease (PID) but could save > £5M over 20 years (mathematical modelling and health economics analysis). In the APT pilot RCT the proportion of partners treated by the APTHotline [39/111 (35%)], APTPharmacy [46/100 (46%)] and standard patient referral [46/102 (45%)] did not meet national standards but exceeded previously reported outcomes in community settings. Men’s reported willingness to access self-sampling kits for STIs and human immunodeficiency virus infection was high. Traditional health-care settings were preferred but sports venues were acceptable to half of men who played sport (random probability sample survey). Men appear to prefer a ‘straightforward’ approach to STI screening, accessible as part of their daily activities (qualitative study). Uptake of STI screening in the SPORTSMART RCT was high, irrespective of arm [captain led 28/56 (50%); health-care professional led 31/46 (67%); poster only 31/51 (61%)], and costs were similar. Men were at risk of STIs but previous testing was common.ConclusionsMen find traditional health-care settings the most acceptable places to access STI screening. Self-sampling kits in football clubs could widen access to screening and offer a public health impact for men with limited local sexual health services. Available evidence does not support an association between asymptomatic NCNGU and significant adverse clinical outcomes for men or their sexual partners but the literature is of poor quality. Similarities in characteristics of men with and without NCNGU precluded development of a meaningful clinical algorithm to guide STI testing in asymptomatic men. The mathematical modelling and cost-effectiveness analysis of removing all asymptomatic urethral microscopy screening suggests that this would result in a small rise in adverse outcomes such as PID but that it would be highly cost-effective. APT appears to improve outcomes of partner notification in community settings but outcomes still fail to meet national standards. Priorities for future work include improving understanding of men’s collective behaviours and how these can be harnessed to improve health outcomes; exploring barriers to and facilitators of opportunistic STI screening for men attending general practice, with development of evidence-based interventions to increase the offer and uptake of screening; further development of APT for community settings; and studies to improve knowledge of factors specific to screening men who have sex with men (MSM) and, in particular, how, with the different epidemiology of STIs in MSM and the current narrow focus on chlamydia, this could negatively impact MSM’s sexual health.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Claudia Estcourt
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Barts Health NHS Trust, London, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Sutcliffe
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Copas
- Research Department of Infection and Population Health, University College London, London, UK
| | - John Saunders
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Barts Health NHS Trust, London, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Sebastian S Fuller
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Public Health England, London, UK
| | - Louise J Jackson
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Andrew John Sutton
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Peter J White
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ruthie Birger
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Modelling Methodology, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Graham Hart
- Research Department of Infection and Population Health, University College London, London, UK
| | - Pamela Muniina
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jackie Cassell
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
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Jani M, Gavan S, Chinoy H, Dixon WG, Harrison B, Moran A, Barton A, Payne K. A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice. Rheumatology (Oxford) 2016; 55:2131-2137. [PMID: 27576368 PMCID: PMC5144665 DOI: 10.1093/rheumatology/kew292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/29/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To identify and quantify resource required and associated costs for implementing TNF-α inhibitor (TNFi) drug level and anti-drug antibody (ADAb) tests in UK rheumatology practice. METHODS A microcosting study, assuming the UK National Health Service perspective, identified the direct medical costs associated with providing TNFi drug level and ADAb testing in clinical practice. Resource use and costs per patient were identified via four stages: identification of a patient pathway with resource implications; estimation of the resources required; identification of the cost per unit of resource (2015 prices); and calculation of the total costs per patient. Univariate and multiway sensitivity analyses were performed using the variation in resource use and unit costs. RESULTS Total costs for TNFi drug level and concurrent ADAb testing, assessed using ELISAs on trough serum levels, were £152.52/patient (range: £147.68-159.24) if 40 patient samples were tested simultaneously. For the base-case analysis, the pre-testing phase incurred the highest costs, which included booking an additional appointment to acquire trough blood samples. The additional appointment was the key driver of costs per patient (67% of the total cost), and labour accounted for 10% and consumables 23% of the total costs. Performing ELISAs once per patient (rather than in duplicate) reduced the total costs to £133.78/patient. CONCLUSION This microcosting study is the first assessing the cost of TNFi drug level and ADAb testing. The results could be used in subsequent cost-effectiveness analyses of TNFi pharmacological tests to target treatments and inform future policy recommendations.
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Affiliation(s)
- Meghna Jani
- Centre for Musculoskeletal Research
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair
| | - Sean Gavan
- Manchester Centre for Health Economics, Institute of Population Health, Manchester Academic Health Science Centre University of Manchester
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre, Manchester
| | - Hector Chinoy
- Centre for Musculoskeletal Research
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre, Manchester
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford
| | - William G Dixon
- Centre for Musculoskeletal Research
- Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford
| | - Beverley Harrison
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford
| | | | - Anne Barton
- Centre for Musculoskeletal Research
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust Manchester Academic Health Science Centre, Manchester
- Kellgren Centre for Rheumatology, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, Manchester Academic Health Science Centre University of Manchester,
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Costa S, Regier DA, Meissner B, Cromwell I, Ben-Neriah S, Chavez E, Hung S, Steidl C, Scott DW, Marra MA, Peacock SJ, Connors JM. A time-and-motion approach to micro-costing of high-throughput genomic assays. ACTA ACUST UNITED AC 2016; 23:304-313. [PMID: 27803594 DOI: 10.3747/co.23.2987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Genomic technologies are increasingly used to guide clinical decision-making in cancer control. Economic evidence about the cost-effectiveness of genomic technologies is limited, in part because of a lack of published comprehensive cost estimates. In the present micro-costing study, we used a time-and-motion approach to derive cost estimates for 3 genomic assays and processes-digital gene expression profiling (gep), fluorescence in situ hybridization (fish), and targeted capture sequencing, including bioinformatics analysis-in the context of lymphoma patient management. METHODS The setting for the study was the Department of Lymphoid Cancer Research laboratory at the BC Cancer Agency in Vancouver, British Columbia. Mean per-case hands-on time and resource measurements were determined from a series of direct observations of each assay. Per-case cost estimates were calculated using a bottom-up costing approach, with labour, capital and equipment, supplies and reagents, and overhead costs included. RESULTS The most labour-intensive assay was found to be fish at 258.2 minutes per case, followed by targeted capture sequencing (124.1 minutes per case) and digital gep (14.9 minutes per case). Based on a historical case throughput of 180 cases annually, the mean per-case cost (2014 Canadian dollars) was estimated to be $1,029.16 for targeted capture sequencing and bioinformatics analysis, $596.60 for fish, and $898.35 for digital gep with an 807-gene code set. CONCLUSIONS With the growing emphasis on personalized approaches to cancer management, the need for economic evaluations of high-throughput genomic assays is increasing. Through economic modelling and budget-impact analyses, the cost estimates presented here can be used to inform priority-setting decisions about the implementation of such assays in clinical practice.
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Affiliation(s)
- S Costa
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - B Meissner
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - S Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - E Chavez
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - S Hung
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - C Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - D W Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
| | - M A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medical Genetics, University of British Columbia, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - J M Connors
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
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Jackson LJ, Roberts TE, Fuller SS, Sutcliffe LJ, Saunders JM, Copas AJ, Mercer CH, Cassell JA, Estcourt CS. Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial. Sex Transm Infect 2014; 91:100-5. [PMID: 25512670 PMCID: PMC4345770 DOI: 10.1136/sextrans-2014-051715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. METHODS A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. RESULTS There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. CONCLUSIONS Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated.
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Affiliation(s)
- Louise J Jackson
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tracy E Roberts
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sebastian S Fuller
- Centre for Immunology & Infectious Disease: Sexual Health & HIV, Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - Lorna J Sutcliffe
- Centre for Immunology & Infectious Disease: Sexual Health & HIV, Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK
| | - John M Saunders
- Health Economics Unit, School of Population and Health Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK Centre for Immunology & Infectious Disease: Sexual Health & HIV, Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK Centre for Sexual Health and HIV Research, Faculty of Population Health Sciences, University College London, London, UK Division of Primary Care & Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton, UK
| | - Andrew J Copas
- Centre for Immunology & Infectious Disease: Sexual Health & HIV, Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK Centre for Sexual Health and HIV Research, Faculty of Population Health Sciences, University College London, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, Faculty of Population Health Sciences, University College London, London, UK
| | - Jackie A Cassell
- Division of Primary Care & Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton, UK
| | - Claudia S Estcourt
- Centre for Immunology & Infectious Disease: Sexual Health & HIV, Blizard Institute, Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, London, UK
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Manning VL, Kaambwa B, Ratcliffe J, Scott DL, Choy E, Hurley MV, Bearne LM. Economic evaluation of a brief Education, Self-management and Upper Limb Exercise Training in People with Rheumatoid Arthritis (EXTRA) programme: a trial-based analysis. Rheumatology (Oxford) 2014; 54:302-9. [DOI: 10.1093/rheumatology/keu319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Niza C, Rudisill C, Dolan P. Vouchers versus Lotteries: What works best in promoting Chlamydia screening? A cluster randomised controlled trial. APPLIED ECONOMIC PERSPECTIVES AND POLICY 2014; 36:109-124. [PMID: 25061507 PMCID: PMC4105573 DOI: 10.1093/aepp/ppt033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/01/2013] [Indexed: 05/26/2023]
Abstract
In this cluster randomised trial (N=1060), we tested the impact of financial incentives (£5 voucher vs. £200 lottery) framed as a gain or loss to promote Chlamydia screening in students aged 18-24 years, mimicking the standard outreach approach to student in halls of residence. Compared to the control group (1.5%), the lottery increased screening to 2.8% and the voucher increased screening to 22.8%. Incentives framed as gains were marginally more effective (10.5%) that loss-framed incentives (7.1%). This work fundamentally contributes to the literature by testing the predictive validity of Prospect Theory to change health behaviour in the field.
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Affiliation(s)
- Claudia Niza
- Department of Social Policy London School of Economics and Political Science
| | - Caroline Rudisill
- Department of Social Policy London School of Economics and Political Science
| | - Paul Dolan
- Department of Social Policy London School of Economics and Political Science
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Coca L, Petrescu Z, Solovăstru L, Oprea D. The evaluation of the infection with Chlamydia trachomatisof the female population in the Suceava area, Romania. J Eur Acad Dermatol Venereol 2013; 27:e145-7. [DOI: 10.1111/j.1468-3083.2012.04554.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Comparison of methods for estimating the cost of human immunodeficiency virus-testing interventions. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 18:259-67. [PMID: 22473119 DOI: 10.1097/phh.0b013e31822b2077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention, spends approximately 50% of its $325 million annual human immunodeficiency virus (HIV) prevention funds for HIV-testing services. An accurate estimate of the costs of HIV testing in various settings is essential for efficient allocation of HIV prevention resources. OBJECTIVES To assess the costs of HIV-testing interventions using different costing methods. DESIGN, SETTINGS, AND PARTICIPANTS We used the microcosting-direct measurement method to assess the costs of HIV-testing interventions in nonclinical settings, and we compared these results with those from 3 other costing methods: microcosting-staff allocation, where the labor cost was derived from the proportion of each staff person's time allocated to HIV testing interventions; gross costing, where the New York State Medicaid payment for HIV testing was used to estimate program costs, and program budget, where the program cost was assumed to be the total funding provided by Centers for Disease Control and Prevention. MAIN OUTCOME MEASURES Total program cost, cost per person tested, and cost per person notified of new HIV diagnosis. RESULTS The median costs per person notified of a new HIV diagnosis were $12 475, $15 018, $2697, and $20 144 based on microcosting-direct measurement, microcosting-staff allocation, gross costing, and program budget methods, respectively. Compared with the microcosting-direct measurement method, the cost was 78% lower with gross costing, and 20% and 61% higher using the microcosting-staff allocation and program budget methods, respectively. CONCLUSIONS Our analysis showed that HIV-testing program cost estimates vary widely by costing methods. However, the choice of a particular costing method may depend on the research question being addressed. Although program budget and gross-costing methods may be attractive because of their simplicity, only the microcosting-direct measurement method can identify important determinants of the program costs and provide guidance to improve efficiency.
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Abstract
BACKGROUND Microcosting studies collect detailed data on resources used and the value of those resources. Such studies are useful for estimating the cost of new technologies or new community-based interventions, for producing estimates in studies that include nonmarket goods, and for studying within-procedure cost variation. OBJECTIVES The objectives of this article were to (1) describe basic microcosting methods focusing on quantity data collection; and (2) suggest a research agenda to improve methods in and the interpretation of microcosting. RESEARCH DESIGN Examples in the published literature were used to illustrate steps in the methods of gathering data (primarily quantity data) for a microcosting study. RESULTS Quantity data collection methods that were illustrated in the literature include the use of (1) administrative databases at single facilities, (2) insurer administrative data, (3) forms applied across multiple settings, (4) an expert panel, (5) surveys or interviews of one or more types of providers; (6) review of patient charts, (7) direct observation, (8) personal digital assistants, (9) program operation logs, and (10) diary data. CONCLUSIONS Future microcosting studies are likely to improve if research is done to compare the validity and cost of different data collection methods; if a critical review is conducted of studies done to date; and if the combination of the results of the first 2 steps described are used to develop guidelines that address common limitations, critical judgment points, and decisions that can reduce limitations and improve the quality of studies.
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Olonilua O, Ross JDC, Mercer C, Keane F, Brook G, Cassell JA. The limits of health-care seeking behaviour: how long will patients travel for STI care? Evidence from England's 'Patient Access and the Transmission of Sexually Transmitted Infections' ('PATSI') study. Int J STD AIDS 2009; 19:814-6. [PMID: 19050210 DOI: 10.1258/ijsa.2008.008205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SUMMARY The objective of this study was to identify factors associated with (i) longer patient travel time to genitourinary (GU) medicine clinics and (ii) not attending the nearest clinic. Questionnaires were completed by 4600 new attendees from seven sociodemographically and geographically different GU clinics across England between October 2004 and March 2005. These data were then linked to the routine clinic database. Median travel time was 25 minutes and varied significantly by clinic (P < 0.001) but not by gender (P = 0.96). Of all the respondents, 10% spent at least one hour getting to a GU clinic and this was significantly more likely in patients with less education, those who travelled by public transport and those who did not attend their closest clinic. Longer travel times were not associated with delays in seeking care. Patients reporting a previous sexually transmitted infection (STI) diagnosis were more likely not to go to their nearest GU clinic (P = 0.0006), as were those who used/tried to use other health-care providers prior to attending the clinic (P = 0.007). To facilitate access to STI care, comprehensive local services need to be provided to avoid long journey times, especially for those who have to rely on public transport to get to clinic.
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Adams EJ, Turner KME, Edmunds WJ. The cost effectiveness of opportunistic chlamydia screening in England. Sex Transm Infect 2007; 83:267-74; discussion 274-5. [PMID: 17475686 PMCID: PMC2598679 DOI: 10.1136/sti.2006.024364] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/AIM The National Chlamydia Screening Programme (NCSP) is being implemented in England. This study aims to estimate the cost effectiveness of (a) the NCSP strategy (annual screening offer to men and women aged under 25 years) and (b) alternative screening strategies. METHODS A stochastic, individual based, dynamic sexual network model was combined with a cost effectiveness model to estimate the complications and associated costs of chlamydial infection. The model was constructed and parameterised from the perspective of the National Health Service (NHS) (England), including the direct costs of infection, complications and screening. Unit costs were derived from standard data sources and published studies. The average and incremental cost effectiveness ratio (cost per major outcome averted or quality adjusted life year (QALY) gained) of chlamydia screening strategies targeting women and/or men of different age groups was estimated. Sensitivity analyses were done to explore model uncertainty. RESULTS All screening strategies modelled are likely to cost the NHS money and improve health. If pelvic inflammatory disease (PID) progression is less than 10% then screening at any level is unlikely to be cost effective. However, if PID progression is 10% or higher the NCSP strategy compared to no screening appears to be cost effective. The incremental cost effectiveness analysis suggests that screening men and women aged under 20 years is the most beneficial strategy that falls below accepted thresholds. There is a high degree of uncertainty in the findings. CONCLUSIONS Offering an annual screening test to men and women aged under 20 years may be the most cost effective strategy (that is, under accepted thresholds) if PID progression is 10% or higher.
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Affiliation(s)
- Elisabeth J Adams
- Modelling & Economics Unit, Health Protection Agency, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
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Roberts TE, Robinson S, Barton PM, Bryan S, McCarthy A, Macleod J, Egger M, Low N. Cost effectiveness of home based population screening for Chlamydia trachomatis in the UK: economic evaluation of chlamydia screening studies (ClaSS) project. BMJ 2007; 335:291. [PMID: 17656504 PMCID: PMC1941857 DOI: 10.1136/bmj.39262.683345.ae] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the cost effectiveness of screening for Chlamydia trachomatis compared with a policy of no organised screening in the United Kingdom. DESIGN Economic evaluation using a transmission dynamic mathematical model. SETTING Central and southwest England. PARTICIPANTS Hypothetical population of 50,000 men and women, in which all those aged 16-24 years were invited to be screened each year. MAIN OUTCOME MEASURES Cost effectiveness based on major outcomes averted, defined as pelvic inflammatory disease, ectopic pregnancy, infertility, or neonatal complications. RESULTS The incremental cost per major outcome averted for a programme of screening women only (assuming eight years of screening) was 22,300 pounds (33,000 euros; $45,000) compared with no organised screening. For a programme screening both men and women, the incremental cost effectiveness ratio was approximately 28,900 pounds. Pelvic inflammatory disease leading to hospital admission was the most frequently averted major outcome. The model was highly sensitive to the incidence of major outcomes and to uptake of screening. When both were increased the cost effectiveness ratio fell to 6200 pound per major outcome averted for screening women only. CONCLUSIONS Proactive register based screening for chlamydia is not cost effective if the uptake of screening and incidence of complications are based on contemporary empirical studies, which show lower rates than commonly assumed. These data are relevant to discussions about the cost effectiveness of the opportunistic model of chlamydia screening being introduced in England.
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Affiliation(s)
- Tracy E Roberts
- Health Economics Facility, HSMC, University of Birmingham, Birmingham, Switzerland.
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