1
|
Regier DA, Loewen R, Chan B, Ehman M, Pollard S, Friedman JM, Stockler-Ipsiroglu S, van Karnebeek C, Race S, Elliott AM, Dragojlovic N, Lynd LD, Weymann D. Real-world diagnostic outcomes and cost-effectiveness of genome-wide sequencing for developmental and seizure disorders: Evidence from Canada. Genet Med 2024; 26:101069. [PMID: 38205742 DOI: 10.1016/j.gim.2024.101069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To determine real-world diagnostic rates, cost trajectories, and cost-effectiveness of exome sequencing (ES) and genome sequencing (GS) for children with developmental and/or seizure disorders in British Columbia, Canada. METHODS Based on medical records review, we estimated real-world costs and outcomes for 491 patients who underwent standard of care (SOC) diagnostic testing at British Columbia Children's Hospital. Results informed a state-transition Markov model examining cost-effectiveness of 3 competing diagnostic strategies: (1) SOC with last-tier access to ES, (2) streamlined ES access, and (3) first-tier GS. RESULTS Through SOC, 49.4% (95% CI: 40.6, 58.2) of patients were diagnosed at an average cost of C$11,683 per patient (95% CI: 9200, 14,166). Compared with SOC, earlier ES or GS access yielded similar or improved diagnostic rates and shorter times to genetic diagnosis, with 94% of simulations demonstrating cost savings for streamlined ES and 60% for first-tier GS. Net benefit from the perspective of the health care system was C$2956 (95% CI: -608, 6519) for streamlined ES compared with SOC. CONCLUSION Using real-world data, we found earlier access to ES may yield more rapid genetic diagnosis of childhood developmental and seizure disorders and cost savings compared with current practice in a Canadian health care system.
Collapse
Affiliation(s)
- Dean A Regier
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Cancer Control Research, BC Cancer Research Institute, Vancouver, Canada
| | - Rosalie Loewen
- Cancer Control Research, BC Cancer Research Institute, Vancouver, Canada
| | - Brandon Chan
- Cancer Control Research, BC Cancer Research Institute, Vancouver, Canada
| | - Morgan Ehman
- Cancer Control Research, BC Cancer Research Institute, Vancouver, Canada
| | - Samantha Pollard
- Cancer Control Research, BC Cancer Research Institute, Vancouver, Canada
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler-Ipsiroglu
- BC Children's Hospital Research Institute, Vancouver, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Division of Biochemical Genetics, BC Children's Hospital, Vancouver, Canada
| | - Clara van Karnebeek
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Departments of Pediatrics and Human Genetics, Emma Center for Personalized Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Simone Race
- Division of Biochemical Genetics, BC Children's Hospital, Vancouver, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Deirdre Weymann
- Cancer Control Research, BC Cancer Research Institute, Vancouver, Canada.
| |
Collapse
|
2
|
Salmasi S, Safari A, De Vera MA, Högg T, Lynd LD, Koehoorn M, Barry AR, Andrade JG, Deyell MW, Rush KL, Zhao Y, Loewen P. Adherence to direct or vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a long-term observational study. J Thromb Thrombolysis 2024; 57:437-444. [PMID: 38103148 PMCID: PMC10961264 DOI: 10.1007/s11239-023-02921-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/17/2023]
Abstract
Our objectives were to measure long-term adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and to identify patient factors associated with adherence. Using linked, population-based administrative data from British Columbia, Canada, an incident cohort of adults prescribed OACs for AF was identified. We calculated the proportion of days covered (PDC) as a time-dependent covariate for each 90-day window from OAC initiation until the end of follow-up. Associations between patient attributes and adherence were assessed using generalized mixed effect linear regression models. 30,264 patients were included. Mean PDC was 0.69 (SD 0.28) over a median follow-up of 6.7 years. 54% of patients were non-adherent (PDC < 0.8). After controlling for confounders, factors positively associated with adherence were number of drug class switches, history of stroke or transient ischemic attack, history of vascular disease, time since initiation, and age. Age > 75 years at initiation, polypharmacy (among VKA users only), and receiving DOAC (vs. VKA) were negatively associated with adherence. PDC decreased over time for VKA users and increased for DOAC users. Over half of AF patients studied were, on average, nonadherent to OAC therapy and missed 32% of their doses. Several patient factors were associated with higher or lower adherence, and adherence to VKA declined during therapy while DOAC adherence increased slightly over time. To min im ize the risk stroke, adherence-supporting interventions are needed for all patients with AF, particularly those aged > 75 years, those with prior stroke or vascular disease, VKA users with polypharmacy, and DOAC recipients.
Collapse
Affiliation(s)
- Shahrzad Salmasi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Abdollah Safari
- Department of Mathematics, Statistics, and Computer Science, University of Tehran, Tehran, Iran
- Department of Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Tanja Högg
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jason G Andrade
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- UBC Center for Cardiovascular Innovation, Vancouver, BC, Canada
| | - Marc W Deyell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kathy L Rush
- School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Yinshan Zhao
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- UBC Center for Cardiovascular Innovation, Vancouver, BC, Canada.
| |
Collapse
|
3
|
Greenfield J, Metz LM, Khakban A, Llorian ER, Michaux KD, Traboulsee A, Oh J, Smyth P, Lynd LD, Bulloch AGM, Williams JVA, Patten SB. Cancer risk, disease-modifying therapy, and age in multiple sclerosis: A retrospective population-based cohort study. Mult Scler Relat Disord 2023; 80:105091. [PMID: 37924714 DOI: 10.1016/j.msard.2023.105091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Long-term population-based safety studies are needed to investigate cancer outcomes in people with multiple sclerosis (MS) treated with modern disease-modifying therapy (DMT). OBJECTIVES To investigate if exposure to DMT increases the risk of invasive cancer in MS. METHODS We used population-based administrative health data from Alberta, Canada between 2008 and 2018. DMT exposure was defined in two ways: first as exposure to any DMT, and second by DMT type (modulating, sequestering, depleting). Study outcome was time to first diagnosis of invasive cancer. Cancer risk was compared to the general population using standardized incidence ratios (SIRs) and to the unexposed MS cases using hazard ratios (HRs). RESULTS The analysis included 14,313 MS cases: 5,801 (40.5 %) were exposed to DMT. Median (interquartile range) follow-up was 8.4 (4.3, 10.4) years. Compared to the general population, there was no difference in cancer risk for the overall MS population (SIR: 0.94, 95 % confidence interval [CI]: 0.87, 1.02) or the DMT-exposed MS cases (SIR: 0.89; 95 % CI: 0.75, 1.05). Compared to unexposed MS cases, we found an interaction with age for exposure to any DMT (p = 0.001) and modulating DMT (p = 0.001), indicating that a difference in the risk of cancer associated with DMT depends on age. Cancer risk was not associated with exposure to sequestering DMT (HR: 1.28, 95 % CI: 0.78, 2.08) or depleting DMT (HR: 2.29, 95 % CI: 0.86, 6.14). CONCLUSIONS Cancer risk for MS patients was similar to the general population. In the MS population, the age-dependent effect of DMT for cancer risk suggests a higher risk of cancer with age 62 or older and a protective effect at younger age. Further investigation is required to clarify whether the interaction between DMT exposure and age is a causal effect.
Collapse
Affiliation(s)
- Jamie Greenfield
- Department of Clinical Neurosciences, University of Calgary, 9th Floor South Tower, Foothills Medical centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada.
| | - Luanne M Metz
- Department of Clinical Neurosciences, University of Calgary, 9th Floor South Tower, Foothills Medical centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada
| | - Amir Khakban
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kristina D Michaux
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jeanne V A Williams
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
4
|
Ahmadian S, Johnson KM, Ho JK, Sin DD, Lynd LD, Harrison M, Sadatsafavi M. A Cost-Effectiveness Analysis of Azithromycin for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1735-1742. [PMID: 37703432 DOI: 10.1513/annalsats.202304-301oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/13/2023] [Indexed: 09/15/2023] Open
Abstract
Rationale: Daily oral azithromycin therapy can reduce the risk of acute exacerbations of chronic obstructive pulmonary disease (COPD). However, given its adverse events and additional costs, it is not known whether adding long-term azithromycin as an adjunct therapy to inhaled pharmacotherapy is cost effective. Objectives: The objective of this study was to evaluate the cost-effectiveness of add-on azithromycin therapy in COPD as recommended by contemporary COPD management guidelines. Methods: We extended a previously validated Canadian COPD policy model to include azithromycin-related inputs and outcomes. The cost-effectiveness of azithromycin was evaluated over a 20-year time horizon in patients who continue to exacerbate despite receiving maximal inhaled therapies. The benefit of azithromycin was modeled as a reduction in exacerbation rates. Adverse events included cardiovascular death, hearing loss, gastrointestinal symptoms, and antimicrobial resistance. The incremental cost-effectiveness ratio (ICER) was calculated with costs in 2020 Canadian dollars ($) and quality-adjusted life-years (QALYs) discounted at 1.5% per year. The analysis was stratified among patient subgroups based on exacerbation histories. Results: In patients with a positive exacerbation history (one or more events in the previous 12 mo), azithromycin was associated with $49,732 costs, 7.65 QALYs, and 10.95 exacerbations per patient over 20 years. The corresponding values were $48,436, 7.62, and 11.86 for the reference group, resulting in an ICER of $43,200 per QALY gained. In patients defined as frequent exacerbators (two or more moderate or one or more severe events in the past 12 mo), the ICER was reduced to $8,862 per QALY gained. In patients with no history of exacerbation, azithromycin had lower QALYs and higher costs than the reference group. Conclusions: Add-on azithromycin is cost effective in patients with a recent history of exacerbations at commonly accepted willingness-to-pay thresholds of $50,000-$100,000/QALY. Guidelines should consider recommending add-on azithromycin for patients who had at least one moderate or severe exacerbation in the past year, albeit more information about treatment efficacy would strengthen this recommendation.
Collapse
Affiliation(s)
- Safa Ahmadian
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Joseph Khoa Ho
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
| | - Don D Sin
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mark Harrison
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program and
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences
- Centre for Heart Lung Innovation, and
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
| |
Collapse
|
5
|
Mohammadi T, Guh DP, Tam ACT, Pataky RE, Black PC, So A, Lynd LD, Zhang W, Conklin AI. Economic evaluation of prostate cancer risk assessment methods: A cost-effectiveness analysis using population data. Cancer Med 2023; 12:20106-20118. [PMID: 37740609 PMCID: PMC10587968 DOI: 10.1002/cam4.6587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND The current prostate cancer (PCa) screening standard of care (SOC) leads to unnecessary biopsies and overtreatment because decisions are guided by prostate-specific antigen (PSA) levels, which have low specificity in the gray zone (3-10 ng/mL). New risk assessment tools (RATs) aim to improve biopsy decision-making. We constructed a modeling framework to assess new RATs in men with gray zone PSA from the British Columbia healthcare system's perspective. METHODS We evaluated the cost-effectiveness of a new RAT used in biopsy-naïve men aged 50+ with a PSA of 3-10 ng/mL using a time-dependent state-transition model. The model was informed by engaging patient partners and using linked administrative health data, supplemented with published literature. The incremental cost-effectiveness ratio and the probability of the RAT being cost-effective were calculated. Probabilistic analysis was used to assess parameter uncertainty. RESULTS In the base case, a RAT based on an existing biomarker's characteristics was a dominant strategy associated with a cost savings of $44 and a quality-adjusted life years (QALY) gain of 0.00253 over 18 years of follow-up. At a cost-effectiveness threshold of $50,000/QALY, the probability that using a RAT is cost-effective relative to the SOC was 73%. Outcomes were sensitive to RAT costs and accuracy, especially the detection rate of high-grade PCa. Results were also impacted by PCa prevalence and assumptions about undetected PCa survival. CONCLUSIONS Our findings showed that a more accurate RAT to guide biopsy can be cost-effective. Our proposed general model can be used to analyze the cost-effectiveness of any novel RAT.
Collapse
Affiliation(s)
- Tima Mohammadi
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Daphne P. Guh
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Alexander C. T. Tam
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, BC CancerVancouverBritish ColumbiaCanada
| | - Peter C. Black
- Department of Urologic Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alan So
- Department of Urologic Sciences, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Larry D. Lynd
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Wei Zhang
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Annalijn I. Conklin
- Centre for Advancing Health Outcomes (formerly Centre for Health Evaluation and Outcome Sciences), Providence Health Care Research InstituteSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| |
Collapse
|
6
|
Amegadzie JE, Lee TY, Sadatsafavi M, Lynd LD, Sin DD, Johnson KM. Trends in hospital admissions for chronic obstructive pulmonary disease over 16 years in Canada. CMAJ 2023; 195:E1172-E1179. [PMID: 37696554 PMCID: PMC10495179 DOI: 10.1503/cmaj.221051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an ambulatory care-sensitive condition, and the rate of hospital admissions for COPD is an indicator of the quality of outpatient care. We sought to determine long-term trends in hospital admissions for COPD in Canada. METHODS Using a comprehensive national database of hospital admissions in Canada, we identified those with a main discharge diagnosis of COPD for patients aged 40 years and older between 2002 and 2017. We calculated sex-specific, age-standardized trends in annual rates of hospital admissions for COPD separately for younger (40-64 yr) and older adults (≥ 65 yr). We used spline regression to examine changes in the admissions trends for each sex and age group. RESULTS Over 16 years, 1 134 359 hospital admissions were for COPD. Between 2002 and 2017, the total number of admissions increased by 68.8%, from 52 937 to 89 384. The overall crude admission rate increased by 30.0%, from 368 to 479 per 100 000 population, and the sex-and age-standardized admission rate increased by 9.6%, from 437 to 479 per 100 000 population. Age-standardized rates increased by 12.2% among younger females, by 24.4% among younger males and by 29.8% among older females, but decreased by 9.0% among older males. Over the same period, the all-cause sex-and age-standardized admission rate declined by 23.0%. INTERPRETATION Hospital admissions for COPD have increased since 2010, even after adjusting for population growth and aging, and despite declining rates of all-cause hospital admissions. The secular increase in COPD admissions indicates that the burden of COPD on Canadian health care systems is increasing.
Collapse
Affiliation(s)
- Joseph E Amegadzie
- Collaboration for Outcomes Research and Evaluation (Amegadzie, Lee, Sadatsafavi, Lynd, Johnson), and Respiratory Evaluation Sciences Program (Amegadzie, Lee, Sadatsafavi, Johnson), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences (Lynd), Providence Health Institute; The Centre for Heart Lung Innovation (Sin), St. Paul's Hospital; Divisions of Respirology (Sin) and Respiratory Medicine (Johnson), Department of Medicine, University of British Columbia, Vancouver, BC
| | - Tae Yoon Lee
- Collaboration for Outcomes Research and Evaluation (Amegadzie, Lee, Sadatsafavi, Lynd, Johnson), and Respiratory Evaluation Sciences Program (Amegadzie, Lee, Sadatsafavi, Johnson), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences (Lynd), Providence Health Institute; The Centre for Heart Lung Innovation (Sin), St. Paul's Hospital; Divisions of Respirology (Sin) and Respiratory Medicine (Johnson), Department of Medicine, University of British Columbia, Vancouver, BC
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation (Amegadzie, Lee, Sadatsafavi, Lynd, Johnson), and Respiratory Evaluation Sciences Program (Amegadzie, Lee, Sadatsafavi, Johnson), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences (Lynd), Providence Health Institute; The Centre for Heart Lung Innovation (Sin), St. Paul's Hospital; Divisions of Respirology (Sin) and Respiratory Medicine (Johnson), Department of Medicine, University of British Columbia, Vancouver, BC
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (Amegadzie, Lee, Sadatsafavi, Lynd, Johnson), and Respiratory Evaluation Sciences Program (Amegadzie, Lee, Sadatsafavi, Johnson), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences (Lynd), Providence Health Institute; The Centre for Heart Lung Innovation (Sin), St. Paul's Hospital; Divisions of Respirology (Sin) and Respiratory Medicine (Johnson), Department of Medicine, University of British Columbia, Vancouver, BC
| | - Don D Sin
- Collaboration for Outcomes Research and Evaluation (Amegadzie, Lee, Sadatsafavi, Lynd, Johnson), and Respiratory Evaluation Sciences Program (Amegadzie, Lee, Sadatsafavi, Johnson), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences (Lynd), Providence Health Institute; The Centre for Heart Lung Innovation (Sin), St. Paul's Hospital; Divisions of Respirology (Sin) and Respiratory Medicine (Johnson), Department of Medicine, University of British Columbia, Vancouver, BC
| | - Kate M Johnson
- Collaboration for Outcomes Research and Evaluation (Amegadzie, Lee, Sadatsafavi, Lynd, Johnson), and Respiratory Evaluation Sciences Program (Amegadzie, Lee, Sadatsafavi, Johnson), Faculty of Pharmaceutical Sciences, University of British Columbia; Centre for Health Evaluation and Outcomes Sciences (Lynd), Providence Health Institute; The Centre for Heart Lung Innovation (Sin), St. Paul's Hospital; Divisions of Respirology (Sin) and Respiratory Medicine (Johnson), Department of Medicine, University of British Columbia, Vancouver, BC
| |
Collapse
|
7
|
Rodriguez Llorian E, Kopac N, Waliji LA, Borle K, Dragojlovic N, Elliott AM, Lynd LD. A Rapid Review on the Value of Biobanks Containing Genetic Information. Value Health 2023; 26:1286-1295. [PMID: 36921900 DOI: 10.1016/j.jval.2023.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Increasing access to health data through biobanks containing genetic information has the potential to expand the knowledge base and thereby improve screening, diagnosis, and treatment options for many diseases. Nevertheless, although privacy concerns and risks surrounding genetic data sharing are well documented, direct evidence in favor of the hypothesized benefits of data integration is scarce, which complicates decision making in this area. Therefore, the objective of this study is to summarize the available evidence on the research and clinical impacts of biobanks containing genetic information, so as to better understand how to quantify the value of expanding genomic data access. METHODS Using a rapid review methodology, we performed a search of MEDLINE/PubMed and Embase databases; and websites of biobanks and genomic initiatives published from 2010 to 2022. We classified findings into 11 indicators including outputs (a direct product of the biobank activities) and outcomes (changes in scientific and clinical capacity). RESULTS Of 8479 abstracts and 101 gray literature sources were reviewed, 96 records were included. Although most records did not report key indicators systematically, the available evidence concentrated on research indicators such as publications and gene-disorder association discoveries (63% of studies), followed by research infrastructure (26%), and clinical indicators (11%) such as supporting the diagnosis of individual patients. CONCLUSIONS Existing evidence on the benefits of biobanks is skewed toward easily quantifiable research outputs. Measuring a comprehensive set of outputs and outcomes inspired by value frameworks is necessary to generate better evidence on the benefits of genomic data sharing.
Collapse
Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Louloua Ashikhusein Waliji
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| |
Collapse
|
8
|
Borle K, Kopac N, Dragojlovic N, Llorian ER, Lynd LD. Defining Need Amid Exponential Change: Conceptual Challenges in Workforce Planning for Clinical Genetic Services. Clin Ther 2023; 45:695-701. [PMID: 37516568 DOI: 10.1016/j.clinthera.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
Rapid growth in the volume of referrals to clinical genetics services in many countries during the past 15 years makes workforce planning a critical policy tool in ensuring that the capacity of the clinical genetics workforce is large enough to meet current and future needs. This article explores the distinctive challenges of workforce planning in clinical genetics and provides recommendations for addressing these challenges using a needs-based planning approach. Specifically, at least 3 features complicate efforts to estimate the need for clinical genetic services: the difficulty in linking many clinical genetic services to concrete health outcomes; the rapidly changing nature of genetic medicine, which creates intrinsic uncertainty about the appropriate level of service; and the heightened relevance of patient preferences in this context. Our recommendations call for needs-based planning studies to include an explicit definition of necessary care, to be flexible in considering nonhealth benefits, to err on the side of including services currently funded by health systems even when evidence about outcomes is limited, and to use scenario analysis and expert input to explore the impact of uncertainty about patients' preferences and future technologies on estimates of workforce requirements.
Collapse
Affiliation(s)
- Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada.
| |
Collapse
|
9
|
Dragojlovic N, Borle K, Kopac N, Nisselle A, Nuk J, Jevon M, Friedman JM, Elliott AM, Lynd LD. Workforce Implications of Increased Referrals to Hereditary Cancer Services in Canada: A Scenario-Based Analysis. Curr Oncol 2023; 30:7241-7251. [PMID: 37623006 PMCID: PMC10453026 DOI: 10.3390/curroncol30080525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Over the last decade, utilization of clinical genetics services has grown rapidly, putting increasing pressure on the workforce available to deliver genetic healthcare. To highlight the policy challenges facing Canadian health systems, a needs-based workforce requirements model was developed to determine the number of Canadian patients in 2030 for whom an assessment of hereditary cancer risk would be indicated according to current standards and the numbers of genetic counsellors, clinical geneticists and other physicians with expertise in genetics needed to provide care under a diverse set of scenarios. Our model projects that by 2030, a total of 90 specialist physicians and 326 genetic counsellors (1.7-fold and 1.6-fold increases from 2020, respectively) will be required to provide Canadians with indicated hereditary cancer services if current growth trends and care models remain unchanged. However, if the expansion in eligibility for hereditary cancer assessment accelerates, the need for healthcare providers with expertise in genetics would increase dramatically unless alternative care models are widely adopted. Increasing capacity through service delivery innovation, as well as mainstreaming of cancer genetics care, will be critical to Canadian health systems' ability to meet this challenge.
Collapse
Affiliation(s)
- Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.D.)
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.D.)
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.D.)
| | - Amy Nisselle
- Australian Genomics Health Alliance, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Department of Pediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1J2, Canada
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Mandy Jevon
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1J2, Canada
| | - Jan M. Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Alison M. Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Women’s Health Research Institute, Vancouver, BC V6H 3N1, Canada
| | - Larry D. Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.D.)
- Centre for Health Evaluation & Outcome Sciences, Providence Health, Vancouver, BC V6Z IY6, Canada
| |
Collapse
|
10
|
Rodriguez Llorian E, Zhang W, Khakban A, Michaux K, Patten S, Traboulsee A, Oh J, Kolind S, Prat A, Tam R, Lynd LD. Employment status, productivity loss, and associated factors among people with multiple sclerosis. Mult Scler 2023:13524585231164295. [PMID: 37060245 DOI: 10.1177/13524585231164295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) affects people in their most productive years of life. Consequently, MS can substantially affect employment and work-related outcomes. OBJECTIVES This study characterizes productivity loss and employment status of people with multiple sclerosis (pwMS) and investigates associated factors. METHODS We used baseline data collected as part of the Canadian Prospective Cohort Study to Understand Progression in Multiple Sclerosis (CanProCo). Using the Valuation of Lost Productivity questionnaire, we measured MS-related paid work productivity loss for those employed, productivity losses incurred by those unemployed (i.e. lost employment time), and unpaid work productivity losses for all. A set of sociodemographic, disease, and performance-related factors were investigated using a two-part regression model for productivity loss and a multinomial logistic model for employment status. RESULTS From the cohort of 888 pwMS enrolled at baseline (mostly showing mild to moderate disability), 75% were employed, and of those unemployed, 69% attributed their unemployment to health-related issues. Total productivity loss over a 3-month period averaged 64 and 395 hours for those employed and unemployed, respectively. Some factors that affected productivity loss and employment status included use of disease-modifying therapies, fatigue, and performance indicators such as cognitive processing speed. CONCLUSION Productivity loss experienced by employed and unemployed pwMS is substantial. Targeting the identified modifiable factors is likely to improve work productivity and permanence of MS patients in the workforce.
Collapse
Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Wei Zhang
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| | - Amir Khakban
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Kristina Michaux
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Scott Patten
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shannon Kolind
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alexandre Prat
- Department of Neurology, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
| | - Roger Tam
- School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| |
Collapse
|
11
|
Grant P, Cook CB, Langlois S, Nuk J, Mung S, Zhang Q, Lynd LD, Austin J, Elliott AM. Evaluation of out-of-pocket pay genetic testing in a publicly funded healthcare system. Clin Genet 2023; 103:424-433. [PMID: 36504324 DOI: 10.1111/cge.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
When genetic tests are not funded publicly, out-of-pocket (OOP) pay options may be discussed with patients. We evaluated trends in genetic testing and OOP pay for two publicly funded British Columbia clinical programs serving >12 000 patients/year (The Hereditary Cancer Program [HCP] and Provincial Medical Genetics Program [PMGP]) between 2015-2019. Linear and regression models were used to explore the association of OOP pay with patient demographic variables at HCP. An interrupted time series and linear and logistic regression models were used on PMGP data to examine the effect of a change in the funding body. The total number of tests completed through PMGP, and HCP increased by 260% and 320%, respectively. OOP pay increased at HCP by 730%. The mean annual income of patients who paid OOP at HCP was ≥$3500 higher than in the group with funded testing (p < 0.0001). The likelihood of OOP pay increased at PMGP before the funding body change (OR per month: 1.07; 95% CI: 1.04, 1.10); while this likelihood had an immediate 87% drop when the change occurred (OR: 0.13; 95% CI: 0.06, 0.32). Patients with higher incomes are more likely to pay OOP. Financial barriers can create disparities in clinical outcomes. Funding decisions have a significant impact on rate of OOP pay.
Collapse
Affiliation(s)
- Peter Grant
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Courtney B Cook
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada
| | - SzeWing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, British Columbia, Canada
| | - Qian Zhang
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | -
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences (CHEOS), Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Jehannine Austin
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
12
|
Rodriguez Llorian E, Waliji LA, Dragojlovic N, Michaux KD, Nagase F, Lynd LD. Frameworks for Health Technology Assessment at an Early Stage of Product Development: A Review and Roadmap to Guide Applications. Value Health 2023:S1098-3015(23)00107-9. [PMID: 36990207 DOI: 10.1016/j.jval.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/18/2023] [Accepted: 03/16/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Early health technology assessment (eHTA) can be used to evaluate and optimize a medical product's value proposition and to inform go/no-go decisions by using health economic modeling, literature scanning, and stakeholder preference studies at an early stage of development. eHTA frameworks offer high-level guidance on conducting this complex, iterative, and multidisciplinary process. The objective of this study was to review and summarize existing eHTA frameworks, understood as systematic approaches to guide early evidence generation and decision making. METHODS Using a rapid review methodology, we identified all relevant studies published in English, French, and Spanish from PubMed/MEDLINE and Embase until February 2022. We only included frameworks relevant to the preclinical and early clinical (phase I) stages of medical product development. RESULTS From 737 reviewed abstracts, 53 publications describing 46 frameworks were selected for inclusion and classified into categories based on their scope: (1) criteria frameworks, which provide an overview of eHTA; (2) process frameworks, which offer stepwise guidance for conducting eHTA, including preferred methods; and (3) methods frameworks, which provide detailed descriptions of specific eHTA methods. Most of the frameworks did not specify their target users or the specific stage of technology development. CONCLUSIONS Despite some variability and gaps found across existing frameworks, the structure provided by this review helps inform eHTA applications. Remaining challenges are the frameworks' limited accessibility to users without a background in health economics, poor distinctions being made among early lifecycle stages and technology types, and the inconsistent terminology used to describe eHTA in different contexts.
Collapse
Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Louloua Ashikhusein Waliji
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Kristina D Michaux
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Fernanda Nagase
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada.
| |
Collapse
|
13
|
Khakban A, Rodriguez Llorian E, Michaux KD, Patten SB, Traboulsee A, Oh J, Lynd LD. Direct Health Care Costs Associated With Multiple Sclerosis: A Population-Based Cohort Study in British Columbia, Canada, 2001-2020. Neurology 2023; 100:e899-e910. [PMID: 36450607 PMCID: PMC9990437 DOI: 10.1212/wnl.0000000000201645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS), a leading cause of nontraumatic neurologic disability in young adults, exerts a substantial economic burden on the health care system. The objective of this study was to quantify the excess health care costs of MS in British Columbia, Canada. METHODS A retrospective-matched cohort study of patients with MS was conducted using population-based administrative health data from 2001 to 2020. Patients with MS who satisfied a validated case definition were matched to 5 unique controls without MS on sex, age, and cohort entry date. Patients and controls were followed to the end of 2020 or to their last health care resource use, whichever came first. We calculated the direct medical costs for each individual, including outpatient services use, hospital admissions, and dispensed medications. We used generalized linear models with an identity link and normal distribution to estimate the excess cost of MS as the mean cost difference between patients with MS and controls. All costs were reported in 2020 Canadian dollars. RESULTS A total of 17,071 patients with MS were matched to 85,355 controls. Overall, 72.4% were female, and the mean age at cohort entry date was 46.1 years. The excess cost of MS was $6,881 (95% CI: $6,713, $7,049) per patient-year. Inpatient, outpatient, and medication costs accounted for 25%, 10%, and 65% of excess costs, respectively. Excess costs were higher in patients with MS with at least one disease-modifying therapy (DMT) prescription ($13,267; 95% CI: $12,992-$13,542) compared with non-DMT users ($3,469; 95% CI: $3,297-$3,641) and even higher among frequent DMT users ($24,835; 95% CI: $24,528-$25,141). Patients with MS with a history of at least one relapse requiring hospitalization had higher excess costs ($10,543; 95% CI: $10,136-$10,950) compared with patients with MS without a relapse; hospitalizations accounted for 51% of the costs in this group. The excess cost of hospitalizations was $1,391 lower among frequent DMT users than non-DMT users. DISCUSSION The economic burden of MS is considerable, with medications, particularly DMTs, being the largest cost driver. Future studies should investigate how disease management strategies, including early diagnosis and timely use of DMTs, could offset future and ongoing costs while improving patients' quality of life.
Collapse
Affiliation(s)
- Amir Khakban
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada
| | - Elisabet Rodriguez Llorian
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada
| | - Kristina D Michaux
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada
| | - Scott B Patten
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada
| | - Anthony Traboulsee
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada
| | - Jiwon Oh
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada
| | - Larry D Lynd
- From the Collaboration for Outcomes Research and Evaluation (A.K., E.R.L., K.D.M., L.D.L.), Faculty of Pharmaceutical Sciences, and Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver; Department of Community Health Sciences (S.B.P.), University of Calgary, AB; Division of Neurology (J.O.), St. Michael's Hospital, University of Toronto; and Centre for Health Evaluation and Outcome Sciences (CHÉOS) (L.D.L.), St. Paul's Hospital, Vancouver, BC, Canada.
| | | |
Collapse
|
14
|
Sirrs S, Anderson H, Jiwani B, Lynd LD, Lun E, Nakagawa B, Regier D, Rizzardo S, McFarlane A. Expensive Drugs for Rare Diseases in Canada: What Value and at What Cost? Healthc Pap 2023; 21:10-26. [PMID: 36692912 DOI: 10.12927/hcpap.2023.27000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There has been explosive growth in the market for expensive drugs for rare diseases (EDRDs). Traditional standards of evidence are not achievable for rare diseases, so lower standards are applied. The price of these drugs is extremely high. This combination of lower standards and higher prices make EDRDs attractive to manufacturers. Legislation designed to incentivize drug development for rare diseases contains loopholes that drive prices up worldwide. Canada compounds those problems with a complex network of agencies that impede communication between those providing market authorization and those purchasing drugs. Drug pricing is not related to metrics like investment or value, but rather willingness to pay. Without high-quality evidence to assess value, we inadvertently prioritize patients with rare diseases over those with common diseases, creating conflict among ethical principles such as social utility, justice and the rule of rescue. Lack of transparency over what is being funded and for whom makes it hard to mitigate challenges through effective policy development. We review the evidentiary, economic and ethical issues around EDRDs and ways to move forward, including enhanced transparency and the development of high-quality evidence to ensure that we do not pay for drugs that do not work.
Collapse
Affiliation(s)
- Sandra Sirrs
- Clinical Professor, Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC
| | | | - Bashir Jiwani
- Lead Ethicist and Executive Director, Ethics and Diversity Services, Fraser Health Authority, Surrey, BC
| | - Larry D Lynd
- Associate Dean, Research, Professor and Director, Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Eric Lun
- Executive Director, BC Transplant, Provincial Specialized Programs and Clinical Policy, Provincial Health Services Authority, Vancouver, BC
| | - Bob Nakagawa
- Former Assistant Deputy Minister - Pharmaceutical Services Division, BC Ministry of Health, Coquitlam, BC
| | - Dean Regier
- Clinical Scientist, Cancer Control Research, BC Cancer, Associate Professor, School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Shirin Rizzardo
- Senior Economic and Socioeconomic Analyst, Patented Medicine Prices Review Board, Vancouver, BC
| | - Anne McFarlane
- Chair, British Columbia Expensive Drugs for Rare Diseases Advisory Committee, Provincial Health Services Authority, Victoria, BC
| |
Collapse
|
15
|
Rodriguez Llorian E, Dragojlovic N, Campbell TM, Friedman JM, Osiovich H, Elliott AM, Lynd LD. The effect of rapid exome sequencing on downstream health care utilization for infants with suspected genetic disorders in an intensive care unit. Genet Med 2022; 24:1675-1683. [PMID: 35622065 DOI: 10.1016/j.gim.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study aimed to compare downstream utilization of medical services among critically ill infants admitted to intensive care units who received rapid exome sequencing (ES) and those who followed alternative diagnostic testing pathways. METHODS Using propensity score-weighted regression models including sex, age at admission, and severity indicators, we compared a group of 47 infants who underwent rapid ES with a group of 211 infants who did not receive rapid ES. Utilization and cost indicators were compared between cohorts using negative binomial models for utilization and two-part models for costs. RESULTS After controlling for patients' sociodemographic and clinical characteristics, we found no statistically significant difference in outpatient visits, hospitalizations, intensive care unit or total length of stay, or length of stay-associated costs between the cohorts at 12- or 26-month follow-up. Similarly, there was no evidence of higher utilization or costs by the ES group when infants who died were removed from the analysis. CONCLUSION When examining utilization during and beyond the diagnostic trajectory, there is no evidence that ES changes frequency of outpatient visits or use of in-hospital resources in critically ill infants with suspected genetic disorders.
Collapse
Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa M Campbell
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Horacio Osiovich
- Division of Neonatology, Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
16
|
Salmasi S, Högg T, Safari A, De Vera MA, Lynd LD, Koehoorn M, Barry AR, Andrade JG, Loewen P. The Random Effects Warfarin Days' Supply (REWarDS) Model: Development and Validation of a Novel Method for Estimating Exposure to Warfarin Using Administrative Data. Am J Epidemiol 2022; 191:1116-1124. [PMID: 35015808 DOI: 10.1093/aje/kwab295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/26/2021] [Accepted: 12/23/2021] [Indexed: 11/15/2022] Open
Abstract
Warfarin's complex dosing is a significant barrier to measurement of its exposure in observational studies using population databases. Using population-based administrative data (1996-2019) from British Columbia, Canada, we developed a method based on statistical modeling (Random Effects Warfarin Days' Supply (REWarDS)) that involves fitting a random-effects linear regression model to patients' cumulative dosage over time for estimation of warfarin exposure. Model parameters included a minimal universally available set of variables from prescription records for estimation of patients' individualized average daily doses of warfarin. REWarDS estimates were validated against a reference standard (manual calculation of the daily dose using the free-text administration instructions entered by the dispensing pharmacist) and compared with alternative methods (fixed window, fixed tablet, defined daily dose, and reverse wait time distribution) using Pearson's correlation coefficient (r), the intraclass correlation coefficient, and the root mean squared error. REWarDS-estimated days' supply showed strong correlation and agreement with the reference standard (r = 0.90 (95% confidence interval (CI): 0.90, 0.90); intraclass correlation coefficient = 0.95 (95% CI: 0.94, 0.95); root mean squared error = 8.24 days) and performed better than all of the alternative methods. REWarDS-estimated days' supply was valid and more accurate than estimates from all other available methods. REWarDS is expected to confer optimal precision in studies measuring warfarin exposure using administrative data.
Collapse
|
17
|
Borle K, Kopac N, Dragojlovic N, Rodriguez Llorian E, Friedman JM, Elliott AM, Lynd LD. Where is genetic medicine headed? Exploring the perspectives of Canadian genetic professionals on future trends using the Delphi method. Eur J Hum Genet 2022; 30:496-504. [PMID: 35031678 PMCID: PMC9090755 DOI: 10.1038/s41431-021-01017-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Driven by technological and scientific advances, the landscape of genetic medicine is rapidly changing, which complicates strategic planning and decision-making in this area. To address this uncertainty, we sought to understand genetic professionals' opinions about the future of clinical genetic and genomic services in Canada. We used the Delphi method to survey Canadian genetic professionals about their perspectives on whether scenarios about changes in service delivery and the use of genomic testing would be broadly implemented in their jurisdiction by 2030. We conducted two survey rounds; the response rates were 32% (27/84) and 67% (18/27), respectively. The most likely scenario was the universal use of noninvasive prenatal screening. The least likely scenarios involved population-based genome-wide sequencing for unaffected individuals. Overall, the scenarios perceived as most likely were those that have existing evidence about their benefit and potential medical necessity, whereas scenarios were seen as unlikely if they involved emerging technologies. Participants expected that the need for genetic healthcare services would increase by 2030 owing to changes in clinical guidelines and increased use of genome-wide sequencing. This study highlights the uncertainty in the future of genetic and genomic service provision and contributes evidence that could be used to inform strategic planning in clinical genetics.
Collapse
Affiliation(s)
- Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,BC Women's Hospital Research Institute, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada.
| |
Collapse
|
18
|
Rodriguez Llorian E, Zhang W, Khakban A, Patten S, Traboulsee A, Oh J, Kolind S, Prat A, Tam R, Lynd LD. Productivity loss among people with early multiple sclerosis: A Canadian study. Mult Scler 2022; 28:1414-1423. [PMID: 35137613 PMCID: PMC9260491 DOI: 10.1177/13524585211069070] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To analyze work productivity loss and costs, including absenteeism (time missed from work), presenteeism (reduced productivity while working), and unpaid work loss, among a sample of employed people with multiple sclerosis (pwMS) in Canada, as well as its association with clinical, sociodemographic, and work-related factors. METHODS We used cross-sectional data collected as part of the Canadian Prospective Cohort Study to Understand Progression in MS (CanProCo) and information from the Valuation of Lost Productivity questionnaire. RESULTS Among 512 pwMS who were employed, 97% showed no or mild disability and 55% experienced productivity loss due to MS in the prior 3 months. Total productivity time loss over a 3-month period averaged 60 hours (SD = 107; 23 from presenteeism, 19 from absenteeism, and 18 from unpaid work), leading to a mean cost of lost productivity of CAD$2480 (SD = 4282) per patient, with an hourly paid productivity loss greater than the wage loss. Fatigue retained significant associations with all productivity loss outcomes. CONCLUSION Unpaid work loss and productivity losses exceeding those of the employee alone (due to teamwork and associated factors) are key additional contributors of the high economic burden of MS. Workplace accommodations and treatments targeted at fatigue could lessen the economic impact of MS.
Collapse
Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Wei Zhang
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada/Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| | - Amir Khakban
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Scott Patten
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shannon Kolind
- Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alexandre Prat
- Department of Neurology, Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
| | - Roger Tam
- Department of Radiology and School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada/Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
| |
Collapse
|
19
|
Salmasi S, De Vera MA, Safari A, Lynd LD, Koehoorn M, Barry AR, Andrade JG, Deyell MW, Rush K, Zhao Y, Loewen P. Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation. J Am Coll Cardiol 2021; 78:2395-2404. [PMID: 34886959 DOI: 10.1016/j.jacc.2021.09.1370] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Conventional adherence summary measures do not capture the dynamic nature of adherence. OBJECTIVES This study aims to characterize distinct long-term oral anticoagulant adherence trajectories and the factors associated with them in patients with atrial fibrillation. METHODS Adults with incident atrial fibrillation were identified using linked population-based administrative health data in British Columbia, Canada (1996-2019). Group-based trajectory modeling was used to model patients' 90-day proportions of days covered over time to identify distinct 5-year adherence trajectories. Multinomial regression analysis was used to assess the effect of various demographic and clinical factors on exhibiting each adherence trajectory. RESULTS The study cohort included 19,749 patients with AF (mean age: 70.6 ± 10.6 years), 56% male, mean CHA2DS2-VASc stroke risk score 2.8 ± 1.4. Group-based trajectory modeling identified 4 distinct oral anticoagulants adherence trajectories: "consistent adherence" (n = 14,631, 74% of the cohort), "rapid decline and discontinuation" (n = 2,327, 12%), "rapid decline and partial recovery" (n = 1,973, 10%), and "slow decline and discontinuation" (n = 819, 4%). Very few patient variables were found to be associated with specific adherence trajectories. CONCLUSIONS There is heterogeneity among nonadherent patients in the rate and timing of decline in their medication taking. Clinical and demographic characteristics were found to be inadequate to predict patients' adherence trajectories. Insights from this study could be used to inform the design and timing of adherence interventions, and qualitative studies may be needed to better understand the psychosocial determinants and reasons for the behaviors reflected in the identified trajectories.
Collapse
Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Abdollah Safari
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arden R Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; UBC Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada
| | - Kathy Rush
- School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Yinshan Zhao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Loewen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; UBC Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada.
| |
Collapse
|
20
|
Pollard S, Weymann D, Dunne J, Mayanloo F, Buckell J, Buchanan J, Wordsworth S, Friedman JM, Stockler-Ipsiroglu S, Dragojlovic N, Elliott AM, Harrison M, Lynd LD, Regier DA. Toward the diagnosis of rare childhood genetic diseases: what do parents value most? Eur J Hum Genet 2021; 29:1491-1501. [PMID: 33903739 PMCID: PMC8484431 DOI: 10.1038/s41431-021-00882-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/18/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Genomic testing is becoming routine for diagnosing rare childhood genetic disease. Evidence underlying sustainable implementation is limited, focusing on short-term endpoints such as diagnostic yield, unable to fully characterize patient and family valued outcomes. Although genomic testing is becoming widely available, evidentiary and outcomes uncertainty persist as key challenges for implementation. We examine whether the current evidence base reflects public tolerance for uncertainty for genomics to diagnose rare childhood genetic disease. We conducted focus groups with general population parents in Vancouver, Canada, and Oxford, United Kingdom, to discuss expectations and concerns related to genomic testing to diagnose rare childhood genetic disease. Applying a purposive sampling technique, recruitment continued until thematic saturation was reached. Transcripts were analysed using thematic analysis. Thirty-three parents participated across four focus groups. Participants valued causal diagnoses alongside management strategies to improve patient health and wellbeing. Further, participants valued expanding the evidence base to reduce evidentiary uncertainty while ensuring security of information. Willingness to pay out of pocket for testing reflected perceived familial health benefit. Diagnostic yield fails to fully capture valued outcomes, and efforts to resolve uncertainty better reflect public priorities. Evaluations of genomic testing that fully integrate valued endpoints are necessary to ensure consistency with best practices and public willingness to accept the uncertain familial benefit.
Collapse
Affiliation(s)
- Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - Jessica Dunne
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - Fatemeh Mayanloo
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada
| | - John Buckell
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - James Buchanan
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- grid.4991.50000 0004 1936 8948Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jan M. Friedman
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Sylvia Stockler-Ipsiroglu
- grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788Division of Biochemical Genetics, BC Children’s Hospital, Vancouver, Canada
| | - Nick Dragojlovic
- grid.17091.3e0000 0001 2288 9830Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Alison M. Elliott
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, Canada ,grid.414137.40000 0001 0684 7788BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Mark Harrison
- grid.17091.3e0000 0001 2288 9830Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada ,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Larry D. Lynd
- grid.17091.3e0000 0001 2288 9830Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada ,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Dean A. Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
21
|
Enns EA, Wainstein T, Dragojlovic N, Kopac N, Lynd LD, Elliott AM. Far and wide: Exploring provider utilization of remote service provision for genome-wide sequencing in Canada. Mol Genet Genomic Med 2021; 9:e1784. [PMID: 34532994 PMCID: PMC8580085 DOI: 10.1002/mgg3.1784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/31/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background In Canada, funding for genome‐wide sequencing (GWS; exome and whole genome) is provincially regulated. We characterized the uptake of GWS by genetics health professionals (GHPs) across Canada and describe how they use remote technologies for patient access to GWS and genomic counseling. Methods We distributed a survey to 574 Canadian GHPs addressing: GWS use, remote technologies (e.g., telephone, videoconferencing) for GWS and provider opinions regarding these technologies. Data were summarized using descriptive statistics. Associations between variables were evaluated using Chi‐square and Fisher's Exact tests for categorical data, and t‐tests or Mann–Whitney U tests for continuous data. Results Of 116 GHPs, 50% reported using GWS in the last year and 57% of GWS users reported using remote technologies. Clinical geneticists who did not use GWS reported lack of provincial funding as the principal reason. Remote technologies were most commonly used for informed consent and results, and rarely used for initial consultations. Average wait times for a GWS appointment were shorter for remote appointments (mean 44.2 (SD 40.2) weeks) than for in‐person (mean 58.2 (SD 42.9), p = 0.036). Conclusion The use of GWS varied across Canada, professional designation, and discipline. Funding remains a barrier to GWS access. Remote technologies increase patient access with reduced wait times.
Collapse
Affiliation(s)
- Emily A Enns
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Tasha Wainstein
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
22
|
Ho JK, Borle K, Dragojlovic N, Dhillon M, Kitchin V, Kopac N, Ross C, Lynd LD. Economic Evidence on Potentially Curative Gene Therapy Products: A Systematic Literature Review. Pharmacoeconomics 2021; 39:995-1019. [PMID: 34156648 DOI: 10.1007/s40273-021-01051-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aim of this review was to summarize all available evidence on the cost effectiveness of potentially curative gene therapies and identify challenges that economic evaluations face in this area. METHODS We conducted a systematic review of four databases (PubMed/MEDLINE, Embase, CINAHL, EconLit) and grey literature sources. We conducted the search on August 23, 2019 and updated it on November 26, 2020. We included all English, French and Spanish language studies that addressed a gene therapy that had received regulatory approval or had entered a phase III trial, and also reported on costs related to the therapy. Critical appraisal was conducted to assess quality of reporting in included studies. RESULTS Fifty-six studies were identified. Of the 42 full economic evaluations, 71% (n = 30) evaluated chimeric antigen receptor T-cell therapies, most used either a Markov model (n = 17, 40%) and/or a partitioned survival model (n = 17, 40%), and 76% (n = 32) adopted a public or private payer perspective. The model characteristics with the greatest impact on cost effectiveness included assumptions about the efficacy of the treatment and the comparators used. CONCLUSION All gene therapies in this review were shown to be more effective than their comparators, although due to high costs not all were considered cost effective at standard cost-effectiveness thresholds. Despite their high cost, some gene therapies have the potential to dominate the alternatives in conditions with high mortality/disability. The choice of comparator and assumptions regarding long-term effectiveness had substantial impacts on cost-effectiveness estimates and need to be carefully considered. Both the quality of inputs and the quality of reporting were highly variable.
Collapse
Affiliation(s)
- Joseph Khoa Ho
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Kennedy Borle
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Manrubby Dhillon
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Kitchin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nicola Kopac
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada
| | - Colin Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, BC, Canada.
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada.
| |
Collapse
|
23
|
Hategeka C, Lynd LD, Kenyon C, Tuyisenge L, Law MR. Impact of a Multifaceted Intervention to Improve Emergency Care on Newborn and Child Health Outcomes in Rwanda. Health Policy Plan 2021; 37:12-21. [PMID: 34459893 DOI: 10.1093/heapol/czab109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/17/2021] [Accepted: 08/28/2021] [Indexed: 11/13/2022] Open
Abstract
Implementing context-appropriate neonatal and pediatric advanced life support management interventions has increasingly been recommended as one of the approaches to reduce under-five mortality in resource-constrained settings like Rwanda. One such intervention is ETAT+, which stands for Emergency Triage, Assessment and Treatment plus Admission care for severely ill newborns and children. In 2013, ETAT+ was implemented in Rwandan district hospitals. We evaluated the impact of the ETAT+ intervention on newborn and child health outcomes. We used monthly time series data from the DHIS2-enabled Rwanda Health Management Information System from 2012 to 2016 to examine neonatal and pediatric hospital mortality rate. Each hospital contributed data for 12 and 36 months before and after ETAT+ implementation, respectively. Using controlled interrupted time series analysis and segmented regression model, we estimated longitudinal changes in neonatal and pediatric hospital mortality rate in intervention hospitals relative to matched concurrent control hospitals. We also studied changes in case fatality rate specifically for ETAT+ targeted conditions. Our study cohort consisted of seven intervention hospitals and fourteen matched control hospitals contributing 142,424 neonatal and pediatric hospital admissions. After controlling for secular trends and autocorrelation, we found that the ETAT+ implementation had no statistically significant impact on the rate of all-cause neonatal and pediatric hospital mortality in intervention hospitals relative to control hospitals. However, the case fatality rate for ETAT+ targeted neonatal conditions decreased immediately following implementation by 5% (95% CI: -9.25, -0.77) and over time by 0.8% monthly (95% CI: -1.36, -0.25), in intervention hospitals compared with control hospitals. Case fatality rate for ETAT+ targeted pediatric conditions did not decrease following the ETAT+ implementation. While ETAT+ focuses on improving quality of hospital care for both newborns and children, we only found an impact on neonatal hospital mortality for ETAT+ targeted conditions that should be interpreted with caution given the relatively short pre-intervention period and potential regression to the mean.
Collapse
Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.,Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Cynthia Kenyon
- Division of Neonatal-Perinatal Medicine, Children's Hospital at London Health Sciences Centre, London, ON, Canada
| | - Lisine Tuyisenge
- Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
24
|
Bansback N, Chiu JA, Metcalfe R, Lapointe E, Schabas A, Lenzen M, Traboulsee A, Lynd LD, Carruthers R. Preliminary testing of a patient decision aid for patients with relapsing-remitting multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211029966. [PMID: 34350027 PMCID: PMC8287362 DOI: 10.1177/20552173211029966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Multiple first-line disease modifying therapies (DMTs) are available for
relapsing-remitting multiple sclerosis (RRMS), each with different
characteristics. We developed an interactive patient decision aid (PtDA) to
promote informed shared decision-making (SDM). Objective To test the preliminary effectiveness of the PtDA in participants with
RRMS. Methods Knowledge, and decisional conflict were measured pre- and post-
implementation of the PtDA, SDM after the consultation, and 6-month
treatment patterns were observed. Differences in scores were analyzed using
descriptive statistics and paired t-tests. Qualitative interviews with
patients and neurologists were analyzed using thematic analysis. Results 52 participants were recruited: most were female (81%), 40 years of age or
younger (62%), and had experienced MS for less than 5 years (56%). After
participants used the PtDA, there was a significant improvement in
decisional conflict (change = 1.00; p < 0.001) and
knowledge (change = 2.15, p < 0.001). Nearly all patients wanted SDM, and
25 (56%) reported this occurred in their consult. Qualitative results
suggested the PtDA supported both patients and neurologists in making
decisions. Conclusion This pilot study suggests that PtDA use helps RRMS patients and their
clinician select a DMT. Future studies will assess the feasibility of
implementation and the impact of the PtDA on timely DMT initiation and
longer-term adherence.
Collapse
Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Judy A Chiu
- Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
| | - Rebecca Metcalfe
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Alice Schabas
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | | | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
25
|
Pollard S, Weymann D, Dunne J, Mayanloo F, Buckell J, Buchanan J, Wordsworth S, Friedman JM, Stockler-Ipsiroglu S, Dragojlovic N, Elliott AM, Harrison M, Lynd LD, Regier DA. Correction to: Toward the diagnosis of rare childhood genetic diseases: what do parents value most? Eur J Hum Genet 2021; 29:1589. [PMID: 34145384 DOI: 10.1038/s41431-021-00925-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Samantha Pollard
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada.
| | - Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - Jessica Dunne
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - Fatemeh Mayanloo
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - John Buckell
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - James Buchanan
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Sylvia Stockler-Ipsiroglu
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Biochemical Genetics, BC Children's Hospital, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Mark Harrison
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
26
|
Grant P, Langlois S, Lynd LD, Austin JC, Elliott AM. Out-of-pocket and private pay in clinical genetic testing: A scoping review. Clin Genet 2021; 100:504-521. [PMID: 34080181 DOI: 10.1111/cge.14006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Full coverage of the cost of clinical genetic testing is not always available through public or private insurance programs, or a public healthcare system. Consequently, some patients may be faced with the decision of whether to finance testing out-of-pocket (OOP), meet OOP expenses required by their insurer, or not proceed with testing. A scoping review was conducted to identify literature associated with patient OOP and private pay in clinical genetic testing. Seven databases (EMBASE, MEDLINE, CINAHL, PsychINFO, PAIS, the Cochrane Database of Systematic Reviews, and the JBI Evidence-Based Practice database) were searched, resulting in 83 unique publications included in the review. The presented evidence includes a descriptive analysis, followed by a narrative account of the extracted data. Results were divided into four groups according to clinical indication: (1) hereditary breast and ovarian cancer, (2) other hereditary cancers, (3) prenatal testing, (4) other clinical indications. The majority of studies focused on hereditary cancer and prenatal genetic testing. Overall trends indicated that OOP costs have fallen and payer coverage has improved, but OOP expenses continue to present a barrier to patients who do not qualify for full coverage.
Collapse
Affiliation(s)
- Peter Grant
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada
| | - Sylvie Langlois
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jehannine C Austin
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (BC), Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
27
|
Dragojlovic N, Kopac N, Borle K, Tandun R, Salmasi S, Ellis U, Birch P, Adam S, Friedman JM, Elliott AM, Lynd LD. Utilization and uptake of clinical genetics services in high-income countries: A scoping review. Health Policy 2021; 125:877-887. [PMID: 33962789 DOI: 10.1016/j.healthpol.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
Ongoing rapid growth in the need for genetic services has the potential to severely strain the capacity of the clinical genetics workforce to deliver this care. Unfortunately, assessments of the scale of this health policy challenge and potential solutions are hampered by the lack of a consolidated evidence base on the growth in genetic service utilization. To enable health policy research and strategic planning by health systems in this area, we conducted a scoping review of the literature on the utilization and uptake of clinical genetics services in high-income countries published between 2010 and 2018. One-hundred-and-ninety-five unique studies were included in the review. Most focused on cancer (85/195; 44%) and prenatal care (50/195; 26%), which are consistently the two areas with the greatest volume of genetic service utilization in both the United States and other high-income countries. Utilization and uptake rates varied considerably and were influenced by contextual factors including health system characteristics, provider knowledge, and patient preferences. Moreover, growth in genetic service utilization appears to be driven to a significant degree by technological advances and the integration of new tests into clinical care. Our review highlights both the policy challenge posed by the rapid growth in the utilization of genetic services and the variability in this trend across clinical indications and health systems.
Collapse
Affiliation(s)
- Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Rachel Tandun
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, 2198 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada; BC Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Women's Hospital Research Institute, H214 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6.
| |
Collapse
|
28
|
Chen W, Sadatsafavi M, FitzGerald JM, Lynd LD, Sin DD. Gender modifies the effect of body mass index on lung function decline in mild-to-moderate COPD patients: a pooled analysis. Respir Res 2021; 22:59. [PMID: 33602241 PMCID: PMC7891012 DOI: 10.1186/s12931-021-01656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Low body weight is associated with poor prognosis in patients with chronic obstructive pulmonary disease (COPD). However, it is not known whether gender modifies this relationship. Methods We pooled data of 8686 COPD patients from 7 studies with a median length of 36-months of follow up. Using a longitudinal natural cubic spline regression model, we examined the dose–response relationship between body mass index (BMI) and the rate of decline in forced expiratory volume in one second (FEV1) in patients with GOLD 1 and 2 disease, stratified by gender and adjusted for age, smoking status, and cohort effects. Results There was an inverse linear relationship between BMI and the rate of FEV1 decline in GOLD Grades 1 and 2, which was modified by gender (p < 0.001). In male patients, an increase of BMI by 1 kg/m2 reduced FEV1 decline by 1.05 mL/year (95% CI 0.96, 1.14). However, in female patients, BMI status did not have a clinically meaningful impact on FEV1 decline: an increase of baseline BMI by 1 kg/m2 reduced FEV1 decline by 0.16 ml/year (95% CI 0.11, 0.21). These gender-modified relationships were similar between GOLD 1 and 2 patients, and between current and former smokers. Conclusion In mild to moderate COPD, higher BMI was associated with a less rapid decline of FEV1 in male patients whereas this association was minimal in females patients. This gender-specific BMI effect was independent of COPD severity and smoking status.
Collapse
Affiliation(s)
- Wenjia Chen
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Room 8446, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.,Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 7th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Larry D Lynd
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.,Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 7th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, Canada
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Room 8446, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
| |
Collapse
|
29
|
Sadatsafavi M, McCormack J, Petkau J, Lynd LD, Lee TY, Sin DD. Should the number of acute exacerbations in the previous year be used to guide treatments in COPD? Eur Respir J 2021; 57:2002122. [PMID: 32855228 PMCID: PMC7876420 DOI: 10.1183/13993003.02122-2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/17/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In contemporary management of chronic obstructive pulmonary disease (COPD), the frequent exacerbator phenotype, based on a 12-month history of acute exacerbation of COPD (AECOPD), is a major determinant of therapeutic recommendations. However, there is considerable debate as to the stability of this phenotype over time. METHODS We used fundamental principles in time-to-event analysis to demonstrate that variation in the frequent exacerbator phenotype has two major sources: variability in the underlying AECOPD rate and randomness in the occurrence of individual AECOPDs. We re-analysed data from two large cohorts, the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study and the SubPopulations and InteRmediate OutcoMes In COPD Study (SPIROMICS), using a Bayesian model that separated these sources of variability. We then evaluated the stability of the frequent exacerbator phenotype based on these results. RESULTS In both cohorts, the pattern of AECOPDs strongly supported the presence of an individual-specific underlying AECOPD rate which is stable over time (Bayes Factor less than 0.001). Despite this, the observed AECOPD rate can vary markedly year-to-year within individual patients. For those with an underlying rate of 0.8-3.1 events·year-1, the frequent exacerbator classification, based on the observed rate, changes more than 30% of the time over two consecutive years due to chance alone. This value increases to more than 45% for those with an underlying rate of 1.2-2.2 events·year-1. CONCLUSIONS While the underlying AECOPD rate is a stable trait, the frequent exacerbator phenotype based on observed AECOPD patterns is unstable, so much so that its suitability for informing treatment decisions should be questioned. Whether evaluating AECOPD history over longer durations or using multivariate prediction models can result in more stable phenotyping needs to be evaluated.
Collapse
Affiliation(s)
- Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- UBC Centre for Heart Lung Innovation and Dept of Medicine (Respirology), University of British Columbia, Vancouver, BC, Canada
| | - James McCormack
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - John Petkau
- Dept of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Larry D. Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, Vancouver, BC, Canada
| | - Tae Yoon Lee
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Don D. Sin
- UBC Centre for Heart Lung Innovation and Dept of Medicine (Respirology), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
30
|
Sirrs SM, Arthus MF, Bichet DG, Rockman-Greenberg C, LeMoine K, Morel CF, Lachmann R, Lynd LD, Wasim S, West ML, Hollak C. Independent Registries Are Cost-Effective Tools to Provide Mandatory Postauthorization Surveillance for Orphan Medicinal Products. Value Health 2021; 24:268-273. [PMID: 33518033 DOI: 10.1016/j.jval.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/21/2020] [Accepted: 10/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Orphan medicinal products (OMPs) often receive market authorization under conditions imposed by regulators for ongoing postauthorization surveillance (PAS) to answer questions that remain at the time of market entry. This surveillance may be provided through industry-funded registries (IFRs). Nevertheless, data in these registries may not be of sufficient quality to answer these questions and may not always be accessible for regulatory review. We propose that a mandatory independent registry is an efficient and cost-effective tool for PAS for OMPs. METHODS Using data from the Canadian Fabry Disease Initiative, we reviewed costs per unique patient from sites participating in both the independent national registry and IFRs for Fabry disease and compared data completeness from the Canadian Fabry Disease Initiative to that in published documents from IFRs. RESULTS The costs of data collection through the independent registry were 17% to 36% (depending on site) lower than costs to collect data in the IFRs, and completeness of data collected through the independent registry was higher than that through the IFRs. Data from the independent registry were reviewed annually to guide indications for publicly funded Fabry disease therapy. Even when enrollment ceased to be a requirement to receive therapy, 77% of patients continued to enroll in the registry, suggesting the structure was acceptable to patients. CONCLUSIONS Independent registries are cost-effective and efficient tools and should be mandated by regulatory agencies as the preferred tool for PAS for OMPs. Countries with publicly funded health systems should consider investment in registry infrastructure for OMPs.
Collapse
Affiliation(s)
- Sandra M Sirrs
- Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada.
| | | | - Daniel G Bichet
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | | | - Kaye LeMoine
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Chantal F Morel
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada
| | - Syed Wasim
- University of Toronto, Toronto, Ontario, Canada
| | - Michael L West
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carla Hollak
- Division of Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
31
|
Elliott AM, Dragojlovic N, Campbell T, Adam S, Souich CD, Fryer M, Lehman A, Karnebeek CV, Lynd LD, Friedman JM. Utilization of telehealth in paediatric genome-wide sequencing: Health services implementation issues in the CAUSES Study. J Telemed Telecare 2021; 29:318-327. [PMID: 33470133 DOI: 10.1177/1357633x20982737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Genome-wide sequencing (exome or whole genome) is transforming the care and management of paediatric patients with a rare disease because of its diagnostic capabilities. Genome-wide sequencing is most effective when both parents and the child are sequenced as a trio. Genetic counselling is recommended for all families considering genome-wide sequencing. Although telehealth is well established in genetic counselling for hereditary cancer and prenatal genetics, its use with genome-wide sequencing has not been well studied. The CAUSES Clinic at BC Children's and Women's Hospitals was a translational paediatric trio-based genome-wide sequencing initiative. Pre-test genetic counselling via telehealth (at a clinical site near the family's residence) was offered to families who had been previously evaluated by a clinical geneticist. We report on the first 300 families seen in the CAUSES clinic and compare health services implementation issues of families seen via telehealth versus on-site. METHODS Demographics, cost to families (travel and time), time to first appointment, complete trio sample accrual and diagnostic rates were studied. RESULTS Of the 300 patients, 58 (19%) were seen via telehealth and 242 (81%) were seen on-site for pre-test counselling. The mean time to completion of accrual of trio samples in the telehealth group was 56.3 (standard deviation ±87.3) days versus 18.9 (standard deviation ±62.4) days in the onsite group (p < 2.2 × 10-16). The mean per-family estimated actual or potential travel/time cost savings were greater in the telehealth group (Can$987; standard deviation = Can$1151) than for those seen on-site (Can$305; standard deviation = Can$589) (p = 0.0004). CONCLUSIONS Telehealth allowed for access to genome-wide sequencing for families in remote communities and for them to avoid significant travel and time costs; however, there was a significant delay to accrual of the complete trio samples in the telehealth group, impacting on time of result reporting and delaying diagnoses for families for whom genome-wide sequencing was diagnostic.
Collapse
Affiliation(s)
- Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Canada.,BC Children's Hospital Research Institute, Canada.,Women's Health Research Institute, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Canada
| | - Teresa Campbell
- Department of Medical Genetics, University of British Columbia, Canada
| | - Shelin Adam
- Department of Medical Genetics, University of British Columbia, Canada.,BC Children's Hospital Research Institute, Canada
| | - Christèle du Souich
- Department of Medical Genetics, University of British Columbia, Canada.,BC Children's Hospital Research Institute, Canada
| | - Michele Fryer
- Office of Virtual Health, Provincial Health Services Authority, Canada
| | - Anna Lehman
- Department of Medical Genetics, University of British Columbia, Canada.,BC Children's Hospital Research Institute, Canada
| | - Clara van Karnebeek
- BC Children's Hospital Research Institute, Canada.,Emma Children's Hospital, University of Amsterdam, The Netherlands
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), University of British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Canada
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Canada.,BC Children's Hospital Research Institute, Canada
| |
Collapse
|
32
|
Tsao NW, Rebic N, Lynd LD, De Vera MA. Maternal and neonatal outcomes associated with biologic exposure before and during pregnancy in women with inflammatory systemic diseases: a systematic review and meta-analysis of observational studies. Rheumatology (Oxford) 2021; 59:1808-1817. [PMID: 32118278 DOI: 10.1093/rheumatology/keaa064] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/23/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To determine the association between exposure to biologics in pregnant women with inflammatory systemic diseases and maternal and neonatal outcomes through a meta-analysis of findings from studies identified in a systematic review. METHODS We conducted a systematic review of Medline, Embase, and Cochrane Database of Systematic Reviews to identify observational studies assessing the perinatal impacts of biologic in women with inflammatory systemic disease. Findings were meta-analysed across included studies with random-effects models. Crude risk estimates and, where possible, adjusted risk estimates were pooled to determine the impact on results when confounding is addressed. RESULTS Overall, 24 studies were included in the meta-analysis. Meta-analyses of crude risk estimates resulted in pooled odds ratios (OR) for the association of biologic use during pregnancy and the following respective outcomes: congenital anomalies (1.30, 95% CI: 1.02, 1.67), preterm birth (OR 1.61, 95% CI: 1.37, 1.89), and low birth weight (OR 1.68, 95% CI: 1.21, 2.31). However, in pooled analyses of adjusted risk estimates we observed that the association between biologics use during pregnancy in disease-matched exposed and unexposed pregnant women was no longer statistically significant for congenital anomalies (adjusted OR 1.18, 95% CI: 0.88, 1.57). CONCLUSION Pooled results from studies reporting adjusted risk estimates showed no increased risk of congenital anomalies associated with biologics use, suggesting that increased rates of adverse outcomes may be due to disease activity itself or other confounders.
Collapse
Affiliation(s)
- Nicole W Tsao
- University of British Columbia Faculty of Pharmaceutical SciencesVancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, Vancouver, BC, Canada
| | - Nevena Rebic
- University of British Columbia Faculty of Pharmaceutical SciencesVancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Centre for Health Evaluation & Outcomes Sciences, Vancouver, BC, Canada
| | - Mary A De Vera
- University of British Columbia Faculty of Pharmaceutical SciencesVancouver, BC, Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.,Arthritis Research Canada, Richmond, Vancouver, BC, Canada
| |
Collapse
|
33
|
Yamoah L, Dragojlovic N, Smith A, Lynd LD, Marra CA. Evaluating New Zealanders' Values for Drug Coverage Decision Making: Trade-Offs between Treatments for Rare and Common Conditions. Pharmacoeconomics 2021; 39:109-119. [PMID: 33150565 DOI: 10.1007/s40273-020-00974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND New Zealand's near static healthcare budget limits access to expensive medications including those for rare conditions. As such, it is necessary to know the public's priority for values in the drug funding decision-making process. OBJECTIVES The objectives of this study were to measure the relative societal importance of values of New Zealanders in informing drug funding decisions and to determine how New Zealanders trade off funding in various scenarios between common and rare diseases. METHODS An online survey was conducted between 17 April and 17 May, 2019 on a sample of 500 New Zealanders aged ≥ 18 years. Participants ranked 13 values using an analytical hierarchy process. Participants were then presented with different trade-off scenarios to measure their attitudes towards funding drugs for common and rare diseases. RESULTS The values ranked in the top five by most were potential effect on quality of life (71.8%), ability of the drug to work (57.6%), severity (57.6%), safety (57%), and potential to extend life (56%). Adherence and rarity held the lowest and second lowest ranking. Most believe that resources should be allocated towards drugs that have been proven to work and have the greatest health benefits. In trade-offs between access to an expensive drug therapy for a rare disease with uncertain benefits or receive a fixed cash payment, the overwhelming consensus was to receive the cash payment. CONCLUSIONS New Zealanders ultimately value drug-related factors (e.g. quality of life and efficacy) and disease-related factors (e.g. severity of disease and equity) the most but did not value disease rarity.
Collapse
Affiliation(s)
- Linda Yamoah
- Pharmacy Intern, Wellington, New Zealand
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Nick Dragojlovic
- Collaboration for Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alesha Smith
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Carlo A Marra
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| |
Collapse
|
34
|
Zhang W, Sun H, Guh DP, Lynd LD, Hollis A, Grootendorst P, Anis AH. The Impact of Tiered-Pricing Framework on Generic Entry in Canada. Int J Health Policy Manag 2020; 11:768-776. [PMID: 33233033 PMCID: PMC9309918 DOI: 10.34172/ijhpm.2020.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Generic drug prices have been capped at specified percentages of the interchangeable branded drug’s price by the Canadian provincial public drug plans since 1993. The Pan-Canadian Pharmaceutical Alliance, formed as a coalition by the provinces/territories in Canada, implemented an alternative approach, a tiered-pricing framework (TPF) for new generic drugs on April 1, 2014, under which the percentage varies with the number of generic firms in each market. We evaluate the impact of the TPF on generic entry, ie, listing in public drug plans in Canada.
Methods: Our study compared the pre-TPF period (01/01/2012-03/31/2014) with the TPF period (04/01/2014- 06/30/2016). Prescription drugs from nine provincial public drug plans were grouped into a "market" if they had the same active ingredient and strength, route of administration, and dosage form. Each "market" was contestable by generics and met the eligibility criteria for TPF. At the "market" level, Cox proportional-hazards models with time-varying covariates were used to measure the impact of the TPF on the first generic listing in any provincial public drug plan in Canada relative to the first launch date worldwide.
Results: A total of 189 markets in Canada were selected for the analyses. Generic drugs in small markets were more likely to be listed in Canada during the TPF period compared to the pre-TPF period (hazard ratio [HR], 95% CI: 3.81, 1.51-9.62). There was no significant difference in generic drug listings in large markets between the two policy periods. Conclusion: TPF speeds up generic entry in small markets and generates the benefits of generic competition while avoiding the pitfalls of the previously employed price-cap regulations.
Collapse
Affiliation(s)
- Wei Zhang
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Daphne P Guh
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Larry D Lynd
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Aidan Hollis
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
35
|
Hategeka C, Ruton H, Karamouzian M, Lynd LD, Law MR. Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review. BMJ Glob Health 2020; 5:e003567. [PMID: 33055094 PMCID: PMC7559052 DOI: 10.1136/bmjgh-2020-003567] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND When randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions. METHODS We searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427). RESULTS Of 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time. CONCLUSIONS The use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.
Collapse
Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hinda Ruton
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Mohammad Karamouzian
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- HIV/STI Surveillance Research Centre, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
36
|
Abstract
BACKGROUND To monitor the magnitude of the drug shortage problem in Canada, since 2017, Health Canada has required manufacturers to report drug shortages. This study aimed to identify the factors associated with drug shortages in Canada. METHODS We conducted a retrospective cohort study of all prescription drugs available on the market between Mar. 14, 2017, and Sept. 12, 2018, in Canada. All drugs of the same active ingredient, dosage form, route of administration and strength were grouped into a "market." Our main outcome was shortages at the market level, determined using the Drug Shortages Canada database. We used logistic regression to identify associated factors such as market structure, route or dosage form, and Anatomic Therapeutic Chemical (ATC) classification. RESULTS Among the 3470 markets included in our analysis, 13.3% were reported to be in shortage. Markets with a single generic manufacturer were more likely to be in shortage than other markets. Markets with oral nonsolid route or dosage form were more likely to be in shortage than those that were oral solid with regular release (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.11 to 2.49). Markets for sensory organs were more likely to be in shortage than most other ATC classes. Markets with a higher proportion of drugs covered by public insurance programs were more likely to be in shortage (OR 1.03, 95% CI 1.00 to 1.05 per 10% increase). INTERPRETATION Markets with a single generic manufacturer were most likely to be in shortage. To ensure the security of drug supply, governments should be vigilant in monitoring markets with a single generic manufacturer, with complex manufacturing processes, with higher demand from public programs or those that are in certain ATC classes.
Collapse
Affiliation(s)
- Wei Zhang
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.
| | - Daphne P Guh
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont
| | - Larry D Lynd
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont
| | - Aidan Hollis
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont
| | - Paul Grootendorst
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences (Zhang, Guh, Sun, Lynd, Anis), St. Paul's Hospital; School of Population and Public Health (Zhang, Anis) and Faculty of Pharmaceutical Sciences (Lynd), University of British Columbia, Vancouver, BC; Department of Economics (Hollis), University of Calgary, Calgary, Alta.; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont
| |
Collapse
|
37
|
Dragojlovic N, Borle K, Kopac N, Ellis U, Birch P, Adam S, Friedman JM, Nisselle A, Elliott AM, Lynd LD. The composition and capacity of the clinical genetics workforce in high-income countries: a scoping review. Genet Med 2020; 22:1437-1449. [PMID: 32576987 DOI: 10.1038/s41436-020-0825-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 01/25/2023] Open
Abstract
As genetics becomes increasingly integrated into all areas of health care and the use of complex genetic tests continues to grow, the clinical genetics workforce will likely face greatly increased demand for its services. To inform strategic planning by health-care systems to prepare to meet this future demand, we performed a scoping review of the genetics workforce in high-income countries, summarizing all available evidence on its composition and capacity published between 2010 and 2019. Five databases (MEDLINE, Embase, PAIS, CINAHL, and Web of Science) and gray literature sources were searched, resulting in 162 unique studies being included in the review. The evidence presented includes the composition and size of the workforce, the scope of practice for genetics and nongenetics specialists, the time required to perform genetics-related tasks, case loads of genetics providers, and opportunities to increase efficiency and capacity. Our results indicate that there is currently a shortage of genetics providers and that there is a lack of consensus about the appropriate boundaries between the scopes of practice for genetics and nongenetics providers. Moreover, the results point to strategies that may be used to increase productivity and efficiency, including alternative service delivery models, streamlining processes, and the automation of tasks.
Collapse
Affiliation(s)
- Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - Patricia Birch
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Shelin Adam
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,BC Women's Hospital Research Institute, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada.
| |
Collapse
|
38
|
Raymakers A, Sin DD, Sadatsafavi M, FitzGerald JM, Marra CA, Lynd LD. Statin use and lung cancer risk in chronic obstructive pulmonary disease patients: a population-based cohort study. Respir Res 2020; 21:118. [PMID: 32429927 PMCID: PMC7236956 DOI: 10.1186/s12931-020-01344-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/26/2020] [Indexed: 01/03/2023] Open
Abstract
Background Patients living with chronic obstructive pulmonary disease (COPD) are at an increased risk of lung cancer. A common comorbidity of COPD is cardiovascular disease; as such, COPD patients often receive statins. This study sought to understand the association between statin exposure and lung cancer risk in a population-based cohort of COPD patients. Methods We identified a population-based cohort of COPD patients based on having filled at least three prescriptions for an anticholinergic or short-acting beta-agonist (SABA). We used an array of methods of defining medication exposure including three conventional methods (ever statin exposure, cumulative duration of use, and cumulative dose) and two novel methods (recency-weighted cumulative duration of use and recency-weighted cumulative dose). To assess residual confounding, a negative control exposure was used to test the validity of our results. All exposure variables were time-dependent. Results The population-based cohort of COPD had 39,879 patients with mean age of 70.6 (SD: 11.2) years and, of which, 53.5% were female. There were 12,469 patients who received at least one statin prescription. Results from the reference case multivariable analysis indicated a reduced risk from statin exposure (HR: 0.85 (95% CI: 0.73–1.00) in COPD patients, but this result not statistically significant. Using the two recency-weighted modelling approaches, statin exposure was associated with a statistically significant reduction in lung cancer risk (recency-weighted cumulative dose, HR: 0.85 (95% CI: 0.77–0.93) and recency-weighted cumulative duration of use, HR: 0.97 (95% CI: 0.96–0.99). Multivariable analysis incorporating the negative control exposure was not statistically significant (HR: 0.89 (95% CI: 0.75–1.10). Conclusions The results of this population-based analysis indicate that statin use in COPD patients may reduce the risk of lung cancer. While the effect was not statistically significantly across all exposure definitions, the overall results support the hypothesis that COPD patients might benefit from statin therapy.
Collapse
Affiliation(s)
- Ajn Raymakers
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T1Z3, Canada.,BC Cancer, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - D D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada.,Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - M Sadatsafavi
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T1Z3, Canada
| | - J M FitzGerald
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - C A Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - L D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T1Z3, Canada. .,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada.
| |
Collapse
|
39
|
Tsao NW, Salmasi S, Li K, Nakagawa B, Lynd LD, Marra CA. Pharmacists' perceptions of their working conditions and the factors influencing this: Results from 5 Canadian provinces. Can Pharm J (Ott) 2020; 153:161-169. [PMID: 32528600 DOI: 10.1177/1715163520915230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Our previous study in British Columbia (BC) indicated that pharmacists have a poor perception of their working conditions. The objective of this study is to assess pharmacists' perceptions of their working conditions in 4 other Canadian provinces. Methods This was a cross-sectional study across Alberta, New Brunswick, Prince Edward Island and Newfoundland and Labrador, using a survey adapted from the Oregon Board of Pharmacy. Data collected previously from BC were also included in the analyses. The survey was emailed to all pharmacist registrants. Respondents were provided with 6 statements and asked to rate their agreement with them, using a 5-point Likert scale. Statements were framed such that agreement with them indicated good perception of working conditions. Logistic regression analyses were used to study the relationship between workplace factors on perception of working conditions. Results Pharmacists perceived their working conditions to be poor. Pharmacists indicated that they do not have time for break/lunch (48.3% of respondents), work in environments that are not conducive to safe and effective primary care (26.5%), are not satisfied with the amount of time they have to do their job (44.0%) and face shortage of staff (shortage of pharmacists: 33.7%, technicians: 36.4%, clerk staff: 30.3%). Significant factors associated with poor perception were workplace-imposed quotas, high prescription volume, working in chain pharmacies and long prescription wait times. Conclusion A high percentage of Canadian pharmacists perceived their working conditions to be poor. Considering the patient-related consequences of pharmacists' poor working conditions and the system-related reasons identified behind it, we call for collaborative efforts to tackle this issue.
Collapse
Affiliation(s)
- Nicole W Tsao
- Collaboration for Outcomes Research and Evaluation (CORE) (Tsao, Salmasi, Li, Lynd), Faculty of Pharmaceutical Sciences, University of British Columbia.,College of Pharmacists of British Columbia (Nakagawa), Vancouver.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute (Lynd), Vancouver, British Columbia.,School of Pharmacy, University of Otago (Marra), Dunedin, New Zealand
| | - Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation (CORE) (Tsao, Salmasi, Li, Lynd), Faculty of Pharmaceutical Sciences, University of British Columbia.,College of Pharmacists of British Columbia (Nakagawa), Vancouver.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute (Lynd), Vancouver, British Columbia.,School of Pharmacy, University of Otago (Marra), Dunedin, New Zealand
| | - Kathy Li
- Collaboration for Outcomes Research and Evaluation (CORE) (Tsao, Salmasi, Li, Lynd), Faculty of Pharmaceutical Sciences, University of British Columbia.,College of Pharmacists of British Columbia (Nakagawa), Vancouver.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute (Lynd), Vancouver, British Columbia.,School of Pharmacy, University of Otago (Marra), Dunedin, New Zealand
| | - Bob Nakagawa
- Collaboration for Outcomes Research and Evaluation (CORE) (Tsao, Salmasi, Li, Lynd), Faculty of Pharmaceutical Sciences, University of British Columbia.,College of Pharmacists of British Columbia (Nakagawa), Vancouver.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute (Lynd), Vancouver, British Columbia.,School of Pharmacy, University of Otago (Marra), Dunedin, New Zealand
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE) (Tsao, Salmasi, Li, Lynd), Faculty of Pharmaceutical Sciences, University of British Columbia.,College of Pharmacists of British Columbia (Nakagawa), Vancouver.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute (Lynd), Vancouver, British Columbia.,School of Pharmacy, University of Otago (Marra), Dunedin, New Zealand
| | - Carlo A Marra
- Collaboration for Outcomes Research and Evaluation (CORE) (Tsao, Salmasi, Li, Lynd), Faculty of Pharmaceutical Sciences, University of British Columbia.,College of Pharmacists of British Columbia (Nakagawa), Vancouver.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute (Lynd), Vancouver, British Columbia.,School of Pharmacy, University of Otago (Marra), Dunedin, New Zealand
| |
Collapse
|
40
|
Raymakers AJN, Sadatsafavi M, Sin DD, FitzGerald JM, Marra CA, Lynd LD. Avoiding immortal time bias in observational studies. Eur Respir J 2020; 55:55/3/1902494. [PMID: 32198270 DOI: 10.1183/13993003.02494-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/06/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Adam J N Raymakers
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Carlo A Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
41
|
Salmasi S, Tsao NW, Li K, Shaske JN, Marra CA, Lynd LD. Characterization of pharmacist-based medication management services in a community pharmacy. Res Social Adm Pharm 2020; 16:178-182. [DOI: 10.1016/j.sapharm.2019.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/26/2022]
|
42
|
Michaux KD, Hou K, Karakochuk CD, Whitfield KC, Ly S, Verbowski V, Stormer A, Porter K, Li KH, Houghton LA, Lynd LD, Talukder A, McLean J, Green TJ. Effect of enhanced homestead food production on anaemia among Cambodian women and children: A cluster randomized controlled trial. Matern Child Nutr 2019; 15 Suppl 3:e12757. [PMID: 31148398 PMCID: PMC6593652 DOI: 10.1111/mcn.12757] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
There is inconsistent evidence on the efficacy of agriculture programmes at improving women and children's anaemia and nutritional status. The primary aim of this study was to evaluate the impact of a nutrition‐sensitive enhanced homestead food production (EHFP) programme on anaemia in women (18–45 years) and children (6–59 months) in rural Cambodia. Secondary outcomes were women's micronutrient status and women and children's anthropometry. In this cluster‐randomized controlled trial, 900 households from 90 villages (clusters) were randomized to either (a) home gardens and behaviour change communication (BCC) on nutrition, hygiene, women's empowerment, and marketing (EHFP); (b) home gardens plus fishponds and BCC (EHFP + F); or (c) control (no intervention). Haemoglobin concentration and anthropometry were measured in women and children at baseline and at 22 months. Venous blood samples were collected in a subset of women (n = 450) at baseline and at 22 months. Generalized linear mixed effect models with repeated measures were used to evaluate the difference across groups and the change from baseline to end of study. Ninety clusters, 552 women, and 754 children completed the trial. Compared with control, we found a statistically significant impact on anaemia prevalence in children (−14.0 percentage points; P = 0.02) and retinol binding protein concentrations in women (difference in difference: 0.34; P = 0.02) randomized to EHFP and EHFP + F groups, respectively. No other statistically significant effects on anaemia, nutritional biomarker concentrations, or anthropometry were observed. Future research is needed to examine longer term impacts of EHFP on anthropometry in women and children and into the nutritional causes of anaemia among children in Cambodia.
Collapse
Affiliation(s)
- Kristina D Michaux
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kroeun Hou
- Helen Keller International, New York, NY, USA
| | - Crystal D Karakochuk
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyly C Whitfield
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Sokhoing Ly
- Helen Keller International, New York, NY, USA
| | - Vashti Verbowski
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ame Stormer
- Helen Keller International, New York, NY, USA
| | | | - Kathy H Li
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Judy McLean
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy J Green
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.,Healthy Mothers, Babies, Children Research Theme, South Australia Health and Medical Research Institute, Women's and Children's Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
43
|
Hategeka C, Traboulsee AL, McMullen K, Lynd LD. Association of Unemployment and Informal Care with Stigma in Multiple Sclerosis: Evidence from the Survey on Living with Neurological Conditions in Canada. Int J MS Care 2019; 21:214-225. [PMID: 31680783 DOI: 10.7224/1537-2073.2017-108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Multiple sclerosis (MS) typically affects young adults during their primary productive years. We assessed the magnitude of, and factors associated with, employment status and informal care in people with MS in Canada. Methods Data were compiled from the nationally representative cross-sectional Survey on Living with Neurological Conditions in Canada (SLNCC), which included adolescents and adults (age ≥15 years). Employment status was categorized as currently working or not working. The frequency of informal care that people with MS received was categorized as none, less than daily, or daily. Logistic regression analyses were undertaken to identify factors associated with employment status and informal care requirements in people with MS. Results Of 4409 SLNCC respondents, 631 had MS, of whom 530 were included in the analysis. Of 358 respondents aged 18 to 65 years, 47.8% were not working because of MS; 44.0% reported receiving informal care, with more than half requiring daily care. For caregivers' employment, 15.5% reduced work and 8.2% stopped working because of caregiving. Greater feelings of stigmatization were associated with not working (adjusted odds ratio, 7.42 [95% CI, 2.59-21.28]) and greater informal care (adjusted odds ratio, 3.83 [95% CI, 1.84-7.96]), adjusting for sex, age, education, health-related quality of life, time since MS diagnosis, and comorbidity. Conclusions People who feel stigmatized because of their MS are more likely to be unemployed and to require more informal care. Further research is needed to understand the temporal nature of the association between stigma and employment, productivity loss, and informal care.
Collapse
|
44
|
Tsao NW, Hanley GE, Lynd LD, Amiri N, De Vera MA. Risk of congenital anomalies in infants born to women with autoimmune disease using biologics before or during pregnancy: a population-based cohort study. Clin Exp Rheumatol 2019; 37:976-982. [PMID: 30943142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the association between perinatal biologic use and congenital anomalies in women with autoimmune disease. METHODS We linked population-based administrative health data including information on all medications with a perinatal registry in British Columbia, Canada. Women with one or more autoimmune diseases who had pregnancies between January 1st, 2002 and December 31st, 2012 were included. Exposure to biologics was defined as having at least one biologic prescription 3 months before conception or during the first trimester of pregnancy. Each exposed pregnancy was matched with five unexposed pregnancies using high dimensional propensity scores (HDPS). Logistic regression modelling was used to evaluate the association between biologics use and congenital anomalies. RESULTS The HDPS-matched cohort included 117 pregnancies (107 women) exposed to biologics, and 585 pregnancies (562 women) that were not exposed to biologics during the period of interest; 6% of newborns had ≥1 congenital anomalies at birth, in the exposed and unexposed groups. There were no obvious patterns with regards to the congenital anomalies observed in the biologics exposed group. In primary analysis, the OR for the association between biologic exposure and congenital anomalies was 1.06 (95%CI 0.46-2.47). Secondary and sensitivity analyses did not change the results appreciably. CONCLUSIONS These population-based data suggest that the use of biologics before and during pregnancy is not associated with an increased risk of congenital anomalies.
Collapse
Affiliation(s)
- Nicole W Tsao
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver; Collaboration for Outcomes Research and Evaluation, Vancouver; and Arthritis Research Canada, Richmond, Canada
| | - Gillian E Hanley
- University of British Columbia Faculty of Medicine, Department of Obstetrics & Gynecology, Vancouver, Canada
| | - Larry D Lynd
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver; Collaboration for Outcomes Research and Evaluation, Vancouver; Centre for Health Evaluation & Outcomes Sciences, Vancouver, Canada
| | - Neda Amiri
- University of British Columbia Faculty of Medicine, Department of Medicine, Division of Rheumatology, Vancouver, Canada
| | - Mary A De Vera
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver; Collaboration for Outcomes Research and Evaluation, Vancouver; and Arthritis Research Canada, Richmond, Canada.
| |
Collapse
|
45
|
Bansback N, Chiu JA, Carruthers R, Metcalfe R, Lapointe E, Schabas A, Lenzen M, Lynd LD, Traboulsee A. Development and usability testing of a patient decision aid for newly diagnosed relapsing multiple sclerosis patients. BMC Neurol 2019; 19:173. [PMID: 31325961 PMCID: PMC6642472 DOI: 10.1186/s12883-019-1382-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) patients often struggle with treatment decisions, in part due to the increasing number of approved disease modifying therapies, each with different characteristics, and also since physicians can struggle to identify which of these characteristics matter most to each individual patient. Decision uncertainty can contribute to late treatment initiation and treatment non-adherence-causes of 'undertreatment' in MS. An interactive online patient decision aid that informs patients of their options, considers their individual preferences and goals, and facilitates conversations with their physicians, could improve how patients with relapsing forms of MS make evidence-based treatment decisions. OBJECTIVE To develop and evaluate a prototype patient decision aid (PtDA) for first-line disease modifying therapies for relapsing-remitting multiple sclerosis. METHODS Informed by previous studies and International Patient Decision Aid Standards guidelines, a prototype PtDA was developed for patients with relapsing multiple sclerosis considering first line treatment. Patients with relapsing multiple sclerosis were recruited from the University of British Columbia's Multiple Sclerosis Clinic to participate in either an online survey or a focus group. Online survey participants completed the PtDA, followed by measures of acceptability, usability, and preparedness for decision-making, and provided general feedback. Focus group participants assessed usability of the revised PtDA. The analysis of qualitative and quantitative data led to improvements of the PtDA prototype. RESULTS The prototype PtDA received high ratings for acceptability and usability, and after its use, participants reported high-levels of preparedness for decision-making. Analysis of all qualitative data identified three key themes: the need for credible information; the usefulness of the PtDA; and the importance of normalizing and sharing experiences. Nine content areas were identified for revision. Overall, participants found the PtDA to be a valuable tool for facilitating treatment decisions. CONCLUSIONS This mixed methods study has led to the development of a PtDA that can support patients with RRMS as they make treatment decisions. Future studies will assess the feasibility of implementation and the impact of the PtDA on both the timely treatment initiation and longer-term adherence.
Collapse
Affiliation(s)
- Nick Bansback
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Judy A. Chiu
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Rebecca Metcalfe
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6 Canada
| | - Emmanuelle Lapointe
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Alice Schabas
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | | | - Larry D. Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
- Collaboration for Outcomes Research and Evaluation, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Anthony Traboulsee
- Division of Neurology, University of British Columbia, Djavad Mowafaghian Center for Brain Health, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3 Canada
| |
Collapse
|
46
|
Raymakers AJ, Sadatsafavi M, Sin DD, FitzGerald JM, Marra CA, Lynd LD. Inhaled corticosteroids and the risk of lung cancer in COPD: a population-based cohort study. Eur Respir J 2019; 53:13993003.01257-2018. [DOI: 10.1183/13993003.01257-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/13/2019] [Indexed: 01/20/2023]
Abstract
Inhaled corticosteroids (ICSs) are often prescribed in patients with chronic obstructive pulmonary disease (COPD). Their impact on the risk of lung cancer, a leading cause of mortality in COPD patients, remains uncertain.Population-based linked administrative data between the years 1997 and 2007 from the province of British Columbia, Canada, were used to evaluate the association between lung cancer risk and ICS use in COPD patients. COPD was defined on the basis of receipt of three COPD-related prescriptions in subjects ≥50 years of age. Exposure to ICS was incorporated into multivariable Cox regression models using several time-dependent methods (“ever” exposure, cumulative duration of use, cumulative dose, weighted cumulative duration of use and weighted cumulative dose).There were 39 676 patients who met the inclusion criteria. The mean±sd age of the cohort was 70.7±11.1 years and 53% were female. There were 994 (2.5%) cases of lung cancer during follow-up. In the reference case analysis (time-dependent “ever” exposure), ICS exposure was associated with a 30% reduced risk of lung cancer (HR 0.70 (95% CI 0.61–0.80)). ICS exposure was associated with a decrease in the risk of lung cancer diagnosis over all five methods of quantifying exposure.This population-based study suggests that ICS use reduces the risk of lung cancer in COPD patients.
Collapse
|
47
|
Salmasi S, De Vera MA, Barry A, Bansback N, Harrison M, Lynd LD, Loewen PS. Assessment of Condition and Medication Knowledge Gaps Among Atrial Fibrillation Patients: A Systematic Review and Meta-analysis. Ann Pharmacother 2019; 53:773-785. [DOI: 10.1177/1060028019835845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Patient education facilitates construction of a correct illness representation, improves beliefs about medications, and improves knowledge, factors that have been associated with better adherence. Objective: Our objective was to characterize the published literature about atrial fibrillation (AF) patients’ disease and medication knowledge to identify knowledge gaps and misconceptions to inform AF patient education strategies. Methods: Following PRISMA guidelines, we searched PubMed, EMBASE, CINAHL, and PsychINFO from inception to May 2018 for studies that assessed AF patients’ knowledge about their condition and medications. For quantitative studies, we extracted the proportion of participants who provided correct answers to the questions asked about their condition, medications, or risk of stroke. We classified data for related questions into knowledge domains. A random-effects meta-analysis was conducted for each knowledge domain. A domain was considered a knowledge gap if the pooled mean proportion of participants who demonstrated knowledge of it was ≤50%, regardless of CI. Qualitative data were summarized narratively. Results: A total of 21 studies were included. AF- and stroke-related knowledge gaps and misconceptions included the following: AF can be asymptomatic, AF can predispose to heart failure, women are at a higher risk of stroke, the definition of ischemic stroke, and patients’ awareness of their diagnosis. Medication-related knowledge gaps were antithrombotic-drug interactions, antithrombotic-food interactions, vitamin K content of foods, the term INR (international normalized ratio) and its interpretation, and the required actions in case of a missed dose. Conclusion and Relevance: This systematic review identified several AF patient knowledge gaps about their condition and its treatment that can inform the development of AF patient education programs.
Collapse
Affiliation(s)
| | | | - Arden Barry
- University of British Columbia, Vancouver, BC, Canada
- Chilliwack General Hospital, BC, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | - Mark Harrison
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | - Larry D. Lynd
- University of British Columbia, Vancouver, BC, Canada
- Providence Health Research Institute, Vancouver, BC, Canada
| | | |
Collapse
|
48
|
Rizzardo S, Bansback N, Dragojlovic N, Douglas C, Li KH, Mitton C, Marra C, Blanis L, Lynd LD. Evaluating Canadians' Values for Drug Coverage Decision Making. Value Health 2019; 22:362-369. [PMID: 30832975 DOI: 10.1016/j.jval.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Decision makers are facing growing challenges in prioritizing drugs for reimbursement because of soaring drug costs and increasing pressures on financial resources. In addition to cost and effectiveness, payers are using other values to dictate which drugs are prioritized for funding, yet there are limited data on the Canadian public's priorities. OBJECTIVES To measure the relative societal importance of values considered most relevant in informing drug reimbursement decisions in a representative sample of Canadians. METHODS An online survey of 2539 Canadians aged 19 years and older was performed in which 13 values used in drug funding prioritization were ranked and then weighted using an analytic hierarchy process. RESULTS Canadians value safe and efficacious drugs that have certainty of evidence. The values ranked in the top 5 by most of our subjects were potential effect on quality of life (65.4%), severity of the disease (62.6%), ability of drug to work (61.1%), safety (60.5%), and potential to extend life (49.4%). Values related to patient or disease characteristics such as rarity, socioeconomic status, and health and lifestyle choices held the lowest rankings and weights. CONCLUSIONS Canadians value, above all, treatment-related factors (eg, efficacy and safety) and disease-related factors (eg, severity and equity). Decision makers are currently using additional justifications to prioritize drugs for reimbursement, such as rarity and unmet need, which were not found to be highly valued by Canadians. Decision makers should integrate the public's values into a Canadian reimbursement framework for prioritization of drugs competing for limited funds.
Collapse
Affiliation(s)
- Shirin Rizzardo
- Pharmaceutical Services Division, British Columbia Ministry of Health, Victoria, BC, Canada
| | - Nick Bansback
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Conor Douglas
- Department of Science and Technology Studies, York University, Toronto, ON, Canada
| | - Kathy H Li
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Craig Mitton
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Carlo Marra
- National School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Litsa Blanis
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Larry D Lynd
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
49
|
Tsao NW, Lynd LD, Sayre EC, Sadatsafavi M, Hanley G, De Vera MA. Use of biologics during pregnancy and risk of serious infections in the mother and baby: a Canadian population-based cohort study. BMJ Open 2019; 9:e023714. [PMID: 30787081 PMCID: PMC6398640 DOI: 10.1136/bmjopen-2018-023714] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To investigate the association between exposure to biologics during pregnancy and serious infections in mothers and infants. DESIGN Retrospective cohort study. SETTING Population-based. PARTICIPANTS Women with one or more autoimmune diseases identified by International Classification of Diseases 9th/10th revision codes in healthcare administrative databases in British Columbia, Canada, who had pregnancies ending in a live or stillbirth between 1 January 2002 and 31 December 2012. Women were defined as exposed if they had at least one biologic prescription during pregnancy, and infants born to these women were considered exposed in utero. Disease-matched women with no biologics prescriptions during pregnancy, and their infants, comprised the unexposed groups. PRIMARY OUTCOME MEASURES Serious infections requiring hospitalisation. RESULTS Over the 10-year study period, there were 6218 women (8607 pregnancies) who had an autoimmune disease diagnosis, of which 90 women were exposed to biologics during pregnancy, with 100 babies born to these women. Among women exposed to biologics during pregnancy, occurrence of serious postpartum infections were low, ranging from 0% to 5%, depending on concomitant exposures to immunosuppressants. In multivariable models using logistic regression, the OR for the association of biologics exposure with serious maternal postpartum infections was 0.79 (95% CI 0.24 to 2.54). In infants exposed to biologics in utero, occurrence of serious infections during the first year of life ranged from 0% to 7%, depending on concomitant exposures to immunosuppressants in utero. Multivariable models showed no association between biologics exposure in utero and serious infant infections (OR 0.56, 95% CI 0.17 to 1.81). CONCLUSIONS These population-based data suggest that the use of biologics by women with autoimmune diseases during pregnancy is not associated with an increased risk of serious infections in mothers, during post partum or in infants during the first year of life.
Collapse
Affiliation(s)
- Nicole W Tsao
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian Hanley
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
50
|
Loewen PS, Bansback N, Hicklin J, Andrade JG, Kapanen AI, Kwan L, Lynd LD, McClean A, MacGillivray J, Salmasi S. Evaluating the Effect of a Patient Decision Aid for Atrial Fibrillation Stroke Prevention Therapy. Ann Pharmacother 2019; 53:665-674. [PMID: 30724102 DOI: 10.1177/1060028019828420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Stroke prevention therapy decisions for patients with atrial fibrillation (AF) are complex and require trade-offs, but few validated patient decision aids (PDAs) are available to facilitate shared decision making. OBJECTIVE To evaluate the effects of a novel PDA on decision-making parameters for AF patients choosing stroke prevention therapy. METHODS We developed an evidence-based individualized online AF PDA for stroke prevention therapy and evaluated it in a prospective observational pilot study. The primary outcome was decisional conflict. Secondary outcomes were knowledge, usability/acceptability, patient preferences, effects on therapy choices, and participant feedback. RESULTS 37 participants completed the PDA. The PDA could be completed independently and was well accepted. It significantly decreased the mean decisional conflict score ( P < 0.001) and all its subscales and increased participant AF knowledge ( P = 0.02). 76% of participants indicated that their individualized therapy attribute ranking was congruent with their values. The PDA-generated best-match therapy was chosen by 70% of participants in decision 1 (no therapy, aspirin, or oral anticoagulant), and 17% for decision 2 (choice of anticoagulant). Among AF patients, 60% chose a different drug than that currently prescribed to them. Conclusion and Relevance: Our PDA was effective for reducing decisional conflict, increasing patient knowledge, eliciting patients' values, and presenting therapy options that aligned with patients' values and preferences. Using the PDA revealed that many patients have therapy preferences different from their currently prescribed treatment. The PDA is a practical and potentially valuable tool to facilitate decision making about stroke prevention therapy for AF.
Collapse
Affiliation(s)
- Peter S Loewen
- 1 The University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- 1 The University of British Columbia, Vancouver, BC, Canada.,2 Providence Health Research Institute, Vancouver, BC, Canada
| | - James Hicklin
- 1 The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Leanne Kwan
- 4 Royal Columbian Hospital, New Westminster, BC, Canada
| | - Larry D Lynd
- 1 The University of British Columbia, Vancouver, BC, Canada.,2 Providence Health Research Institute, Vancouver, BC, Canada
| | - Alison McClean
- 1 The University of British Columbia, Vancouver, BC, Canada
| | | | | |
Collapse
|