1
|
Ghanbarian S, Wong GWK, Bunka M, Edwards L, Cressman S, Conte T, Peterson S, Vijh R, Price M, Schuetz C, Erickson D, Riches L, Landry G, McGrail K, Austin J, Bryan S. A Canadian Simulation Model for Major Depressive Disorder: Study Protocol. Pharmacoecon Open 2024; 8:493-505. [PMID: 38528312 DOI: 10.1007/s41669-024-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is a common, often recurrent condition and a significant driver of healthcare costs. People with MDD often receive pharmacological therapy as the first-line treatment, but the majority of people require more than one medication trial to find one that relieves symptoms without causing intolerable side effects. There is an acute need for more effective interventions to improve patients' remission and quality of life and reduce the condition's economic burden on the healthcare system. Pharmacogenomic (PGx) testing could deliver these objectives, using genomic information to guide prescribing decisions. With an already complex and multifaceted care pathway for MDD, future evaluations of new treatment options require a flexible analytic infrastructure encompassing the entire care pathway. Individual-level simulation models are ideally suited for this purpose. We sought to develop an economic simulation model to assess the effectiveness and cost effectiveness of PGx testing for individuals with major depression. Additionally, the model serves as an analytic infrastructure, simulating the entire patient pathway for those with MDD. METHODS AND ANALYSIS Key stakeholders, including patient partners, clinical experts, researchers, and modelers, designed and developed a discrete-time microsimulation model of the clinical pathways of adults with MDD in British Columbia (BC), including all publicly-funded treatment options and multiple treatment steps. The Simulation Model of Major Depression (SiMMDep) was coded with a modular approach to enhance flexibility. The model was populated using multiple original data analyses conducted with BC administrative data, a systematic review, and an expert panel. The model accommodates newly diagnosed and prevalent adult patients with MDD in BC, with and without PGx-guided treatment. SiMMDep comprises over 1500 parameters in eight modules: entry cohort, demographics, disease progression, treatment, adverse events, hospitalization, costs and quality-adjusted life-years (payoff), and mortality. The model predicts health outcomes and estimates costs from a health system perspective. In addition, the model can incorporate interactive decision nodes to address different implementation strategies for PGx testing (or other interventions) along the clinical pathway. We conducted various forms of model validation (face, internal, and cross-validity) to ensure the correct functioning and expected results of SiMMDep. CONCLUSION SiMMDep is Canada's first medication-specific, discrete-time microsimulation model for the treatment of MDD. With patient partner collaboration guiding its development, it incorporates realistic care journeys. SiMMDep synthesizes existing information and incorporates provincially-specific data to predict the benefits and costs associated with PGx testing. These predictions estimate the effectiveness, cost-effectiveness, resource utilization, and health gains of PGx testing compared with the current standard of care. However, the flexible analytic infrastructure can be adapted to support other policy questions and facilitate the rapid synthesis of new data for a broader search for efficiency improvements in the clinical field of depression.
Collapse
Affiliation(s)
- Shahzad Ghanbarian
- School for 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.
| | - Gavin W K Wong
- School for 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
| | - Mary Bunka
- School for 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
| | - Louisa Edwards
- School for 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
| | - Sonya Cressman
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Tania Conte
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Morgan Price
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schuetz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - David Erickson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Psychology Department, Fraser Health, Vancouver, BC, Canada
| | | | | | - Kim McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Stirling Bryan
- School for 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
| |
Collapse
|
2
|
Marshall DA, Suryaprakash N, Bryan S, Barker KL, MacKean G, Zelinsky S, McCarron TL, Santana MJ, Moayyedi P, Lavallee DC. Measuring the Impact of Patient Engagement in Health Research: An Exploratory Study Using Multiple Survey Tools. J Can Assoc Gastroenterol 2024; 7:177-187. [PMID: 38596802 PMCID: PMC10999763 DOI: 10.1093/jcag/gwad045] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Background Studies report various ways in which patients are involved in research design and conduct. Limited studies explore the influence of patient engagement (PE) at each research stage in qualitative research from the perspectives of all stakeholders. Methods We established two small research groups, a Patient Researcher-Led Group and an Academic Researcher-Led Group. We recruited patient research partners (PRP; n = 5), researchers (n = 5), and clinicians (n = 4) to design and conduct qualitative research aimed at identifying candidate attributes related to patient preferences for tapering biologic treatments in inflammatory bowel disease. We administered surveys before starting, two months into, and post-project work. The surveys contained items from three PE evaluation tools. We assessed the two groups regarding the influence and impact each stakeholder had during the different research stages. Results PRPs had a moderate or a great deal of influence on the critical research activities across the research stages. They indicated moderate/very/extremely meaningful engagement and agreed/strongly agreed impact of PE. PRPs helped operationalize the research question; design the study and approach; develop study materials; recruit participants; and collect and interpret the data. Conclusion The three tools together provide deeper insight into the influence of PE at each research stage. Lessons learnt from this study suggest that PE can impact many aspects of research including the design, process, and approach in the context of qualitative research, increasing the patient-centeredness of the study. More comprehensive validated tools are required that work with a more diverse subject pool and in other contexts.
Collapse
Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario L8S 4K1, Canada
| | - Nitya Suryaprakash
- School of Population and Public Health, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- British Columbia, Strategy for Patient Oriented Research (SPOR) Support Unit, Vancouver V6H 4A7, British Columbia, Canada
| | - Karis L Barker
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
| | - Gail MacKean
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
| | - Sandra Zelinsky
- Alberta, Strategy for Patient Oriented Research (SPOR) Support Unit, Calgary, Alberta T2N 4N1, Canada
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario L8S 4K1, Canada
| | - Tamara L McCarron
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
| | - Maria J Santana
- Department of Pediatrics, University of Calgary, Calgary, Alberta T3B 6A8, Canada
- Alberta, Strategy for Patient Oriented Research (SPOR) Support Unit, Calgary, Alberta T2N 4N1, Canada
| | - Paul Moayyedi
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario L8S 4K1, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Danielle C Lavallee
- School of Population and Public Health, University of British Columbia, Vancouver V6T 1Z3, British Columbia, Canada
- Michael Smith Health Research British Columbia, Vancouver, British Columbia V6H 3X8, Canada
| |
Collapse
|
3
|
Marshall DA, Suryaprakash N, Lavallee DC, McCarron TL, Zelinsky S, Barker KL, MacKean G, Santana MJ, Moayyedi P, Bryan S. Studying How Patient Engagement Influences Research: A Mixed Methods Study. Patient 2024:10.1007/s40271-024-00685-8. [PMID: 38488995 DOI: 10.1007/s40271-024-00685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND There is evidence supporting the value of patient engagement (PE) in research to patients and researchers. However, there is little research evidence on the influence of PE throughout the entire research process as well as the outcomes of research engagement. The purpose of our study is to add to this evidence. METHODS We used a convergent mixed method design to guide the integration of our survey data and observation data to assess the influence of PE in two groups, comprising patient research partners (PRPs), clinicians, and researchers. A PRP led one group (PLG) and an academic researcher led the other (RLG). Both groups were given the same research question and tasked to design and conduct an inflammatory bowel disease (IBD)-related patient preference study. We administered validated evaluation tools at three points and observed PE in the two groups conducting the IBD study. RESULTS PRPs in both groups took on many operational roles and influenced all stages of the IBD-related qualitative study: launch, design, implementation, and knowledge translation. PRPs provided more clarity on the study design, target population, inclusion-exclusion criteria, data collection approach, and the results. PRPs helped operationalize the project question, develop study material and data collection instruments, collect data, and present the data in a relevant and understandable manner to the patient community. The synergy of collaborative partnership resulted in two projects that were patient-centered, meaningful, understandable, legitimate, rigorous, adaptable, feasible, ethical and transparent, timely, and sustainable. CONCLUSION Collaborative and meaningful engagement of patients and researchers can influence all stages of qualitative research including design and approach, and outputs.
Collapse
Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada.
- IMAGINE SPOR Chronic Disease Network, Hamilton, ON, Canada.
| | - Nitya Suryaprakash
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Tamara L McCarron
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
| | - Sandra Zelinsky
- Alberta Strategy for Patient Oriented Research (SPOR) Support Unit, Edmonton, AB, Canada
| | - Karis L Barker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Health Research Innovation Centre (HRIC) Building, Room 3C58, Calgary, AB, T2N 4Z6, Canada
| | - Maria J Santana
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Moayyedi
- IMAGINE SPOR Chronic Disease Network, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Michael Smith Health Research, British Columbia, Vancouver, BC, Canada
| |
Collapse
|
4
|
Yan J, Xie S, Johnson JA, Pullenayegum E, Ohinmaa A, Bryan S, Xie F. Canada population norms for the EQ-5D-5L. Eur J Health Econ 2024; 25:147-155. [PMID: 36828968 DOI: 10.1007/s10198-023-01570-1] [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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE In Canada, population norms are only available for 2 provinces, Alberta and Quebec. The objective of this study was to derive the population norms for the EQ-5D-5L based on a representative sample of the Canadian general population. METHODS Data from the Canadian EQ-5D-5L valuation study, a cross-sectional study, were used. A quota sampling method was used to recruit a representative sample of the Canadian general population in terms of age, sex, and education. EQ-5D-5L utilities and EQ VAS were summarized using descriptive statistics and the impact of demographic characteristics on the EQ-5D-5L utilities was evaluated using statistical hypothesis testing and Tobit regression. RESULTS 1207 eligible participants were included in the analysis. Pain/discomfort (53.1%) was the most frequently reported domain with any problem, and self-care (7.6%) domain was the least. The mean (standard deviation [SD]) EQ-5D-5L utility was 0.864 (0.121) and the mean (SD) EQ VAS was 82.3 (14.23). The highest mean EQ-5D-5L utility was 0.881 in age group 25-34 while the lowest was 0.839 in age group 55-64. Participants who had full-time employment, were married, a higher annual household income and no chronic health conditions had significantly higher EQ-5D-5L utilities. CONCLUSION This article reports the first Canadian population norms for the EQ-5D-5L and can be used as population references for economic evaluations and clinical research.
Collapse
Affiliation(s)
- Jiajun Yan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | | | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
5
|
Ashe MC, Grover S, Bryan S, Cook WL, Donaldson MG, Brasher PMA. Perceived Health Status and Capability after Hip Fracture: Secondary Outcomes from an Randomized Controlled Trial. Gerontology 2024; 70:235-240. [PMID: 38185111 DOI: 10.1159/000536131] [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: 02/15/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Hip fractures can have a significant impact on the lives of older people and their families. We conducted a pragmatic randomized controlled trial of post-discharge comprehensive geriatric care (CGC) for community-dwelling older adults after a surgically repaired hip fracture. The objective of this study was to conduct a secondary analysis to compare changes in health status and perceived capability from baseline to 12 months after randomization with: the EuroQol 5-Dimension (EQ-5D-5L) (1) utility score and (2) visual analog scale (VAS); and (3) well-being as measured by participants' perceptions of their ability (or capability) toward completing life activities using the ICEpop Capability Measure for Older People (ICECAP-O). METHODS We tested the effect of usual care (control) versus usual care and an outpatient CGC clinic (intervention) on mobility after hip fracture in community-dwelling older adults (65 years+). In this secondary analysis, we report the following outcomes: EQ-5D-5L utility score and VAS collected monthly via telephone and ICECAP-O collected in person three times at baseline, 6 months, and 12 months. Data were analyzed using area under the curve and regression adjusted for baseline values for utility scores and capability, and constrained longitudinal data analysis for VAS. RESULTS We enrolled 53 older adults, including 34 women and 19 men, with mean (SD) age of 80 (8) years. There were no statistical or clinically meaningful differences between groups (control group - intervention group values) for all variables: utility score = -0.028 (95% CI: -0.071, 0.014; p = 0.18); VAS: -0.03 (95% CI: -0.39 to 0.33; p = 0.86); and capability = -0.021 (95% CI: -0.090, 0.046; p = 0.54). CONCLUSIONS There were no differences in outcomes between groups over 12 months, but values remained constant, contrary to a potential decline for this age group, especially after a major life event like a hip fracture.
Collapse
Affiliation(s)
- Maureen C Ashe
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Sanya Grover
- Department of Family Practice, The University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- UBC School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Wendy L Cook
- Providence Health Care, Vancouver, British Columbia, Canada
- Division of Geriatric Medicine, Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - Meghan G Donaldson
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Affdal A, Ballesteros F, Malo MF, Sancho C, Cochran-Mavrikakis SL, Bryan S, Keown P, Sapir-Pichhadze R, Fortin MC. Canadian Kidney Transplant Professionals' Perspectives on Precision Medicine and Molecular Matching in Kidney Allocation. Transplant Direct 2024; 10:e1565. [PMID: 38111837 PMCID: PMC10727564 DOI: 10.1097/txd.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background Antibody-mediated rejection is an important cause of kidney transplant loss. A new strategy requiring application of precision medicine tools in transplantation considers molecular compatibility between donors and recipients and holds the promise of improved immunologic risk, preventing rejection and premature graft loss. The objective of this study was to gather Canadian transplant professionals' perspectives on molecular compatibility in kidney transplantation. Methods Seventeen Canadian transplant professionals (14 nephrologists, 2 nurses, and 1 surgeon) participated in semistructured interviews in 2021. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach. Results Participants identified fair access to transplantation as the most important principle in kidney allocation. Molecular compatibility was viewed as a promising innovation. However, participants were concerned about increased waiting times, negative impact on some patients, and potential problems related to the adequacy of information explaining this new technology. To mitigate the challenges associated with molecular matching, participants suggested integrating a maximum waiting time for molecular-matched kidneys and expanding the program nationally/internationally. Conclusions Molecular matching in kidney transplantation is viewed as a promising technology for decreasing the incidence of antibody-mediated rejection and improving graft survival. Further studies are needed to determine how to ethically integrate this technology into the kidney allocation algorithm.
Collapse
Affiliation(s)
- Aliya Affdal
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Françoise Malo
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Carina Sancho
- Bioethics Program, École de santé publique de l’Université de Montréal, Montréal, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver,Canada
| | - Paul Keown
- Division of Nephrology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Canadian Donation and Transplantation Research Program, Canada
- Division of Nephrology, Faculty of Medicine, McGill University, Montréal, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Canadian Donation and Transplantation Research Program, Canada
- Division of Nephrology, Faculty of Medicine, Université de Montréal, Montréal, Canada
| |
Collapse
|
7
|
Cressman S, Ghanbarian S, Edwards L, Peterson S, Bunka M, Hoens AM, Riches L, Austin J, Vijh R, McGrail K, Bryan S. Costs of major depression covered / not covered in British Columbia, Canada. BMC Health Serv Res 2023; 23:1446. [PMID: 38124043 PMCID: PMC10734183 DOI: 10.1186/s12913-023-10474-y] [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: 04/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the world's leading causes of disability. Our purpose was to characterize the total costs of MDD and evaluate the degree to which the British Columbia provincial health system meets its objective to protect people from the financial impact of illness. METHODS We performed a population-based cohort study of adults newly diagnosed with MDD between 2015 and 2020 and followed their health system costs over two years. The expenditure proportion of MDD-related, patient paid costs relative to non-subsistence income was estimated, incidences of financial hardship were identified and the slope index of inequality (SII) between the highest and lowest income groups compared across regions. RESULTS There were 250,855 individuals diagnosed with MDD in British Columbia over the observation period. Costs to the health system totalled >$1.5 billion (2020 CDN), averaging $138/week for the first 12 weeks following a new diagnosis and $65/week to week 52 and $55/week for weeks 53-104 unless MDD was refractory to treatment ($125/week between week 12-52 and $101/week over weeks 53-104). The proportion of MDD-attributable costs not covered by the health system was 2-15x greater than costs covered by the health system, exceeding $700/week for patients with severe MDD or MDD that was refractory to treatment. Population members in lower-income groups and urban homeowners had disadvantages in the distribution of financial protection received by the health system (SII reached - 8.47 and 15.25, respectively); however, financial hardship and inequities were mitigated province-wide if MDD went into remission (SII - 0.07 to 0.6). CONCLUSIONS MDD-attributable costs to health systems and patients are highest in the first 12 weeks after a new diagnosis. During this time, lower income groups and homeowners in urban areas run the risk of financial hardship.
Collapse
Affiliation(s)
- Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Linda Riches
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Patient Partner, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Rohit Vijh
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
- The School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
8
|
Marshall DA, Suryaprakash N, Lavallee DC, Barker KL, Mackean G, Zelinsky S, McCarron TL, Santana MJ, Moayyedi P, Bryan S. Exploring the outcomes of research engagement using the observation method in an online setting. BMJ Open 2023; 13:e073953. [PMID: 37989365 PMCID: PMC10668270 DOI: 10.1136/bmjopen-2023-073953] [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] [Received: 03/23/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The objective of this study was to explore the outcomes of research engagement (patient engagement, PE) in the context of qualitative research. DESIGN We observed engagement in two groups comprised of patients, clinicians and researchers tasked with conducting a qualitative preference exploration project in inflammatory bowel disease. One group was led by a patient research partner (PLG, partner led group) and the other by an academic researcher (RLG, researcher led group). A semistructured guide and a set of critical outcomes of research engagement were used as a framework to ground our analysis. SETTING The study was conducted online. PARTICIPANTS Patient research partners (n=5), researchers (n=5) and clinicians (n=4) participated in this study. MAIN OUTCOME MEASURES Transcripts of meetings, descriptive and reflective observation data of engagement during meetings and email correspondence between group members were analysed to identify the outcomes of PE. RESULTS Both projects were patient-centred, collaborative, meaningful, rigorous, adaptable, ethical, legitimate, understandable, feasible, timely and sustainable. Patient research partners (PRPs) in both groups wore dual hats as patients and researchers and influenced project decisions wearing both hats. They took on advisory and operational roles. Collaboration seemed easier in the PLG than in the RLG. The RLG PRPs spent more time than their counterparts in the PLG sharing their experience with biologics and helping their group identify a meaningful project question. A formal literature review informed the design, project materials and analysis in the RLG, while the formal review informed the project materials and analysis in the PLG. A PRP in the RLG and the PLG lead leveraged personal connections to facilitate recruitment. The outcomes of both projects were meaningful to all members of the groups. CONCLUSIONS Our findings show that engagement of PRPs in research has a positive influence on the project design and delivery in the context of qualitative research in both the patient-led and researcher-led group.
Collapse
Affiliation(s)
- Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario, Canada
| | - Nitya Suryaprakash
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Danielle C Lavallee
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
- Michael Smith Health Research, Vancouver, British Columbia, Canada
- British Columbia SPOR SUPPORT Unit, Vancouver, British Columbia, Canada
| | - Karis L Barker
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gail Mackean
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario, Canada
- Alberta SPOR SUPPORT Unit, Calgary, Alberta, Canada
| | - Tamara L McCarron
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Alberta SPOR SUPPORT Unit, Calgary, Alberta, Canada
- Department of Paediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Paul Moayyedi
- IMAGINE SPOR Chronic Disease Network, Hamilton, Ontario, Canada
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Stirling Bryan
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
- Michael Smith Health Research, Vancouver, British Columbia, Canada
- British Columbia SPOR SUPPORT Unit, Vancouver, British Columbia, Canada
| |
Collapse
|
9
|
Ghanbarian S, Wong GWK, Bunka M, Edwards L, Cressman S, Conte T, Price M, Schuetz C, Riches L, Landry G, Erickson D, McGrail K, Peterson S, Vijh R, Hoens AM, Austin J, Bryan S. Cost-effectiveness of pharmacogenomic-guided treatment for major depression. CMAJ 2023; 195:E1499-E1508. [PMID: 37963621 DOI: 10.1503/cmaj.221785] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/18/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Pharmacogenomic testing to identify variations in genes that influence metabolism of antidepressant medications can enhance efficacy and reduce adverse effects of pharmacotherapy for major depressive disorder. We sought to establish the cost-effectiveness of implementing pharmacogenomic testing to guide prescription of antidepressants. METHODS We developed a discrete-time microsimulation model of care pathways for major depressive disorder in British Columbia, Canada, to evaluate the effectiveness and cost-effectiveness of pharmacogenomic testing from the public payer's perspective over 20 years. The model included unique patient characteristics (e.g., metabolizer phenotypes) and used estimates derived from systematic reviews, analyses of administrative data (2015-2020) and expert judgment. We estimated incremental costs, life-years and quality-adjusted life-years (QALYs) for a representative cohort of patients with major depressive disorder in BC. RESULTS Pharmacogenomic testing, if implemented in BC for adult patients with moderate-severe major depressive disorder, was predicted to save the health system $956 million ($4926 per patient) and bring health gains of 0.064 life-years and 0.381 QALYs per patient (12 436 life-years and 74 023 QALYs overall over 20 yr). These savings were mainly driven by slowing or avoiding the transition to refractory (treatment-resistant) depression. Pharmacogenomic-guided care was associated with 37% fewer patients with refractory depression over 20 years. Sensitivity analyses estimated that costs of pharmacogenomic testing would be offset within about 2 years of implementation. INTERPRETATION Pharmacogenomic testing to guide antidepressant use was estimated to yield population health gains while substantially reducing health system costs. These findings suggest that pharmacogenomic testing offers health systems an opportunity for a major value-promoting investment.
Collapse
Affiliation(s)
- Shahzad Ghanbarian
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Gavin W K Wong
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Mary Bunka
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Louisa Edwards
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Sonya Cressman
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Tania Conte
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Morgan Price
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Christian Schuetz
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Linda Riches
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Ginny Landry
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - David Erickson
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Kim McGrail
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Sandra Peterson
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Rohit Vijh
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Alison M Hoens
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Jehannine Austin
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- The Centre for Clinical Epidemiology and Evaluation (Ghanbarian, Wong, Bunka, Edwards, Cressman, Conte, Bryan), Vancouver Coastal Health Research Institute, and The School of Public and Population Health (Ghanbarian, Wong, Bunka, Edwards, Conte, Vijh, Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Cressman), Simon Fraser University, Burnaby, BC; Department of Family Practice (Price, Vijh), and Department of Physiatry (Schuetz), Faculty of Medicine, University of British Columbia, Vancouver, BC; Patient partner (Riches), Prince George, BC; Patient partner (Landry), New Westminster, BC; Psychology Department (Erickson), Fraser Health, New Westminster, BC; Centre for Health Services and Policy Research (McGrail, Peterson), and Departments of Physical Therapy (Hoens) and Medical Genetics (Austin), University of British Columbia, Vancouver, BC
| |
Collapse
|
10
|
Pataky RE, Bryan S, Sadatsafavi M, Peacock S, Regier DA. Real-World Cost Effectiveness of a Policy of KRAS Testing to Inform Cetuximab or Panitumumab for Third-Line Therapy of Metastatic Colorectal Cancer in British Columbia, Canada. Pharmacoecon Open 2023; 7:997-1006. [PMID: 37819586 PMCID: PMC10721761 DOI: 10.1007/s41669-023-00444-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Cetuximab and panitumumab, two anti-EGFR therapies, are widely used for third-line therapy of metastatic colorectal cancer (mCRC) with wild-type KRAS, but there remains uncertainty around their cost effectiveness. The objective of this analysis was to conduct a real-world cost-effectiveness analysis of the policy change introducing KRAS testing and third-line anti-EGFR therapy mCRC in British Columbia (BC), Canada. METHODS We conducted secondary analysis of administrative data for a cohort of mCRC patients treated in BC in 2006-2015. Patients potentially eligible for KRAS testing and third-line therapy after the policy change (July 2009) were matched 2:1 to pre-policy patients using genetic matching on propensity score and baseline covariates. Costs and survival time were calculated over an 8-year time horizon, with bootstrapping to characterize uncertainty around endpoints. Cost effectiveness was expressed using incremental cost-effectiveness ratios (ICER) and the probability of cost effectiveness at a range of thresholds. RESULTS The cohort included 1757 mCRC patients (n = 456 pre-policy and n = 1304 post-policy; of those, n = 420 received cetuximab or panitumumab). There was a significant increase in survival and cost following the policy change. Adoption of KRAS testing and anti-EGFR therapy had an ICER of CA$73,759 per life-year gained (LYG) (95% CI 46,133-186,446). In scenario analysis, a reduction in cetuximab and panitumumab cost of at least 50% was required to make the policy change cost effective at a threshold of CA$50,000/LYG. CONCLUSION A policy of third-line anti-EGFR therapy informed by KRAS testing may be considered cost effective at thresholds above CA$70,000/LYG. Reduction in drug costs, through price discounts or potential future biosimilars, would make anti-EGFR therapy considerably more cost effective. By using real-world data for a large cohort with long follow-up we can assess the value of a policy of KRAS testing and anti-EGFR therapy achieved in practice.
Collapse
Affiliation(s)
- Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- BC Cancer Research Centre, 675 W. 10th Ave, Vancouver, BC, V5Z 1L3, Canada.
| | - Stirling Bryan
- 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
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
11
|
Duncan R, Stewart K, Scheuermeyer FX, Abu-Laban RB, Ho K, Lavallee D, Christenson J, Wood N, Bryan S, Hedden L. Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service. BMC Health Serv Res 2023; 23:1031. [PMID: 37759257 PMCID: PMC10523598 DOI: 10.1186/s12913-023-09821-w] [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: 03/24/2023] [Accepted: 07/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND British Columbia 8-1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers' subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases. METHODS We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan-Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios. RESULTS We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68-0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46-0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01-1.62]) or within 7 days (1.23 [95%CI: 1.11-1.37]), were more likely to do so than urban callers. INTERPRETATION Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to "Go to ED" is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.
Collapse
Affiliation(s)
- Ross Duncan
- Michael Smith Health Research British Columbia, Vancouver, Canada.
- BC Emergency Medicine Network, Vancouver, Canada.
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Kurtis Stewart
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Frank X Scheuermeyer
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Riyad B Abu-Laban
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kendall Ho
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Danielle Lavallee
- Michael Smith Health Research British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jim Christenson
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nancy Wood
- BC Emergency Medicine Network, Vancouver, Canada
| | - Stirling Bryan
- Michael Smith Health Research British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay Hedden
- Michael Smith Health Research British Columbia, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| |
Collapse
|
12
|
Edwards L, Bentley C, Burgess M, Sapir-Pichhadze R, Hartell D, Keown P, Bryan S. Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. BMC Nephrol 2023; 24:165. [PMID: 37296384 PMCID: PMC10255937 DOI: 10.1186/s12882-023-03224-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
Collapse
Affiliation(s)
- Louisa Edwards
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | | | - Michael Burgess
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada
| | | | - Paul Keown
- Department of Medicine, UBC, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| |
Collapse
|
13
|
Slomp C, Edwards L, Burgess M, Sapir-Pichhadze R, Keown P, Bryan S. Public values and guiding principles for implementing epitope compatibility in kidney transplantation allocation criteria: results from a Canadian online public deliberation. BMC Public Health 2023; 23:844. [PMID: 37165330 PMCID: PMC10170053 DOI: 10.1186/s12889-023-15790-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Epitope compatibility in deceased donor kidney allocation is an emerging area of precision medicine (PM), seeking to improve compatibility between donor kidneys to transplant candidates in the hope of avoiding kidney rejection. Though the potential benefits of using epitope compatibility are promising, the implied modification of deceased organ allocation criteria requires consideration of significant clinical and ethical trade-offs. As a matter of public policy, these trade-offs should consider public values and preferences. We invited members of the Canadian public to participate in a deliberation about epitope compatibility in deceased donor kidney transplantation; to identify what is important to them and to provide recommendations to policymakers. METHODS An online public deliberation was conducted with members of the Canadian public, in which participants were asked to construct recommendations for policymakers regarding the introduction of epitope compatibility to kidney allocation criteria. In the present paper, a qualitative analysis was conducted to identify the values reflected in participants' recommendations. All virtual sessions were recorded, transcribed, and analyzed using NVivo 12 software. RESULTS Thirty-two participants constructed nine recommendations regarding the adoption of epitope compatibility into deceased donor kidney allocation. Five values were identified that drove participants' recommendations: Health Maximization, Protection/Mitigation of Negative Impacts, Fairness, Science/Evidence-based Healthcare, and Responsibility to Maintain Trust. Conflicts between these values were discussed in terms of operational principles that were required for epitope compatibility to be implemented in an acceptable manner: the needs for Flexibility, Accountability, Transparent Communication and a Transition Plan. All nine recommendations were informed by these four principles. Participant deliberations were often dominated by the conflict between Health Maximization and Fairness or Protection/Mitigation of Negative Impacts, which was discussed as the need for Flexibility. Two additional values (Efficient Use of Resources and Logic/Rationality) were also discussed and were reasons for some participants voting against some recommendations. CONCLUSIONS Public recommendations indicate support for using epitope compatibility in deceased donor kidney allocation. A flexible approach to organ allocation decision-making may allow for the balancing of Health Maximization against maintaining Fairness and Mitigating Negative Impacts. Flexibility is particularly important in the context of epitope compatibility and other PM initiatives where evidence is still emerging.
Collapse
Affiliation(s)
- Caitlin Slomp
- BC Children's Hospital Research Institute, 938 W 28th Ave, BC, V5Z 4H4, Vancouver, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Louisa Edwards
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michael Burgess
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Paul Keown
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| |
Collapse
|
14
|
Ho K, Abu-Laban RB, Stewart K, Duncan R, Scheuermeyer FX, Hedden L, Lauscher HN, Sundhu S, Chadha R, Christenson J, Grafstein E, Lavallee DC, Purssell R, Tallon JM, Wood N, Bryan S. Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study. CMAJ Open 2023; 11:E459-E465. [PMID: 37220956 DOI: 10.9778/cmajo.20220196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician. METHODS We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes. RESULTS We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died. INTERPRETATION This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits.
Collapse
Affiliation(s)
- Kendall Ho
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Riyad B Abu-Laban
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Kurtis Stewart
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Ross Duncan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Frank X Scheuermeyer
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Lindsay Hedden
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Helen Novak Lauscher
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Sandra Sundhu
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Rina Chadha
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Jim Christenson
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Danielle C Lavallee
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Roy Purssell
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - John M Tallon
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Nancy Wood
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| |
Collapse
|
15
|
Bunka M, Wong G, Kim D, Edwards L, Austin J, Doyle-Waters MM, Gaedigk A, Bryan S. Evaluating treatment outcomes in pharmacogenomic-guided care for major depression: A rapid review and meta-analysis. Psychiatry Res 2023; 321:115102. [PMID: 36780865 DOI: 10.1016/j.psychres.2023.115102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
Pharmacogenomic (PGx) testing may increase the probability of remission and response in patients with major depressive disorder (MDD) undergoing pharmacotherapy. Given the potential implications of these outcomes and recent proliferation of PGx studies, we conducted a systematic review to evaluate the effectiveness of PGx testing on clinical outcomes in patients with MDD as compared to treatment as usual (TAU). MEDLINE, Embase, PsycInfo, and CENTRAL were searched for English-language articles from 2000 to 2021 for randomized controlled trials (RCTs) comparing PGx-guided treatment vs. TAU in patients with MDD. Meta-analyses were conducted in R. Ten RCTs were included: eight reported remission and seven reported response. The best available evidence suggests that PGx-guided care for moderate-to-severe adult depression is more likely to result in remission and response than TAU (both risk ratios significant). However, there are limitations in the evidence base, including high risk of bias and inconsistency between trials. Despite the consequent very low certainty in the magnitude of effect, there is confidence in the direction. Though modest, the beneficial effects of PGx for adults with moderate-severe MDD could - as a result of the scope and scale of the condition and its impacts - have important ramifications for patients and the health system.
Collapse
Affiliation(s)
- Mary Bunka
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Gavin Wong
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Dan Kim
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jehannine Austin
- BC Mental Health and Substance Use Services Research Institute, UBC, Vancouver, BC, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia (UBC), 828 West 10th Avenue, Research Pavilion, 7th Floor, Vancouver, BC V5Z 1M9, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
16
|
Yaghoubi M, Cressman S, Edwards L, Shechter S, Doyle-Waters MM, Keown P, Sapir-Pichhadze R, Bryan S. A Systematic Review of Kidney Transplantation Decision Modelling Studies. Appl Health Econ Health Policy 2023; 21:39-51. [PMID: 35945483 DOI: 10.1007/s40258-022-00744-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Genome-based precision medicine strategies promise to minimize premature graft loss after renal transplantation, through precision approaches to immune compatibility matching between kidney donors and recipients. The potential adoption of this technology calls for important changes to clinical management processes and allocation policy. Such potential policy change decisions may be supported by decision models from health economics, comparative effectiveness research and operations management. OBJECTIVE We used a systematic approach to identify and extract information about models published in the kidney transplantation literature and provide an overview of the status of our collective model-based knowledge about the kidney transplant process. METHODS Database searches were conducted in MEDLINE, Embase, Web of Science and other sources, for reviews and primary studies. We reviewed all English-language papers that presented a model that could be a tool to support decision making in kidney transplantation. Data were extracted on the clinical context and modelling methods used. RESULTS A total of 144 studies were included, most of which focused on a single component of the transplantation process, such as immunosuppressive therapy or donor-recipient matching and organ allocation policies. Pre- and post-transplant processes have rarely been modelled together. CONCLUSION A whole-disease modelling approach is preferred to inform precision medicine policy, given its potential upstream implementation in the treatment pathway. This requires consideration of pre- and post-transplant natural history, risk factors for allograft dysfunction and failure, and other post-transplant outcomes. Our call is for greater collaboration across disciplines and whole-disease modelling approaches to more accurately simulate complex policy decisions about the integration of precision medicine tools in kidney transplantation.
Collapse
Affiliation(s)
- Mohsen Yaghoubi
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, USA
| | - Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
| | - Steven Shechter
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Department of Medicine, Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada.
| |
Collapse
|
17
|
Estabrooks C, Saeidzadeh S, Bryan S, Norton P, Ginsburg L, Hoben M, McLeod D. SUPPORTING NURSING HOME MANAGERS TO ACT ON PERFORMANCE FEEDBACK DATA: A PROVINCEWIDE IMPLEMENTATION. Innov Aging 2022. [PMCID: PMC9766171 DOI: 10.1093/geroni/igac059.1520] [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: 12/24/2022] Open
Abstract
INFORM (Improving Nursing home care through Feedback on perfoRMance data) is a tested research intervention targeting care managers that demonstrated positive two year follow up results and has subsequently been shaped into an operationally acceptable “implementation package”. This package or innovation is being scaled up in one Canadian province’s total Long-Term-Care (LTC) home population with in depth process evaluation during the first cohort of LTC homes. This evaluation will, among other things, assess sector needs for adaptation (vs fidelity). At its core INFORM is designed to address managers’ learning needs with respect to using data to make positive change in a continuous learning loop. We will discuss the transformation of a research intervention to a sector innovation and report on interim process evaluation results.
Collapse
Affiliation(s)
| | | | - Stirling Bryan
- Michael Smith Health Research, Vancouver, British Columbia, Canada
| | | | | | | | - Don McLeod
- Translating Research in Elder Care, Edmonton, Alberta, Canada
| |
Collapse
|
18
|
Slomp C, Morris E, Edwards L, Hoens AM, Landry G, Riches L, Ridgway L, Bryan S, Austin J. Pharmacogenomic Testing for Major Depression: A Qualitative Study of the Perceptions of People with Lived Experience and Professional Stakeholders. Can J Psychiatry 2022:7067437221140383. [PMID: 36437757 DOI: 10.1177/07067437221140383] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES With increasing evidence for the clinical utility of pharmacogenomic (PGx) testing for depression, there is a growing need to consider issues related to the clinical implementation of this testing. The perspectives of key stakeholders (both people with lived experience [PWLE] and providers) are critical, but not frequently explored. The purpose of this study was to understand how PWLE and healthcare providers/policy experts (P/HCPs) perceive PGx testing for depression, to inform the consideration of clinical implementation within the healthcare system in British Columbia (BC), Canada. METHODS We recruited two cohorts of participants to complete individual 1-h, semi-structured interviews: (a) PWLE, recruited from patient and research engagement networks and organizations and (b) P/HCPs, recruited via targeted invitation. Interviews were audiotaped, transcribed verbatim, de-identified, and analysed using interpretive description. RESULTS Seventeen interviews were completed with PWLE (7 with experience of PGx testing for depression; 10 without); 15 interviews were completed with P/HCPs (family physicians, psychiatrists, nurses, pharmacists, genetic counsellors, medical geneticists, lab technologists, program directors, and insurers). Visual models of PWLE's and P/HCP's perceptions of and attitudes towards PGx testing were developed separately, but both were heavily influenced by participants' prior professional and/or personal experiences with depression and/or PGx testing. Both groups expressed a need for evidence and numerous considerations for the implementation of PGx testing in BC, including the requirement for conclusive economic analyses, patient and provider education, technological and clinical support, local testing facilities, and measures to ensure equitable access to testing. CONCLUSIONS While hopeful about the potential for therapeutic benefit from PGx testing, PWLE and P/HCPs see the need for robust evidence of utility, and BC-wide infrastructure and policies to ensure equitable and effective access to PGx testing. Further research into the accessibility, effectiveness, and cost-effectiveness of various implementation strategies is needed to inform PGx testing use in BC.
Collapse
Affiliation(s)
- Caitlin Slomp
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Emily Morris
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Louisa Edwards
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Alison M Hoens
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | | | | | | | - Stirling Bryan
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
- Department of Medical Genetics, 8166University of British Columbia, Vancouver, Canada
| |
Collapse
|
19
|
Bunka M, Ghanbarian S, Riches L, Landry G, Edwards L, Hoens AM, Bryan S. Collaborating with Patient Partners to Model Clinical Care Pathways in Major Depressive Disorder: The Benefits of Mixing Evidence and Lived Experience. Pharmacoeconomics 2022; 40:971-977. [PMID: 35877043 PMCID: PMC9522760 DOI: 10.1007/s40273-022-01175-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Partnering with patients can enrich the design and development of models of clinical care pathways, yet the practice is not commonplace. Guidelines or "best practices" for patient involvement in modeling are scarce. OBJECTIVES In this paper, we outline the steps we took to form an effective partnership with patients to design a robust microsimulation Markov model of major depressive disorder care pathways in British Columbia, Canada, with the aim of encouraging other teams to partner with patients in healthcare modeling endeavors. METHODS We describe three unique phases of our collaborative process: uncertainty, mapping, and structured collaboration. We then explore the unique contributions the patient partners made, not only to the model itself, but to our process. Key perspectives are shared from both the modeler and the patient partners in their own words. RESULTS The patient partners made distinct contributions by challenging and verifying modeling assumptions, noting limitations of the model, and suggesting areas for future research. Both the patient partners and the modelers saw great value in the partnership and agreed that the model was strengthened by the diversity of the team. CONCLUSIONS We present our learning and key recommendations for future modeling teams in the absence of tested frameworks. We encourage more widespread adoption of patient involvement in modeling and the development of guidelines for such work to increase the democracy of scientific decision making.
Collapse
Affiliation(s)
- Mary Bunka
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
| | - Shahzad Ghanbarian
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | | | | | - Louisa Edwards
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada
| | - Stirling Bryan
- School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 712 - 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| |
Collapse
|
20
|
Pataky RE, Bryan S, Sadatsafavi M, Peacock S, Regier DA. Tools for the Economic Evaluation of Precision Medicine: A Scoping Review of Frameworks for Valuing Heterogeneity-Informed Decisions. Pharmacoeconomics 2022; 40:931-941. [PMID: 35895254 DOI: 10.1007/s40273-022-01176-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Precision medicine highlights the importance of exploring heterogeneity in the effectiveness and costs of interventions. Our objective was to identify and compare frameworks for valuing heterogeneity-informed decisions, and consider their strengths and weaknesses for application to precision medicine. METHODS We conducted a scoping review to identify papers that proposed an analytical framework to place a value, in terms of costs and health benefits, on using heterogeneity to inform treatment selection. The search included English-language papers indexed in MEDLINE, Embase or EconLit, and a manual review of references and citations. We compared the frameworks qualitatively considering: the purpose and setting of the analysis; the types of precision medicine interventions where the framework could be applied; and the framework's ability to address the methodological challenges of evaluating precision medicine. RESULTS Four analytical frameworks were identified: value of stratification, value of heterogeneity, expected value of individualised care and loss with respect to efficient diffusion. Each framework is suited to slightly different settings and research questions. All focus on maximising net benefit, and quantify the opportunity cost of ignoring heterogeneity by comparing individualised or stratified decisions to a means-based population-wide decision. Where the frameworks differ is in their approaches to uncertainty, and in the additional metrics they consider. CONCLUSIONS Identifying and utilising heterogeneity is at the core of precision medicine, and the ability to quantify the value of heterogeneity-informed decisions is critical. Using an analytical framework to value heterogeneity will help provide evidence to inform investment in precision medicine interventions, appropriately capturing the value of targeted health interventions.
Collapse
Affiliation(s)
- Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer Research Centre, 675 W. 10th Ave, Vancouver, BC, V5Z 1L3, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Stirling Bryan
- 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
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer Research Centre, 675 W. 10th Ave, Vancouver, BC, V5Z 1L3, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer Research Centre, 675 W. 10th Ave, Vancouver, BC, V5Z 1L3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
21
|
Randall E, Bryan S, Black C, Goldsmith LJ. What matters to patients following total knee arthroplasty? A grounded theory of adapting to a knee replacement. BMC Musculoskelet Disord 2022; 23:845. [PMID: 36068507 PMCID: PMC9446772 DOI: 10.1186/s12891-022-05695-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 07/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure. Methods Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants’ experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants’ stories about what was front of mind when they reflected on satisfaction with their new knee. Results Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee’s achieved adequacy and the straightforwardness of the adapting process. Discussion The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants’ adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure. Conclusions The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.
Collapse
Affiliation(s)
- Ellen Randall
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada.
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada
| | - Charlyn Black
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Services and Policy Research, Vancouver, Canada
| | - Laurie J Goldsmith
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,GoldQual Consulting, Toronto, Canada
| |
Collapse
|
22
|
Levin A, Malbeuf M, Hoens AM, Carlsten C, Ryerson CJ, Cau A, Bryan S, Robinson J, Tarling T, Shum J, Lavallee DC. Creating a provincial post COVID-19 interdisciplinary clinical care network as a learning health system during the pandemic: Integrating clinical care and research. Learn Health Syst 2022; 7:e10316. [PMID: 35942206 PMCID: PMC9348470 DOI: 10.1002/lrh2.10316] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Coronavirus Disease-2019 (COVID-19) affects multiple organ systems in the acute phase and also has long-term sequelae. Research on the long-term impacts of COVID-19 is limited. The Post COVID-19 Interdisciplinary Clinical Care Network (PC-ICCN), conceived in July 2020, is a provincially funded resource that is modelled as a Learning Health System (LHS), focused on those people with persistent symptoms post COVID-19 infection. Methods The PC-ICCN emerged through collaboration among over 60 clinical specialists, researchers, patients, and health administrators. At the core of the network are the post COVID-19 Recovery Clinics (PCRCs), which provide direct patient care that includes standardized testing and education at regular follow-up intervals for a minimum of 12 months post enrolment. The PC-ICCN patient registry captures data on all COVID-19 patients with confirmed infection, by laboratory testing or epi-linkage, who have been referred to one of five post COVID-19 Recovery Clinics at the time of referral, with data stored in a fully encrypted Oracle-based provincial database. The PC-ICCN has centralized administrative and operational oversight, multi-stakeholder governance, purpose built data collection supported through clinical operations geographically dispersed across the province, and research operations including data analytics. Results To date, 5364 patients have been referred, with an increasing number and capacity of these clinics, and 2354 people have had at least one clinic visit. Since inception, the PC-ICCN has received over 30 research proposal requests. This is aligned with the goal of creating infrastructure to support a wide variety of research to improve care and outcomes for patients experiencing long-term symptoms following COVID-19 infection. Conclusions The PC-ICCN is a first-in-kind initiative in British Columbia to enhance knowledge and understanding of the sequelae of COVID-19 infection over time. This provincial initiative serves as a model for other national and international endeavors to enable care as research and research as care.
Collapse
Affiliation(s)
- Adeera Levin
- Division of NephrologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Michelle Malbeuf
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
- Providence Health CareVancouverBritish ColumbiaCanada
| | - Alison M Hoens
- Michael Smith Health Research BCVancouverBritish ColumbiaCanada
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
- Centre for Health Evaluation and Outcome SciencesSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Christopher Carlsten
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Legacy for Airway HealthVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
| | - Christopher J Ryerson
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Alessandro Cau
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Stirling Bryan
- Michael Smith Health Research BCVancouverBritish ColumbiaCanada
- Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Jaclyn Robinson
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
- Vancouver Coastal Health AuthorityVancouverBritish ColumbiaCanada
| | - Tamsin Tarling
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Joanne Shum
- Provincial Health Services AuthorityVancouverBritish ColumbiaCanada
| | - Danielle C Lavallee
- Michael Smith Health Research BCVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| |
Collapse
|
23
|
Sherwood K, Tran J, Günther O, Lan J, Aiyegbusi O, Liwski R, Sapir-Pichhadze R, Bryan S, Caulfield T, Keown P. Genome Canada precision medicine strategy for structured national implementation of epitope matching in renal transplantation. Hum Immunol 2022; 83:264-269. [DOI: 10.1016/j.humimm.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 02/08/2023]
|
24
|
Engel L, Bryan S, Whitehurst DGT. Conceptualising 'Benefits Beyond Health' in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis. Pharmacoeconomics 2021; 39:1383-1395. [PMID: 34423386 DOI: 10.1007/s40273-021-01074-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
There is growing interest in extending the evaluative space of the quality-adjusted life-year framework beyond health. Using a critical interpretive synthesis approach, the objective was to review peer-reviewed literature that has discussed non-health outcomes within the context of quality-adjusted life-years and synthesise information into a thematic framework. Papers were identified through searches conducted in Web of Science, using forward citation searching. A critical interpretive synthesis allows for the development of interpretations (synthetic constructs) that go beyond those offered in the original sources. The final output of a critical interpretive synthesis is the synthesising argument, which integrates evidence from across studies into a coherent thematic framework. A concept map was developed to show the relationships between different types of non-health benefits. The critical interpretive synthesis was based on 99 papers. The thematic framework was constructed around four themes: (1) benefits affecting well-being (subjective well-being, psychological well-being, capability and empowerment); (2) benefits derived from the process of healthcare delivery; (3) benefits beyond the recipient of care (spillover effects, externalities, option value and distributional benefits); and (4) benefits beyond the healthcare sector. There is a wealth of research concerning non-health benefits and the evaluative space of the quality-adjusted life-year. Further dialogue and debate are necessary to address conceptual and normative challenges, to explore the societal willingness to sacrifice health for benefits beyond health and to consider the equity implications of different courses of action.
Collapse
Affiliation(s)
- Lidia Engel
- Faculty of Health, Deakin University, Burwood, VIC, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Stirling Bryan
- 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
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
25
|
Trenaman L, Bryan S, Cuthbertson L, Sawatzky R, Stacey D, Bansback N. An economic valuation technique identified different inpatient care experience as priorities for older Canadians than a traditional approach. J Clin Epidemiol 2021; 139:1-11. [PMID: 34182147 DOI: 10.1016/j.jclinepi.2021.06.023] [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] [Received: 10/26/2020] [Revised: 05/25/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To (1) estimate the relative value of older adults' healthcare experiences based on the Canadian Patient Experience Survey for Inpatient Care (CPES-IC) using an economic valuation technique, and (2) compare the results with those of a conventional key-driver analysis of healthcare experiences based on bivariate correlations. STUDY DESIGN AND SETTING An online survey of 1,074 Canadians aged 60 and older who had been hospitalized within five years. Participants completed the CPES-IC and a best-worst scaling (BWS) valuation task. BWS data were analyzed using a conditional logit model. These results were compared to a conventional key-driver analysis that estimates importance through Spearman's correlations between experiences and a global rating of overall experience. RESULTS The valuation approach found that the three experiences most valued by patients were: that staff seemed informed and up-to-date about their hospital care, doctors explained things in a way that they could understand, and that they got all the information they needed about their care and treatment. Three of the top five most valued experiences from the valuation approach were among the top five in the key driver analysis. However, there were noteworthy differences in rank order. CONCLUSION The results of the valuation exercise can inform local and/or system level quality improvement efforts by identifying priorities from an economic evaluation point of view, which are different than those based on a conventional key-driver analysis. Given the degree of uncertainty in estimates both the rank order and confidence intervals should be used to guide decision-making.
Collapse
Affiliation(s)
- Logan Trenaman
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Lena Cuthbertson
- British Columbia Office of Patient-Centred Measurement, Ministry of Health/Providence Health Care, Vancouver, British Columbia, Canada
| | - Rick Sawatzky
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; School of Nursing, Trinity Western University, Vancouver, British Columbia, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada.
| |
Collapse
|
26
|
McNally M, Rock L, Gillis M, Bryan S, Boyd C, Kraglund F, Cleghorn B. Reopening Oral Health Services during the COVID-19 Pandemic through a Knowledge Exchange Coalition. JDR Clin Trans Res 2021; 6:279-290. [PMID: 33902341 PMCID: PMC8207488 DOI: 10.1177/23800844211011985] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 novel coronavirus closed oral health care in Nova Scotia (NS) Canada in March 2020. Preparing for a phased reopening, a knowledge exchange coalition (representing government, academia, hospitals, oral health professions, and regulators) developed return-to-work (RTW) guidelines detailing the augmentation of standard practices to ensure safety for patients, oral health care providers (OHPs), and the community. Using online surveys, this study explored the influence of the RTW guidelines and related education on registered NS OHPs during a phased return to work. METHODS Dissemination of R2W guidelines included website or email communiques and interdisciplinary education webinars that coincided with 2 RTW phases approved by the government. Aligned with each phase, all registered dentists, dental hygienists, and dental assistants were invited to complete an online survey to gauge the influence of the coalition-sponsored education and RTW guidelines, confidence, preparedness, and personal protective equipment use before and after the pandemic. RESULTS Three coalition-sponsored multidisciplinary webinars hosted 3541 attendees prior to RTW. The response to survey 1 was 41% (881/2156) and to survey 2 was 26% (571/2177) of registrants. Survey 1 (82%) and survey 2 (89%) respondents "agreed/strongly agreed" that R2W guidelines were a primary source for guiding return to practice, and most were confident with education received and had the skills needed to effectively treat patients during the COVID-19 pandemic. Confidence and preparedness improved in survey 2. Gowns/lab coat use for aerosol-generating procedures increased from 26% to 93%, and the use of full face shields rose from 6% to 93% during the pandemic. CONCLUSIONS A multistakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure unified reintegration of oral health services in NS during a pandemic. This multiorganizational cooperation lay the foundation for responses to subsequent waves of COVID-19 and may serve as an example for collaboratively responding to future public health threats in other settings. KNOWLEDGE TRANSFER STATEMENT The return-to-work strategy that was developed, disseminated, and assessed through this COVID-19 knowledge exchange coalition will benefit oral health practitioners, professional regulators, government policy makers, and researchers in future pandemic planning.
Collapse
Affiliation(s)
- M McNally
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - L Rock
- School of Dental Hygiene, Dalhousie University, Halifax, NS, Canada
| | - M Gillis
- Provincial Dental Board of Nova Scotia, Bedford, NS, Canada
| | - S Bryan
- College of Dental Hygienists of Nova Scotia, Halifax, NS, Canada
| | - C Boyd
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - F Kraglund
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - B Cleghorn
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
27
|
Lotti F, Twedt D, Warrit K, Bryan S, Vaca C, Krause L, Fukushima K, Boscan P. Effect of two different pre-anaesthetic omeprazole protocols on gastroesophageal reflux incidence and pH in dogs. J Small Anim Pract 2021; 62:677-682. [PMID: 33769569 DOI: 10.1111/jsap.13328] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Gastroesophageal reflux can occur during anaesthesia and may lead to esophagitis and occasionally oesophageal stricture formation. The aim of the study is to assess two omeprazole protocols on gastroesophageal reflux incidence and pH in anaesthetised dogs. MATERIALS AND METHODS Fifty-five dogs undergoing elective ovariectomy were randomly assigned to: omeprazole single dose 1 mg/kg orally the evening before anaesthesia (20 dogs), omeprazole two doses 1 mg/kg orally the evening and 3 hours before anaesthesia (15 dogs), and control group that did not receive omeprazole (20 dogs). An oesophageal impedance/pH probe was used to measure gastroesophageal reflux incidence and pH during anaesthesia. RESULTS Gastroesophageal reflux was observed in 55% (11/20) of control dogs, 55% (11/20) of dogs receiving omeprazole once and 47% (7/15) of dogs receiving omeprazole twice. The incidence was not statistically significant different between groups. Gastroesophageal reflux pH (mean ± sd) was higher in dogs receiving omeprazole twice (6.3 ± 1.5), when compared to either control dogs (3.8 ± 1.1) or dogs receiving omeprazole once (4.1 ± 1.5). Strongly acidic reflux (pH < 4) was observed in 7% (1/15) of dogs receiving omeprazole twice versus 55% (11/20) and 35% (7/20) of control dogs and dogs receiving omeprazole once, respectively. CLINICAL SIGNIFICANCE Omeprazole administered the evening and 3 hours before anaesthesia increased gastroesophageal reflux pH and decreased the incidence of strongly acidic reflux in dogs. A single dose of omeprazole given the evening before anaesthesia had no effect on reflux pH.
Collapse
Affiliation(s)
- F Lotti
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - D Twedt
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - K Warrit
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - S Bryan
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - C Vaca
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - L Krause
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - K Fukushima
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| | - P Boscan
- Department of Clinical Sciences, Veterinary Teaching Hospital (Colorado State University), 300 W. Drake, Fort Collins, CO, 80523-1678, USA
| |
Collapse
|
28
|
Johnson KM, Sadatsafavi M, Adibi A, Lynd L, Harrison M, Tavakoli H, Sin DD, Bryan S. Cost Effectiveness of Case Detection Strategies for the Early Detection of COPD. Appl Health Econ Health Policy 2021; 19:203-215. [PMID: 33135094 DOI: 10.1007/s40258-020-00616-2] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The value of early detection and treatment of chronic obstructive pulmonary disease (COPD) is currently unknown. We assessed the cost effectiveness of primary care-based case detection strategies for COPD. METHODS A previously validated discrete event simulation model of the general population of COPD patients in Canada was used to assess the cost effectiveness of 16 case detection strategies. In these strategies, eligible patients (based on age, smoking history, or symptoms) received the COPD Diagnostic Questionnaire (CDQ) or screening spirometry, at 3- or 5-year intervals, during routine visits to a primary care physician. Newly diagnosed patients received treatment for smoking cessation and guideline-based inhaler pharmacotherapy. Analyses were conducted over a 20-year time horizon from the healthcare payer perspective. Costs are in 2019 Canadian dollars ($). Key treatment parameters were varied in one-way sensitivity analysis. RESULTS Compared to no case detection, all 16 case detection scenarios had an incremental cost-effectiveness ratio (ICER) below $50,000/QALY gained. In the most efficient scenario, all patients aged ≥ 40 years received the CDQ at 3-year intervals. This scenario was associated with an incremental cost of $287 and incremental effectiveness of 0.015 QALYs per eligible patient over the 20-year time horizon, resulting in an ICER of $19,632/QALY compared to no case detection. Results were most sensitive to the impact of treatment on the symptoms of newly diagnosed patients. CONCLUSIONS Primary care-based case detection programs for COPD are likely to be cost effective if there is adherence to best-practice recommendations for treatment, which can alleviate symptoms in newly diagnosed patients.
Collapse
Affiliation(s)
- Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, Canada
- Institute for Heart and Lung Health, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Mark Harrison
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation (The James Hogg Research Centre), St. Paul's Hospital, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
29
|
Seixas BV, Regier DA, Bryan S, Mitton C. Describing practices of priority setting and resource allocation in publicly funded health care systems of high-income countries. BMC Health Serv Res 2021; 21:90. [PMID: 33499854 PMCID: PMC7839200 DOI: 10.1186/s12913-021-06078-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare spending has grown over the last decades in all developed countries. Making hard choices for investments in a rational, evidence-informed, systematic, transparent and legitimate manner constitutes an important objective. Yet, most scientific work in this area has focused on developing/improving prescriptive approaches for decision making and presenting case studies. The present work aimed to describe existing practices of priority setting and resource allocation (PSRA) within the context of publicly funded health care systems of high-income countries and inform areas for further improvement and research. METHODS An online qualitative survey, developed from a theoretical framework, was administered with decision-makers and academics from 18 countries. 450 individuals were invited and 58 participated (13% of response rate). RESULTS We found evidence that resource allocation is still largely carried out based on historical patterns and through ad hoc decisions, despite the widely held understanding that decisions should be based on multiple explicit criteria. Health technology assessment (HTA) was the tool most commonly indicated by respondents as a formal priority setting strategy. Several approaches were reported to have been used, with special emphasis on Program Budgeting and Marginal Analysis (PBMA), but limited evidence exists on their evaluation and routine use. Disinvestment frameworks are still very rare. There is increasing convergence on the use of multiple types of evidence to judge the value of investment options. CONCLUSIONS Efforts to establish formal and explicit processes and rationales for decision-making in priority setting and resource allocation have been still rare outside the HTA realm. Our work indicates the need of development/improvement of decision-making frameworks in PSRA that: 1) have well-defined steps; 2) are based on multiple criteria; 3) are capable of assessing the opportunity costs involved; 4) focus on achieving higher value and not just on adoption; 5) engage involved stakeholders and the general public; 6) make good use and appraisal of all evidence available; and 6) emphasize transparency, legitimacy, and fairness.
Collapse
Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), USA.
| | - Dean A Regier
- Cancer Control Research, BC Cancer and the Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, Canada
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| |
Collapse
|
30
|
Cook WL, Brasher PMA, Guy P, Bryan S, Donaldson MG, Sims-Gould J, McKay HA, Khan KM, Ashe MC. Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT. Gerontology 2020; 66:542-548. [PMID: 33176306 DOI: 10.1159/000510903] [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] [Received: 03/17/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. OBJECTIVE To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. METHODS A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3-12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0-12) at 12 months. RESULTS We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (n = 26) and usual care (UC, n = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI -0.3 to 2.0, p = 0.13). Adverse events were similar in the 2 groups. CONCLUSION The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.
Collapse
Affiliation(s)
- Wendy L Cook
- Division of Geriatric Medicine, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Providence Healthcare, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Pierre Guy
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada.,School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meghan G Donaldson
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada, .,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada,
| |
Collapse
|
31
|
Pearce A, Harrison M, Watson V, Street DJ, Howard K, Bansback N, Bryan S. Respondent Understanding in Discrete Choice Experiments: A Scoping Review. Patient 2020; 14:17-53. [PMID: 33141359 PMCID: PMC7794102 DOI: 10.1007/s40271-020-00467-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
Introduction Despite the recognised importance of participant understanding for valid and reliable discrete choice experiment (DCE) results, there has been limited assessment of whether, and how, people understand DCEs, and how ‘understanding’ is conceptualised in DCEs applied to a health context. Objectives Our aim was to identify how participant understanding is conceptualised in the DCE literature in a health context. Our research questions addressed how participant understanding is defined, measured, and used. Methods Searches were conducted (June 2019) in the MEDLINE, EMBASE, PsychINFO and Econlit databases, as well as hand searching. Search terms were based on previous DCE systematic reviews, with additional understanding keywords used in a proximity-based search strategy. Eligible studies were peer-reviewed journal articles in the field of health, related to DCE or best-worst scaling type 3 (BWS3) studies, and reporting some consideration or assessment of participant understanding. A descriptive analytical approach was used to chart relevant data from each study, including publication year, country, clinical area, subject group, sample size, study design, numbers of attributes, levels and choice sets, definition of understanding, how understanding was tested, results of the understanding tests, and how the information about understanding was used. Each study was categorised based on how understanding was conceptualised and used within the study. Results Of 306 potentially eligible articles identified, 31 were excluded based on titles and abstracts, and 200 were excluded on full-text review, resulting in 75 included studies. Three categories of study were identified: applied DCEs (n = 52), pretesting studies (n = 7) and studies of understanding (n = 16). Typically, understanding was defined in relation to either the choice context, such as attribute terminology, or the concept of choosing. Very few studies considered respondents’ engagement as a component of understanding. Understanding was measured primarily through qualitative pretesting, rationality or validity tests included in the survey, and participant self-report, however reporting and use of the results of these methods was inconsistent. Conclusions Those conducting or using health DCEs should carefully select, justify, and report the measurement and potential impact of participant understanding in their specific choice context. There remains scope for research into the different components of participant understanding, particularly related to engagement, the impact of participant understanding on DCE validity and reliability, the best measures of understanding, and methods to maximise participant understanding. Electronic supplementary material The online version of this article (10.1007/s40271-020-00467-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alison Pearce
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
32
|
Mah C, Noonan VK, Bryan S, Whitehurst DGT. Empirical Validity of a Generic, Preference-Based Capability Wellbeing Instrument (ICECAP-A) in the Context of Spinal Cord Injury. Patient 2020; 14:223-240. [PMID: 32981008 DOI: 10.1007/s40271-020-00451-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Assessing the validity of generic instruments across different clinical contexts is an important area of methodological research in economic evaluation and outcomes measurement. OBJECTIVE Our objective was to examine the empirical validity of a generic, preference-based capability wellbeing instrument (ICECAP-A) in the context of spinal cord injury. METHODS This study consisted of a secondary analysis of data collected using an online cross-sectional survey. The survey included questions regarding demographics, injury classifications and characteristics, secondary health conditions, quality of life and wellbeing, and functioning in activities of daily living. Analysis comprised the descriptive assessment of Spearman's rank correlations between item-/dimension-level data for the ICECAP-A and four preference-based health-related quality of life (HRQoL) instruments, and discriminant and convergent validity approaches to examine 21 evidence-informed or theoretically derived constructs. Constructs were defined using participant and injury characteristics and responses to a range of health, wellbeing and functioning outcomes. RESULTS Three hundred sixty-four individuals completed the survey. Mean index score for the ICECAP-A was 0.761; 12 (3%) individuals reported full capability (upper anchor; score = 1), and there were no reports of zero capabilities (lower anchor; score = 0). The strongest correlations were dominated by items and dimensions on the comparator (HRQoL) instruments that are non-health aspects of quality of life, such as happiness and control over one's life (including self-care). Of 21 hypothesised constructs, 19 were confirmed in statistical tests, the exceptions being the exploratory hypotheses regarding education and age at injury. CONCLUSION The ICECAP-A is an empirically valid outcome measure for assessing capability wellbeing in people with spinal cord injury living in a community setting. The extent to which the ICECAP-A provides complementary information to preference-based HRQoL instruments is dependent on the comparator.
Collapse
Affiliation(s)
- Cassandra Mah
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada.,Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
33
|
Trenaman L, Stacey D, Bryan S, Payne K, Hawker G, Bansback N. Long-term effect of patient decision aids on use of joint replacement and health care costs. Osteoarthritis Cartilage 2020; 28:819-823. [PMID: 32173628 DOI: 10.1016/j.joca.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/21/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Shared decision-making supported by patient decisions aids may improve care and reduce healthcare costs for persons considering total joint replacement. Observational studies and randomized controlled trials (RCTs) have evaluated the short-term impact of decision aids on uptake of surgery and costs, however the long-term effects are unclear. This analysis aimed to evaluate the effect of patient decision aids on 1) use of joint replacement up to 7-years of follow-up, and 2) osteoarthritis-related health system costs. METHODS 324 participants in a Canadian RCT with 2-years follow-up who were randomized to either a decision aid (n = 161) or usual care (n = 163) had their trial and health administrative data linked. The proportion undergoing surgery up to 7-years were compared using cumulative incidence plots and competing risk regression. Mean per-patient costs were compared using two sample t-tests. RESULTS At 2-years, 119 of 161 (73.9%) patients in the decision aid arm and 129 of 163 (79.1%) patients in the usual care arm had surgery. Between two and 7-years, 17 additional patients in both the decision aid (of 42, 40.4%) and usual care (of 34, 50.0%) arms underwent surgery. At 7-years, patients exposed to decision aids had a similar likelihood of undergoing surgery (HR = 0.92, 95% CI:0.73 to 1.17, p = 0.49) and mean per-patient costs ($21,965 vs $23,681, incremental cost: -$1,717, 95% CI:-$5,631 to $2,198) compared to those in usual care. CONCLUSIONS This is the first study to assess the long-term impact of decision aids on use of joint replacement and healthcare costs. These results are not conclusive but can inform future trial design. CLINICAL TRIAL REGISTRATION The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
Collapse
Affiliation(s)
- L Trenaman
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | - D Stacey
- University of Ottawa, Ottawa, Canada
| | - S Bryan
- University of British Columbia, Vancouver, Canada
| | - K Payne
- The University of Manchester, Manchester, UK
| | - G Hawker
- The University of Toronto, Toronto, Canada
| | - N Bansback
- University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada.
| |
Collapse
|
34
|
Ahmed S, Barbera L, Bartlett SJ, Bebb DG, Brundage M, Bryan S, Cheung WY, Coburn N, Crump T, Cuthbertson L, Howell D, Klassen AF, Leduc S, Li M, Mayo NE, McKinnon G, Olson R, Pink J, Robinson JW, Santana MJ, Sawatzky R, Moxam RS, Sinclair S, Servidio-Italiano F, Temple W. A catalyst for transforming health systems and person-centred care: Canadian national position statement on patient-reported outcomes. Curr Oncol 2020; 27:90-99. [PMID: 32489251 PMCID: PMC7253746 DOI: 10.3747/co.27.6399] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.
Collapse
Affiliation(s)
- S Ahmed
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - L Barbera
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - S J Bartlett
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - D G Bebb
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - M Brundage
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Bryan
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - W Y Cheung
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - N Coburn
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - T Crump
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - L Cuthbertson
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - D Howell
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - A F Klassen
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Leduc
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - M Li
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - N E Mayo
- Quebec: Department of Medicine School of Physical and Occupational Therapy, McGill University, Montreal (Ahmed, Mayo); Faculty of Medicine, McGill University, and McGill University Health Systems, Montreal (Bartlett)
| | - G McKinnon
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - R Olson
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - J Pink
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - J W Robinson
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - M J Santana
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - R Sawatzky
- British Columbia: School of Population and Public Health, University of British Columbia, Vancouver (Bryan); Office of Patient-Centred Measurement, British Columbia Ministry of Health, Vancouver (Cuthbertson); Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Prince George (Olson); School of Nursing, Trinity Western University, Langley (Sawatzky)
| | - R S Moxam
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - S Sinclair
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| | - F Servidio-Italiano
- Ontario: Queen's Cancer Research Institute, Kingston (Brundage); Sunnybrook Health Sciences Centre, Toronto (Coburn); Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto (Howell); McMaster University, Hamilton (Klassen); CancerInsight, Oakville (Leduc); Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto (Li); Canadian Partnership Against Cancer, Toronto (Moxam); Colorectal Cancer Resource and Action Network, Oakville (Servidio-Italiano)
| | - W Temple
- Alberta: Department of Oncology, University of Calgary, Calgary (Barbera, Bebb, Cheung); University of Calgary, Calgary (Crump, Temple); Departments of Surgery and Oncology, University of Calgary, Calgary (McKinnon); Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary (Pink, Santana); University of Calgary and Tom Baker Cancer Centre, Calgary (Robinson); Faculty of Nursing, University of Calgary, Calgary (Sinclair)
| |
Collapse
|
35
|
Affiliation(s)
- Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative (Krahn); Toronto General Hospital Research Institute (Krahn), Toronto, Toronto, Ont.; BC SUPPORT Unit (Bryan), BC Academic Health Science Network, Vancouver, BC; School of Population and Public Health (Bryan), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Bryan), Vancouver Coastal Health Research Institute, Vancouver, BC; Canadian Agency for Drugs and Technologies in Health (Lee); School of Epidemiology and Public Health (Lee), University of Ottawa, Ottawa, Ont.; Center for the Evaluation of Value and Risk in Health ( Neumann), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass.
| | - Stirling Bryan
- Toronto Health Economics and Technology Assessment Collaborative (Krahn); Toronto General Hospital Research Institute (Krahn), Toronto, Toronto, Ont.; BC SUPPORT Unit (Bryan), BC Academic Health Science Network, Vancouver, BC; School of Population and Public Health (Bryan), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Bryan), Vancouver Coastal Health Research Institute, Vancouver, BC; Canadian Agency for Drugs and Technologies in Health (Lee); School of Epidemiology and Public Health (Lee), University of Ottawa, Ottawa, Ont.; Center for the Evaluation of Value and Risk in Health ( Neumann), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass
| | - Karen Lee
- Toronto Health Economics and Technology Assessment Collaborative (Krahn); Toronto General Hospital Research Institute (Krahn), Toronto, Toronto, Ont.; BC SUPPORT Unit (Bryan), BC Academic Health Science Network, Vancouver, BC; School of Population and Public Health (Bryan), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Bryan), Vancouver Coastal Health Research Institute, Vancouver, BC; Canadian Agency for Drugs and Technologies in Health (Lee); School of Epidemiology and Public Health (Lee), University of Ottawa, Ottawa, Ont.; Center for the Evaluation of Value and Risk in Health ( Neumann), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass
| | - Peter J Neumann
- Toronto Health Economics and Technology Assessment Collaborative (Krahn); Toronto General Hospital Research Institute (Krahn), Toronto, Toronto, Ont.; BC SUPPORT Unit (Bryan), BC Academic Health Science Network, Vancouver, BC; School of Population and Public Health (Bryan), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Bryan), Vancouver Coastal Health Research Institute, Vancouver, BC; Canadian Agency for Drugs and Technologies in Health (Lee); School of Epidemiology and Public Health (Lee), University of Ottawa, Ottawa, Ont.; Center for the Evaluation of Value and Risk in Health ( Neumann), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass
| |
Collapse
|
36
|
Bryan S, Goldsmith LJ, Suryaprakash N, Sawatzky R, Mulldoon M, Le Mercier M, Moorthy D, Gandhi R, Bains SK, Li LC, Doyle-Waters M, Brown S. A research agenda to improve patients' experience of knee replacement surgery: a patient-oriented modified Delphi study of patients of South Asian origin in British Columbia. CMAJ Open 2020; 8:E226-E233. [PMID: 32220875 PMCID: PMC7124165 DOI: 10.9778/cmajo.20190128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Up to 1 in 5 patients who undergo total knee arthroplasty (TKA) express dissatisfaction with their surgery. Our goal was to understand the experiences of patients of South Asian origin who undergo TKA and to identify a research agenda for this patient population. METHODS We undertook a modified Delphi study in British Columbia to generate and prioritize potential research topics. An initial list of topics was generated using 3 focus groups with patients of South Asian origin who underwent TKA and their caregivers. Focus group sessions were audiotaped and transcribed, and the data were analyzed using thematic analysis. The resulting Delphi question-naire was administered over 2 rounds to patients, caregivers and health professionals. The second-round questionnaire included only topics that were strongly supported in the first round. A patient-oriented approach was adopted, with 3 patient partners as full research team members, who contributed to scoping, design, data collection, analysis and interpretation. RESULTS Twenty-one patients who had undergone TKA and 6 caregivers attended the focus groups. Our analyses resulted in 6 broad themes and 25 research topics, all of which were presented in the first round of the Delphi survey. The survey was completed by 27 patients and 5 caregivers (54% combined response rate) and by 25 clinicians (76% response rate). Top priorities both for patients and caregivers and for clinicians were promoting exercise following surgery and self-management after hospital discharge. One of the highest ranked topics for patients and caregivers was improving knee implants; this was supported by only 60% of clinicians. INTERPRETATION The patients and caregivers in our study prioritized research on promotion of exercise and self-management following surgery and improvement in knee implants. Future patient-oriented research efforts in Canada should emphasize these topics for this patient population.
Collapse
Affiliation(s)
- Stirling Bryan
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Laurie J Goldsmith
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Nitya Suryaprakash
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Richard Sawatzky
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Marilyn Mulldoon
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Moira Le Mercier
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - David Moorthy
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Rajiv Gandhi
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Satwinder Kaur Bains
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Linda C Li
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Mary Doyle-Waters
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| | - Sean Brown
- School of Population and Public Health (Bryan), University of British Columbia, Vancouver, BC; Faculty of Health Sciences (Goldsmith), Simon Fraser University, Burnaby, BC; GoldQual Consulting (Goldsmith), Toronto, Ont.; Centre for Clinical Epidemiology & Evaluation (Bryan, Suryaprakash, Doyle-Waters), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Nursing (Sawatzky), Trinity Western University, Langley, BC; patient partners (Mulldoon, Le Mercier, Moorthy), BC; Department of Surgery (Gandhi), University of Toronto, Toronto, Ont.; South Asian Studies Institute (Bains), University of the Fraser Valley, Abbotsford, BC; Department of Physical Therapy (Li), University of British Columbia, Vancouver, BC; Arthritis Research Canada (Li), Richmond, BC; Fraser Health (Brown), Surrey, BC
| |
Collapse
|
37
|
Johnson KM, Khakban A, Bryan S, Sin DD, Sadatsafavi M. Healthcare system encounters before COPD diagnosis: a registry-based longitudinal cohort study. Thorax 2019; 75:108-115. [PMID: 31704794 DOI: 10.1136/thoraxjnl-2019-213554] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/20/2019] [Accepted: 10/16/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is high interest in strategies for improving early detection of chronic obstructive pulmonary disease (COPD). These strategies often rely on opportunistic encounters between patients with undiagnosed COPD and the healthcare system; however, the frequency of these encounters is currently unknown. METHODS We used administrative health data for the province of British Columbia, Canada, from 1996 to 2015. We identified patients with COPD using a validated case definition, and assessed their visits to pharmacists, primary care and specialist physicians in the 5 years prior to the initial diagnosis of COPD. We used generalised linear models to compare the rate of outpatient visits between COPD and non-COPD comparator subjects matched on age, sex and socioeconomic status. RESULTS We assessed 112 635 COPD and non-COPD pairs (mean 68.6 years, 51.0% male). Patients with COPD interacted with pharmacists most frequently in the 5 years before diagnosis (mean 14.09, IQR 4-17 visits/year), followed by primary care (10.29, IQR 4-13 visits/year) and specialist (8.11, IQR 2-11 visits/year) physicians. In the 2 years prior to diagnosis, 72.1% of patients with COPD had a respiratory-related primary care visit that did not result in a COPD diagnosis. Compared with non-COPD subjects, patients with COPD had higher rates of primary care (rate ratio (RR) 1.40, 95% CI 1.39 to 1.41), specialist (RR 1.35, 95% CI 1.34 to 1.37) and pharmacist (RR 1.62, 95% CI 1.60 to 1.63) encounters. CONCLUSIONS Patients with COPD used higher rates of outpatient services before diagnosis than non-COPD subjects. Case detection technologies implemented in pharmacy or primary care settings have opportunities to diagnose COPD earlier.
Collapse
Affiliation(s)
- Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Amir Khakban
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Don D Sin
- University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Institute for Heart and Lung Health, The University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
38
|
Sampson CJ, Arnold R, Bryan S, Clarke P, Ekins S, Hatswell A, Hawkins N, Langham S, Marshall D, Sadatsafavi M, Sullivan W, Wilson ECF, Wrightson T. Transparency in Decision Modelling: What, Why, Who and How? Pharmacoeconomics 2019; 37:1355-1369. [PMID: 31240636 PMCID: PMC8237575 DOI: 10.1007/s40273-019-00819-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Transparency in decision modelling is an evolving concept. Recently, discussion has moved from reporting standards to open-source implementation of decision analytic models. However, in the debate about the supposed advantages and disadvantages of greater transparency, there is a lack of definition. The purpose of this article is not to present a case for or against transparency, but rather to provide a more nuanced understanding of what transparency means in the context of decision modelling and how it could be addressed. To this end, we review and summarise the discourse to date, drawing on our collective experience. We outline a taxonomy of the different manifestations of transparency, including reporting standards, reference models, collaboration, model registration, peer review and open-source modelling. Further, we map out the role and incentives for the various stakeholders, including industry, research organisations, publishers and decision makers. We outline the anticipated advantages and disadvantages of greater transparency with respect to each manifestation, as well as the perceived barriers and facilitators to greater transparency. These are considered with respect to the different stakeholders and with reference to issues including intellectual property, legality, standards, quality assurance, code integrity, health technology assessment processes, incentives, funding, software, access and deployment options, data protection and stakeholder engagement. For each manifestation of transparency, we discuss the 'what', 'why', 'who' and 'how'. Specifically, their meaning, why the community might (or might not) wish to embrace them, whose engagement as stakeholders is required and how relevant objectives might be realised. We identify current initiatives aimed to improve transparency to exemplify efforts in current practice and for the future.
Collapse
Affiliation(s)
| | - Renée Arnold
- Arnold Consultancy & Technology, LLC, 15 West 72nd Street-23rd Floor, New York, NY, 10023-3458, USA
| | - Stirling Bryan
- University of British Columbia, 701-828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
| | - Philip Clarke
- University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Sean Ekins
- Collaborations Pharmaceuticals Inc., 840 Main Campus Drive, Lab 3510, Raleigh, NC, 27606, USA
| | | | - Neil Hawkins
- University of Glasgow, Lilybank Gardens 1, Glasgow, G12 8RZ, UK
| | - Sue Langham
- Maverex Limited, 5 Brooklands Place, Brooklands Road, Sale, Cheshire, M33 3SD, UK
| | - Deborah Marshall
- University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Mohsen Sadatsafavi
- University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada
| | - Will Sullivan
- BresMed Health Solutions, Steel City House, West Street, Sheffield, S1 2GQ, UK
| | - Edward C F Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Tim Wrightson
- Adis International Limited, 5 The Warehouse Way, Northcote, 0627, Auckland, New Zealand
| |
Collapse
|
39
|
Stafinski T, Deber R, Rhainds M, Martin J, Noseworthy T, Bryan S, Menon D. The Introduction of New Non-Drug Health Technologies into Canadian Healthcare Institutions: Opportunities and Challenges. ACTA ACUST UNITED AC 2019; 15:95-106. [PMID: 31629459 PMCID: PMC7008698 DOI: 10.12927/hcpol.2019.25935] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction: A recent pan-Canadian survey of 48 health organizations concluded that structures, processes, factors and information used to support funding decisions on new non-drug health technologies (NDTs) vary within and across jurisdictions in Canada. Objectives: The objectives of this paper were to elicit the views of key stakeholders on the following: (1) possible rationale for these findings, (2) enablers and barriers to the adoption of new NDTs, (3) approaches to optimizing the usefulness of health technology assessment (HTA) and (4) creation of a centralized pan-Canadian review process for NDTs, similar to that already in place for prescription pharmaceuticals. Methods: A one-day facilitated roundtable involving 12 purposefully selected participants who were healthcare institutional/organizational leaders, hospital-based HTA program leaders and academic experts in HTA was conducted. Results: Participants validated the survey findings and identified the following two enablers of technology adoption: (1) access to dedicated information resources and (2) inclusion of innovation in organizational priorities. Participants also identified four barriers, including the lack of (1) consistent decision-making processes within an organization, (2) agreement on what is affordable, (3) integration of HTA and procurement and (4) HTA literacy. Suggested approaches to optimizing the use of HTA focused on embedding the local context into assessments. Conclusions: Given the nature of NDT decision-making and the importance of accounting for local factors in such processes, the value of a centralized HTA review mechanism similar to that in place for drugs may be limited.
Collapse
Affiliation(s)
- Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB
| | - Raisa Deber
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Marc Rhainds
- Unité d'évaluation des technologies et des modes d'intervention en santé , CHU de Québec - Université Laval, Laval, QC
| | - Janet Martin
- Director, Centre for Medical Evidence, Decision Integrity & Clinical Impact, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Tom Noseworthy
- Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, BC
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB
| |
Collapse
|
40
|
Stafinski T, Deber R, Rhainds M, Martin J, Noseworthy T, Bryan S, Menon D. Decision-Making on New Non-Drug Health Technologies by Hospitals and Health Authorities in Canada. ACTA ACUST UNITED AC 2019; 15:82-94. [PMID: 31629458 PMCID: PMC7008692 DOI: 10.12927/hcpol.2019.25936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: Unlike those for publicly funded drugs in Canada, coverage decision-making processes for non-drug health technologies (NDTs) are not well understood. Objectives: This paper aims to describe existing NDT decision-making processes in different healthcare organizations across Canada. Methods: A self-administered survey was used to determine demographic and financial characteristics of organizations, followed by in-depth interviews with senior leadership of consenting organizations to understand the processes for making funding decisions on NDTs. Results: Seventy-three and 48 organizations completed self-administered surveys and telephone interviews, respectively (with 45 participating in both ways). Fifty-five different processes were identified, the majority of which addressed capital equipment. Most involved multidisciplinary committees (with medical and non-medical representation), but the types of information used to inform deliberations varied. Across all processes, decision-making criteria included local considerations such as alignment with organizational priorities. Conclusions: NDT decision-making processes vary in complexity, depending on characteristics of the healthcare organization and context.
Collapse
Affiliation(s)
- Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB
| | - Raisa Deber
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Marc Rhainds
- Unité d'évaluation des technologies et des modes d'intervention en santé , CHU de Québec - Université Laval, Laval, QC
| | - Janet Martin
- Director, Centre for Medical Evidence, Decision Integrity & Clinical Impact, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Tom Noseworthy
- Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, BC
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB
| |
Collapse
|
41
|
Mitton C, Seixas BV, Peacock S, Burgess M, Bryan S. Health Technology Assessment as Part of a Broader Process for Priority Setting and Resource Allocation. Appl Health Econ Health Policy 2019; 17:573-576. [PMID: 31161365 DOI: 10.1007/s40258-019-00488-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Over the last two decades, economic evaluation of health technologies has developed enormously, affirming its importance within the pursuit of efficiency in the management of health care systems. One concern that has been raised with health technology assessment (HTA) has been its operationalization within the realm of decision making. Here, we suggest a mechanism by which HTA can be understood as an input into a broader framework for priority setting and resource allocation. When HTA is seen in this light, topics that at times have had some lack of clarity, such as public engagement and disinvestment, simply become steps in the overall decision-making process.
Collapse
Affiliation(s)
- Craig Mitton
- 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
| | - Brayan V Seixas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - Michael Burgess
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- W. Maurice Young Centre for Applied Ethics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- 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
| |
Collapse
|
42
|
Masucci L, Schreiber RA, Kaczorowski J, Collet JP, Bryan S. Universal screening of newborns for biliary atresia: Cost-effectiveness of alternative strategies. J Med Screen 2019; 26:113-119. [DOI: 10.1177/0969141319832039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Biliary atresia, a rare newborn liver disease, is the most common cause of liver-related death in children and the main indication for paediatric liver transplantation. Early detection and surgical intervention with a Kasai portoenterostomy offers the best chance for long-term patient survival. We conducted a cost-effectiveness analysis to compare no universal screening with screening using either a home-based infant stool colour card with passive card distribution strategy, or conjugated bilirubin testing. Methods A Markov model was developed, with structure, costs, and probabilities informed by the literature and clinical expert opinion, to simulate a newborn cohort over a 10-year time horizon. Health benefits were expressed as life-years gained. This analysis was conducted from the perspective of the Canadian publicly funded health care system (all costs in Canadian dollars). Both deterministic and probabilistic analyses were conducted. Results Screening using a home-based colour card with passive card distribution was a cost-effective option. For a population of 392,902 annual births in Canada, this strategy cost approximately $192,000 more than no universal screening but led to eight life-years gained (incremental cost-effectiveness ratio (ICER) = $24,065 per life-year gained). Screening using conjugated bilirubin testing versus the colour card cost $2,369,199 more and led to five more life-years gained (ICER= $473,840 per life year gained), and so was not cost-effective. Conclusions A home-based screening program using infant stool colour cards with a passive distribution strategy could be highly cost-effective when administered at a low unit cost and with a reasonable screening performance.
Collapse
Affiliation(s)
- Lisa Masucci
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Richard A Schreiber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of British Columbia, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Canada
| | - JP Collet
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
- Child and Family Research Institute, Vancouver, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
43
|
Sadatsafavi M, Ghanbarian S, Adibi A, Johnson K, FitzGerald JM, Flanagan W, Bryan S, Sin D. Development and Validation of the Evaluation Platform in COPD (EPIC): A Population-Based Outcomes Model of COPD for Canada. Med Decis Making 2019; 39:152-167. [PMID: 30678520 DOI: 10.1177/0272989x18824098] [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: 12/28/2022]
Abstract
BACKGROUND We report the development, validation, and implementation of an open-source population-based outcomes model of chronic obstructive pulmonary disease (COPD) for Canada. METHODS Evaluation Platform in COPD (EPIC) is a discrete-event simulation model of Canadians 40 years of age or older. Three core features of EPIC are its open-population design (incorporating projections of future population growth, aging, and smoking trends), its incorporation of heterogeneity in lung function decline and burden of exacerbations, and its modeling of the natural history of COPD from inception. Multiple original data analyses, as well as values reported in the literature, were used to populate the model. Extensive face validity and internal and external validity evaluations were performed. RESULTS The model was internally validated on demographic projections, mortality rates, lung function trajectories, COPD exacerbations, costs and health state utility values, and stability of COPD prevalence over time within strata of risk factors. In external validation, it moderately overestimated the rate of overall exacerbations in 2 independent trials but generated consistent estimates of rate of severe exacerbations and mortality. LIMITATIONS In its current version, EPIC does not consider uncertainty in the evidence. Several components such as additional (e.g., environmental and occupational) risk factors, treatment, symptoms, and comorbidity will have to be added in future iterations. Predictive validity of EPIC needs to be examined prospectively against future empirical studies. CONCLUSIONS EPIC is the first multipurpose, open-source, outcome- and policy-focused model of COPD for Canada. Platforms of this type have the capacity to be iteratively updated to incorporate the latest evidence and to project the outcomes of many different scenarios within a consistent framework.
Collapse
Affiliation(s)
- Mohsen Sadatsafavi
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shahzad Ghanbarian
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amin Adibi
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kate Johnson
- Faculty of Medicine and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - J Mark FitzGerald
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Don Sin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
44
|
Khowaja AR, Mitton C, Qureshi R, Bryan S, Magee LA, von Dadelszen P, Bhutta ZA. A comparison of maternal and newborn health services costs in Sindh Pakistan. PLoS One 2018; 13:e0208299. [PMID: 30521575 PMCID: PMC6283550 DOI: 10.1371/journal.pone.0208299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/23/2017] [Accepted: 11/15/2018] [Indexed: 12/21/2022] Open
Abstract
Pakistani women suffer the highest rate of maternal mortality in South Asia. A lack of comprehensive knowledge about maternal and newborn health (MNH) services costs impedes policy decisions to maximize the benefit from existing, as well as emerging, MNH interventions in Pakistan. We compared MNH service costs at different levels of care. A cross-sectional survey was conducted during January to March 2016 as part of a large economic evaluation in Sindh, Pakistan. Health providers and facilities were selected from a sampling frame, inclusive of public and private sectors. This study utilized a broad perspective (i.e. costs to the health system and patients/families). The unit costs of MNH services were determined through a simultaneous allocation method in the public facilities; and patient billing department in the private facilities. Descriptive analysis was performed, and an analysis of variance (ANOVA) test was applied to compare overall mean costs both within and between health facilities. A total of 31 eligible health providers and facilities (n = 25 in private; n = 7 in public) were included in the final analysis. An ambulatory visit (AV) for routine antenatal care (ANC) costs $3.6 and $0.9 at secondary- and tertiary-level public facilities, respectively. In the private sector, the costs of an AV for ANC were slightly less ($2.8) at secondary-level and much higher ($6) at tertiary-level facilities compared to the public sector. Diagnostic test costs were much higher in private facilities. The average costs of inpatient admissions were $30.5 at general ward (GW), and $151 at the intensive care unit (ICU) in public facilities. In-patient admissions costs were lower such as $9.3 at GW and $36.5 at ICU in private facilities. Understanding cost is critical to guide decisions of resource allocation within the public sector; and risk mitigation for excessive OOP costs through third party payer for services in the private sector.
Collapse
Affiliation(s)
- Asif Raza Khowaja
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation and School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation and School of Population and Public Health, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Rahat Qureshi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation and School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Laura A. Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London, United Kingdom
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine King's College London, United Kingdom
| | - Zulfiqar A. Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Program for Global Pediatric Research, Hospital For Sick Children, Toronto, Canada
| |
Collapse
|
45
|
Soril L, Mitton C, Seixas B, Bryan S, Clement F. Identifying and Prioritizing Low Value Care in British Columbia Using Three Administrative Health Data Assets. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionClinical recommendations and/or lists of low value care (i.e., health technologies that provide little to clinical benefit for certain patient groups) have garnered attention internationally through campaigns such as Choosing Wisely. However, uptake of such recommendations at the healthcare system-level remains challenging in the absence of routine, data-driven processes.
Objectives and ApproachThe objective of this work was to develop and implement a process, leveraging administrative health data assets and lists of ‘low value’ care, to identify and prioritize technologies at the healthcare system-level for reassessment and potential disinvestment. The British Columbia (BC) healthcare system was selected as the pilot site to test the process. Three provincial administrative health databases were used to examine the extent of low value care across the system: the discharge abstract database (DAD); the Medical Service Plan (MSP) physician claims database; and the MSP laboratory database.
ResultsOver 1300 recommendations of low value technologies (i.e., from the National Institute for Health and Care Excellence “do not do” recommendations, low value technologies in the Australian Medical Benefits Schedule, and Choosing Wisely “Top 5” lists) were identified. Using appropriate coding systems for BC’s administrative health data (e.g., International Classification of Diseases), low value technologies were queried to examine frequencies and costs of technology use between fiscal years 2010/11 and 2014/15. This information was used to rank technologies based high budgetary impact, defined as total in-hospital and claims expenditures exceeding $1M in any fiscal year examined. Clinical experts reviewed the ranked technologies prior to dissemination and stakeholder action. Pilot testing resulted in the prioritization of 9 candidate technologies for reassessment in the BC healthcare system.
Conclusion/ImplicationsThis work demonstrates the feasibility and strength of using administrative data to identify low value care at the healthcare system-level and prioritize candidates for reassessment. Faced with increasing pressure to control exorbitant costs, while maintaining quality of care, this process has been adopted and operationalized by the BC Ministry of Health.
Collapse
|
46
|
Soril LJJ, Seixas BV, Mitton C, Bryan S, Clement FM. Moving low value care lists into action: prioritizing candidate health technologies for reassessment using administrative data. BMC Health Serv Res 2018; 18:640. [PMID: 30111308 PMCID: PMC6094474 DOI: 10.1186/s12913-018-3459-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/15/2018] [Accepted: 08/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Active management of existing health technologies (e.g., devices, diagnostic, and/or medical procedures) to ensure the delivery of high value care is increasingly recognized around the world. A number of initiatives have raised awareness of technologies that may be overused, mis-used, or potentially harmful by compiling them into lists of low value care. However, despite the growing number of lists, changes to local healthcare practices remain challenging for many systems. The objective of this study was to develop and implement a process, leveraging existing initiatives and data assets, to produce a list of prioritized low value technologies for health technology reassessment (HTR). Methods An expert advisory committee comprised of clinical experts and health system decision-makers was convened to determine key process requirements. Once developed, the process was piloted to assess feasibility in the Canadian province of British Columbia (BC). Results The expert advisory committee identified five required attributes for the process: data-driven, routine and replicable, actionable, stakeholder collaboration, and high return on investment. Guided by these attributes, a 5-step process was developed. First, over 1300 published low value technologies (i.e., from the National Institute for Health and Care Excellence [NICE] “do not do” recommendations, low value technologies in the Australian Medical Benefits Schedule, and Choosing Wisely “Top 5” lists) were identified. Using appropriate coding systems for BC’s administrative health data (e.g., International Classification of Diseases [ICD]), the low value technologies were queried to examine frequencies and costs of technology use. This information was used to rank potential candidates for reassessment based on high annual budgetary impact. Lastly, clinical experts reviewed the ranked technologies prior to broad dissemination and stakeholder action. Pilot testing of the process in BC resulted in the prioritization of 9 initial candidate technologies for reassessment. Conclusions This is the first account of a systematic approach to move a collective body of low value technology recommendations into action in a healthcare setting. This work demonstrates the feasibility and strength of using administrative data to identify and prioritize low value technologies for HTR at a population-level. Electronic supplementary material The online version of this article (10.1186/s12913-018-3459-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lesley J J Soril
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Brayan V Seixas
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,British Columbia SUPPORT Unit, Vancouver, BC, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
47
|
Engel L, Bryan S, Noonan VK, Whitehurst DGT. Using path analysis to investigate the relationships between standardized instruments that measure health-related quality of life, capability wellbeing and subjective wellbeing: An application in the context of spinal cord injury. Soc Sci Med 2018; 213:154-164. [PMID: 30081357 DOI: 10.1016/j.socscimed.2018.07.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 01/03/2018] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 01/09/2023]
Abstract
While economic evaluations typically embrace health maximization as the maximization objective using quality-adjusted life years, there is increasing interest in the measurement of capability wellbeing and subjective wellbeing (SWB) for informing policy decisions. The objective of this study was to investigate the relationships between health-related quality of life (HRQoL), capability wellbeing and SWB. Data were used from 364 individuals living with spinal cord injury (SCI) who previously completed a web-based, cross-sectional survey (March-June 2013). Regression analyses were used to study the impacts of secondary health conditions on HRQoL, capability wellbeing and SWB; subsequently, a path analysis was used to assess direct and mediated pathways. HRQoL was measured using the EQ-5D-5L and the Assessment of Quality of Life 8-dimension (AQoL-8D) questionnaire; capability wellbeing was assessed using the ICEpop CAPability measure for Adults (ICECAP-A), and SWB was based on a single life satisfaction item (0-10 rating scale). Mean scores were 0.492, 0.573, 0.761 and 6.319 for EQ-5D-5L, AQoL-8D, ICECAP-A and SWB, respectively. Beta coefficients from the regression analyses indicated that secondary health conditions had the greatest negative impact on individuals' HRQoL (βAQoL-8D = -0.668, βEQ-5D-5L = -0.542), followed by SWB (βSWB = -0.481) and capability wellbeing (βICECAP-A = -0.477). Capability wellbeing mediated the effect of secondary health conditions on HRQoL and SWB. The indirect effect of secondary health conditions on SWB through HRQoL was not statistically significant when using EQ-5D-5L; indirect effects were found when using AQoL-8D, one through HRQoL only and one through both capability wellbeing and HRQoL. This study highlights the different impacts of secondary health conditions on HRQoL, capability and SWB in the context of SCI. While the greatest impact was observed on individuals' HRQoL, our results provide further evidence that capability wellbeing (here, the ICECAP-A) adds complementary information about outcomes that could be used in economic evaluation.
Collapse
Affiliation(s)
- Lidia Engel
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada; School of Health & Social Development Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 828 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada
| | - Vanessa K Noonan
- Rick Hansen Institute, 6400-6818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 W 10th Avenue, BC, V5Z 1M9, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, 828 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 W 10th Avenue, BC, V5Z 1M9, Canada
| |
Collapse
|
48
|
Hall W, Smith N, Mitton C, Urquhart B, Bryan S. Assessing and Improving Performance: A Longitudinal Evaluation of Priority Setting and Resource Allocation in a Canadian Health Region. Int J Health Policy Manag 2018; 7:328-335. [PMID: 29626400 PMCID: PMC5949223 DOI: 10.15171/ijhpm.2017.98] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/09/2015] [Indexed: 11/16/2022] Open
Abstract
Background: In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources.
Methods: The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization’s priority setting and resource allocation (PSRA) process 2 years post the original evaluation.
Results: Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization’s PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to reallocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization.
Conclusion: While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization’s journey, the authors’ intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources.
Collapse
Affiliation(s)
- William Hall
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Neale Smith
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Bonnie Urquhart
- Planning and Performance Improvement, Northern Health Authority, Prince George, BC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia (UBC), Vancouver, BC, Canada
| |
Collapse
|
49
|
Abstract
Canada is seeing increased interest in engaging patients in health research, recognizing the potential to improve its relevance and quality. The momentum is promising, but there may be a tendency to ignore the challenges inherent when lay people and professionals collaborate. We address some of these challenges as they relate to recruitment, training, and support for patients at the British Columbia (BC) Support for People and Patient-Oriented Research Unit, part of Canada's Strategy for Patient-Oriented Research. A retrospective review of a telehealth project demonstrates that, as well as the practical elements of recruitment, training, and support, attention must be paid to issues of credibility, legitimacy, and power when engaging patients. We propose that all patient-oriented research projects would benefit from using a similar framework to guide patient engagement planning and implementation, helping to anticipate and mitigate challenges from the outset. Projects would ideally also include the study of patient engagement methods, to add to this important body of knowledge.
Collapse
Affiliation(s)
- Bev J Holmes
- 1 Michael Smith Foundation for Health Research, Vancouver, British Columbia, Canada
| | | | - Kendall Ho
- 3 University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
50
|
Barer ML, Bryan S. Health Services Research Spending and Healthcare System Impact Comment on "Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal". Int J Health Policy Manag 2018. [PMID: 29524959 PMCID: PMC5890075 DOI: 10.15171/ijhpm.2017.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/09/2022] Open
Abstract
The challenges associated with translating health services and policy research (HSPR) evidence into practice are many and long-standing. Indeed, those challenges have themselves spawned new areas of research, including knowledge translation and implementation science. These sub-disciplines have increased our understanding of the critical success factors associated with the uptake of research evidence into (system) practice. Engaging those for whom research evidence is likely to help solve implementation and/or policy problems, and ensuring that they are key partners throughout the research life-cycle, appear to us (based on current evidence) to be the most direct and effective paths to improved knowledge translation. In that regard, building on Canada's recent Strategy for Patient Oriented Research (SPOR) would seem to offer considerable promise. The "modest" proposals offered by Thakkar and Sullivan seem less likely to bear fruit.
Collapse
Affiliation(s)
- Morris L Barer
- Centre for Health Services and Policy Research and School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation and School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|