Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior ...GDM within their first postnatal year.
In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat ITT analysis) over 12 mo were as follows: -0.23 kg body weight in intervention group (95% CI -0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference -0.95 kg, 95% CI -1.87, -0.04; group by treatment interaction p = 0.04); -2.24 cm waist measurement in intervention group (95% CI -3.01, -1.42) compared with -1.74 cm in usual care group (95% CI -2.52, -0.96) (change difference -0.50 cm, 95% CI -1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference -0.05 mmol/l, 95% CI -0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline.
Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention.
Australian New Zealand Clinical Trials Registry ACTRN12610000338066.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess cost-effectiveness of newborn screening (NBS) for spinal muscular atrophy (SMA) and early treatment with nusinersen or onasemnogene abeparvovec (gene therapy), compared with nusinersen ...without SMA screening.
Informed by an Australian state-wide SMA NBS programme, a decision analytical model nested with Markov models was constructed to evaluate costs and quality-adjusted life-years (QALYs) from a societal perspective with sensitivity analyses.
By treating one presymptomatic SMA infant with nusinersen or gene therapy, an additional 9.93 QALYs were gained over 60 years compared with late treatment in clinically diagnosed SMA. The societal cost was $9.8 million for early nusinersen treatment, $4.4 million for early gene therapy and $4.8 million for late nusinersen treatment. Compared with late nusinersen treatment, early gene therapy would be dominant, gaining 9.93 QALYs while saving $360 000; whereas early nusinersen treatment would result in a discounted incremental cost-effectiveness ratio (ICER) of $507 000/QALY.At a population level, compared with no screening and late treatment with nusinersen, NBS and early gene therapy resulted in 0.00085 QALY gained over 60 years and saving $24 per infant screened (85 QALYs gained and $2.4 million saving per 100 000 infants screened). More than three quarters of simulated ICERs by probability sensitivity analyses showed NBS and gene therapy would be dominant or less than $50 000/QALY, compared with no screening and late nusinersen treatment.
NBS coupled with gene therapy improves the quality and length of life for infants with SMA and would be considered value-for-money from an Australian clinical and policy context.
IMPORTANCE: The HLA-B*15:02 allele has been associated with an increased risk of carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in specific Asian populations (including ...Han Chinese, Malaysian, Thai, and Vietnamese individuals). While HLA-B*15:02 genotype testing in Asian populations is recommended by several international prescribing guidelines, it is not subsidized by the Medicare Benefits Schedule in Australia. OBJECTIVE: To evaluate the cost-effectiveness of HLA-B*15:02 genotyping in Asian Australian patients with epilepsy. DESIGN, SETTING, AND PARTICIPANTS: A model with components of decision analysis and Markov simulation was developed to simulate clinical trajectories of adult Asian Australian patients with newly diagnosed epilepsy being considered for carbamazepine treatment. Cost-effectiveness and cost-utility analyses over a lifetime time horizon were conducted from the perspective of the Australian health care sector. The study was conducted in May 2023 and data analysis was performed from August 2023 to November 2023. INTERVENTION: No HLA-B*15:02 genotyping and the empirical initiation of treatment with carbamazepine vs HLA-B*15:02 genotyping and the initiation of treatment with valproate in allele carriers. MAIN OUTCOMES AND MEASURES: Life-years (LYs), quality-adjusted life-years (QALYs), and costs in 2023 Australian dollars (A$); incremental cost-effectiveness ratios. RESULTS: HLA-B*15:02 screening was associated with an additional mean cost of A$114 (95% CI, −A$83 to A$374; US$76; 95% CI, −US$55 to US$248) and a reduction in 0.0152 LYs (95% CI, 0.0045 to 0.0287 LYs) but improvement by 0.00722 QALYs (95% CI, −0.0247 to −0.01210) compared with no screening, resulting in an incremental cost-effectiveness ratio of A$15 839 per QALY gained (US$10 523 per QALY). Therefore, universal genotyping for Asian Australian individuals was cost-effective compared with current standards of practice at the A$50 000 per QALY willingness-to-pay threshold. Sensitivity analyses demonstrated that the intervention remained cost-effective across a range of costs, utilities, transition probabilities, and willingness-to-pay thresholds. At the A$50 000 per QALY willingness-to-pay threshold, universal screening was the preferred strategy in 88.60% of simulations. CONCLUSIONS AND RELEVANCE: The results of this economic evaluation suggest that HLA-B*15:02 screening represents a cost-effective choice for Asian Australian patients with epilepsy who are being considered for treatment with carbamazepine.
Abstract
Background
The Pharmacy Diabetes Screening Trial (PDST) evaluated three approaches to screening for undiagnosed type 2 diabetes mellitus (T2DM) in community pharmacy: (1) paper-based risk ...assessment (AUSDRISK) alone; and AUSDRISK followed by a point of care test if AUSDRISK ≥ 12; with either (2) HbA1c; or (3) small capillary blood glucose Test (scBGT). This paper reports the perspectives and experiences of the pharmacy screening service of two key stakeholder groups: screening participants and general practitioners (GPs).
Methods
All referred participants (
n
= 2242) received an online survey to determine the outcome of the referral, as well as their level of satisfaction with the service. In addition, a random sample of 2,989 (20%) of non-referred participants were surveyed to determine their overall experience and level of satisfaction with the service. GPs to whom participants were referred were contacted to establish if, since the date of the screening service, their patient had (1) been to see them; (2) had further tests performed (FBG, RBG, OGTT, HbA1c); or (3) been diagnosed with diabetes or prediabetes. Descriptive statistics were reported for quantitative data. Factors associated with visiting the GP following screening were assessed using multivariable logistic regression. Qualitative data were analysed using content analysis.
Results
Response rates 16% (
n
= 369) and 17% (
n
= 520) were achieved for the three-month referred and non-referred participant surveys, respectively. Over 90% of respondents were very positive about the screening service (
n
= 784/853) and would recommend it to a family member or friend (
n
= 784/853). Participants also reported making significant improvements in diet and exercise, because of the screening. Among referred respondents, those who received a POC test were twice as likely to visit their GP compared to those who received a risk assessment only (OR 2.11 95% CI 1.46–3.06
)
. GPs (15.8% response rate,
n
= 57/361) indicated that the referral worked well and that recommendations for follow-up care by the pharmacist were appropriate.
Conclusion
Opportunistic screening of individuals during routine encounters with the community pharmacy in a previously undiagnosed population has been shown to foster positive engagement with consumers and GPs, which may assist in reducing the burden of T2DM on the individual and the community.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We aimed to evaluate factors associated with HRQoL among a cohort of PWID in ...Australia.
Methods
Participants were enrolled in an observational cohort study (the LiveRLife Study) between 2014 and 2018 at 15 sites in Australia. They provided fingerstick whole-blood samples for point-of-care HCV RNA testing and underwent transient elastography to assess liver disease. Participants completed the EQ-5D-3L survey at enrolment. Regression models were used to assess the impact of clinical and socioeconomic characteristics on the EQ-5D-3L scores.
Results
Among 751 participants (median age, 43 years; 67% male), 63% reported injection drug use in the past month, 43% had current HCV infection, and 68% had no/mild liver fibrosis (F0/F1). The mean EQ-5D-3L and EQ-VAS scores were 0.67 and 62, respectively, for the overall study population. There was no significant difference in the EQ-5D-3L scores among people with and without recent injecting drug use (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.78, P = 0.405), and among people receiving and not receiving opioid agonist therapy (mean: 0.66 vs. 0.68, median: 0.73 vs. 0.76, P = 0.215). Participants who were employed were found to have the highest mean EQ-5D-3L (0.83) and EQ-VAS scores (77). The presence of current HCV infection, liver fibrosis stage, and high-risk alcohol consumption had little impact on HRQoL.
Conclusions
The study findings provide important HRQoL data for economic evaluations, useful for guiding the allocation of resources for HCV elimination strategies and interventions among PWID.
Purpose
To examine the acceptability of the methods used to evaluate
Coping-Together
, one of the first self-directed coping skill intervention for couples facing cancer, and to collect preliminary ...efficacy data.
Methods
Forty-two couples, randomized to a minimal ethical care (MEC) condition or to
Coping-Together
, completed a survey at baseline and 2 months after, a cost diary, and a process evaluation phone interview.
Results
One hundred seventy patients were referred to the study. However, 57 couples did not meet all eligibility criteria, and 51 refused study participation. On average, two to three couples were randomized per month, and on average it took 26 days to enrol a couple in the study. Two couples withdrew from MEC, none from
Coping-Together
. Only 44 % of the cost diaries were completed, and 55 % of patients and 60 % of partners found the surveys too long, and this despite the follow-up survey being five pages shorter than the baseline one. Trends in favor of
Coping-Together
were noted for both patients and their partners.
Conclusions
This study identified the challenges of conducting dyadic research, and a number of suggestions were put forward for future studies, including to question whether distress screening was necessary and what kind of control group might be more appropriate in future studies.
Systematic review of the economic impact of cerebral palsy Tonmukayakul, Utsana; Shih, Sophy T.F.; Bourke-Taylor, Helen ...
Research in developmental disabilities,
September 2018, 2018-Sep, 2018-09-00, 20180901, Letnik:
80
Journal Article
Recenzirano
Cerebral palsy (CP) and its associated conditions can pose a significant economic burden on families, the health care system and the general economy. The boundary for inclusion of costs in research ...can vary substantially across studies.
To summarize the evidence for burden of disease for CP including the impacts on the health system, the community and carers.
Literature was identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library. The search was restricted to articles published in English between 1970 and April 2016. All costs were converted to $USD 2016 price.
Twenty-two articles were included. Studies varied from snapshot cost descriptions to more complex lifetime estimates, from prevalence-based to incidence-based studies, and from inclusion to exclusion of non-medical costs. There was a strong positive relationship between CP severity and expenditure. Significant costs were incurred by families and the welfare system to facilitate school and community engagement.
Facilitating participation for people with CP involves substantial expense. The size, nature and distribution of the economic burden emphasises the importance of finding effective strategies to reduce the risk and severity of CP, together with how it is financed.
Aim
Economic appraisal can help guide policy‐making for purchasing decisions, and treatment and management algorithms for health interventions. We conducted a systematic review of economic studies in ...cerebral palsy (CP) to inform future research.
Method
Economic studies published since 1970 were identified from seven databases. Two reviewers independently screened s and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Any discrepancies were resolved by discussion.
Results
Of 980 identified references, 115 were included for full‐text assessment. Thirteen articles met standard criteria for a full economic evaluation, two as partial economic evaluations, and 18 as cost studies. Six were full economic evaluations alongside clinical studies or randomized controlled trials, whereas seven involved modelling simulations. The economic case for administration of magnesium sulfate for imminent preterm birth is compelling, achieving both health gain and cost savings. Current literature suggests intrathecal baclofen therapy and botulinum toxin injection are cost‐effective, but stronger evidence for long‐term effects is needed. Lifestyle and web‐based interventions are inexpensive, but broader measurement of outcomes is required.
Interpretation
Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost‐effective, although stronger evidence of clinical effectiveness is needed.
What this paper adds
Cost‐effectiveness evidence shows prevention is the most significant strategy.
Some treatments are cost‐effective, but stronger evidence for long‐term effectiveness is required.
Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications.
Resumen
Evaluación económica y de costos de las intervenciones para la parálisis cerebral: una revisión sistemática
Objetivo
La evaluación económica puede ayudar a orientar la formulación de políticas para las decisiones de compra y los algoritmos de tratamiento y gestión para las intervenciones de salud. Realizamos una revisión sistemática de los estudios económicos en parálisis cerebral (PC) para informar la investigación futura.
Método
Los estudios económicos publicados desde 1970 se identificaron a partir de siete bases de datos. Dos revisores analizaron de forma independiente los resúmenes y extrajeron los datos siguiendo los lineamientos de los ítems de informes preferidos para revisiones sistemáticas y metaanálisis (PRISMA). Cualquier discrepancia se resolvió mediante discusión.
Resultados
De 980 referencias identificadas, 115 se incluyeron para la evaluación de texto completo. Trece artículos cumplieron con los criterios estándar para una evaluación económica completa, dos como evaluaciones económicas parciales y 18 como estudios de costos. Seis fueron evaluaciones económicas completas junto con estudios clínicos o ensayos controlados aleatorios, mientras que siete incluyeron simulaciones de modelado. El argumento económico para la administración de sulfato de magnesio para un parto prematuro inminente es convincente, logrando tanto un aumento de la salud como un ahorro en los costos. La literatura actual sugiere que el tratamiento con baclofeno intratecal y la inyección de toxina botulínica son rentables, pero se necesitan pruebas más sólidas de los efectos a largo plazo. Las intervenciones mediadas por páginas webs (web‐based interventions) e intervenciones focalizadas en el estilo de vida son económicas, pero se requiere una medición más amplia de los resultados.
Interpretación
La prevención de ls PC evitaría una carga económica significativa. Se ha demostrado que algunos tratamientos e intervenciones son rentables, aunque se necesitan pruebas más sólidas de la eficacia clínica.
Resumo
Avaliação econômica e custo das intervenções para paralisia cerebral: uma revisão sistemática
Objetivo
A apreciação econômica pode ajudar na elaboração de políticas para decisões sobre aquisição de serviços, e nos algoritmos para manejo e tratamento relacionados a intervenções em saúde. Nós realizamos uma revisão sistemática dos estudos econômicos em paralisia cerebral (PC) para informar futuras pesquisas.
Método
Estudos econômicos publicados desde 1970 foram identificados em sete bases de dados. Dois revisores avaliaram independentemente os resumos e extraíram dados seguindo as diretrizes dos Itens preferidos para reportar em revisões sistemáticas e metanálises (PRISMA). Quaisquer discrepâncias foram resolvidas por discussão.
Resultados
Das 980 referências identificadas, 115 foram incluídas para avaliação do texto completo. Treze artigos atenderam aos critérios para avaliação econômica completa, dois como avaliação econômica parcial, e 18 como estudos de custo. Seis foram avaliações econômicas completas acompanhando estudos clínicos, enquanto sete envolveram simulações de modelos. O caso econômico relativo à administração de sulfato de magnésio para o nascimento prematuro iminente é atraente, atingindo tanto ganho em saúde quanto economia de custos. A literatura atual sugere que as terapias com baclofeno intratecal e injeção de toxina botulínica são custo‐efetivas, mas evidências mais fortes quanto aos efeitos de longo prazo são necessárias. Intervenções sobre o estilo de vida e baseadas na internet são baratas, mas medidas de resultados mais amplas são necessárias.
Interpretação
A prevenção da PC evitaria custos econômicos significativos. Alguns tratamentos e intervenções têm se mostrado custo‐efetivos, embora evidências mais fortes de efetividade clínica sejam necessárias.
What this paper adds
Cost‐effectiveness evidence shows prevention is the most significant strategy.
Some treatments are cost‐effective, but stronger evidence for long‐term effectiveness is required.
Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications.
This systematic review is commented on by Marceniuk on page 532 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
Video Podcast: https://www.youtube.com/watch?v=poG_Z6ArWEQ&feature=youtu.be
Public health programs to reduce the significant burden of skin cancer have been implemented in Australia and around the world. The economic rationale for prevention needs to be kept up-to-date as ...relevant disease patterns, risk factors and expenditure patterns change through time. The aim of this study was to update and extend the economic credentials for skin cancer prevention in Australia.
Economic evaluations were conducted in 2015 with multiple methods applied, including cost-effectiveness and cost-benefit analysis, multiple study perspectives (‘societal’, ‘health sector’, ‘3rd party funder’) and counterfactual analysis sourced from cancer incidence between 1982 and 2011. Modelled outcomes included ‘cases prevented’, ‘deaths averted’ and ‘health-adjusted life-years’. Cost-benefit Analysis, including productivity impacts in the general economy, was conducted.
With an additional $AUD 0.16 ($USD 0.12) per capita investment into future skin cancer prevention across Australia, 140,000 skin cancer cases would be prevented over the 20year reference period (2011 to 2030). Depending on study perspective and method, the upgraded program is either dominant (achieving both health gains and cost offsets) or highly cost-effective (health gain at modest net cost). Return on investment (ROI) was $AUD 3.20 per dollar invested, with net social benefit of $AUD 1.43 billion.
The study confirmed the strong economic credentials for skin cancer prevention and provided sound arguments for increased investment in Australia. The reference case analysis provides a useful benchmark for other countries to consider in the design and funding of their prevention programs.
•A comprehensive skin cancer prevention program can be both life-saving and cost-saving.•A potential return of $3.20 can be achieved for every dollar invested.•The SunSmart program in Australia provides a benchmark for other countries to consider.
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