Background: Open-group behavioral weight management programs are effective in the short term but longer term outcomes are unclear. We conducted the first randomized controlled trial to evaluate the ...5-year effectiveness and cost-effectiveness of a commercial opengroup intervention versus standard care. Methods: We randomized 1267 adults from English primary care practices with BMI>=28kg/m2 to either a brief intervention, 12-week behavioral program, or 52-week behavioral program in a 2:5:5 allocation. We followed them up 5 years later. We estimated adjusted differences in 5-year weight change between randomized groups using ANCOVA, assessed within-trial cost-effectiveness, and modeled long-term cost-effectiveness. This study is registered: ISRCTN64986150. Results: We ascertained weight for 871 (69%) participants. Mean (SD) weight change from baseline to 5 years was -0.46kg (8.31) in the brief intervention group, -1.95kg (9.55) in the 12-week program group, and -2.67kg (9.81) in the 52-week program. The adjusted difference (95%CI) was -1.76kg (-3.68, 0.17) between the 52-week program and the brief intervention; -0.96 kg (-2.90, 0.97) between the 12-week program and the brief intervention; and -0.80kg (-2.13, 0.54) between the 52-week and the 12-week program. There was no evidence of any differences between groups in fat mass, glycated hemoglobin, lipid profile and blood pressure. During the study, the 12-week program incurred the lowest cost and produced the highest Quality Adjusted Life Years (QALY). Modeling of clinical events beyond 5 years, suggested the 52-week program would deliver the highest QALYs at the lowest cost. Conclusions: Whilst 5-year differences in weight were not conclusive, they counter the common belief that all weight lost is quickly regained. Although there was no evidence within the trial that cardiovascular risk factors improved, long-term modeling suggests that commercial open-group behavioral programs are likely to reduce the incidence of weight-related disease and may be cost-saving.
Financial Management for Health-System Pharmacists, 2nd edition, serves as a guidebook to support the management of enterprise pharmacy finance across business and care continuums. The 2nd edition ...engages the reader with a mix of chapters, some new to this edition, along with a trove of new health-system pharmacy financial business cases. As leaders look to transform their organizations, the principles and practices provided give the reader the knowledge and guidance to craft a new path forward as they look to improve the provision of pharmacy and patient-care services.
Time Horizons in Cost Analyses/Reply Majer, Istvan M; Kumar, Shaji K; Palmer, Stephen ...
JAMA : the journal of the American Medical Association,
08/2019, Letnik:
322, Številka:
6
Journal Article
Background: Interventions are regularly developed, packaged, and tested aimed at increasing the effectiveness of clinical treatment for adolescents with obesity, but the cost-effectiveness of these ...strategies are less frequently established. Few studies have reported the methods employed and challenges faced when establishing the costs these interventions. The objective of this study is to conduct an economic evaluation of two different obesity intervention programs. This study will establish the economic costs for delivering these programs and the cost basis for a cost-effectiveness analysis of these programs. Methods: Two interventions were developed aimed at increasing the effectiveness of clinical obesity treatment for adolescents. The first (ImPACT), was designed as a compliment to the Brenner Families in Training (BFIT) pediatric weight management clinic, with mHealth components designed to increase self-monitoring, goal setting, and engagement with the clinical team through provision of accessible, educational materials and behavioral self-monitoring tools. The second (Dyad Plus), is a compliment to the youth serving BFIT program and the adult serving By Design Essentials, a weight management clinic for the adult caregiver. Dyad Plus includes six additional virtual lessons for the parent/child dyad designed to build communication skills to reinforce the goals and behavior change strategies taught at each clinic. Economic costs associated with both interventions were collected, evaluated, and calculated. Results: Four types of costs were assessed for each intervention: medical vs. non-medical, and direct vs. non-direct. Costs that were considered unique to conducting the research project were excluded from the cost analysis. Challenges related to the tailored nature of the clinic services and delineation of non-direct costs were encountered. Conclusions: This economic evaluation technique can serve as an example for other investigators who plan to conduct similar economic assessments for their clinical interventions.
Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards ...(CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.
Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments ...related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of
whether
and
how
to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.
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