Some falls prevention interventions for the older population appear cost-effective, but there is uncertainty about others. Therefore, we aimed to model three types of exercise programme each running ...for 25 years among 65+ year olds: (i) a peer-led group-based one; (ii) a home-based one and (iii) a commercial one.
An established Markov model for studying falls prevention in New Zealand (NZ) was adapted to estimate incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-years (QALYs) gained. Detailed NZ experimental, epidemiological and cost data were used for the base year 2011. A health system perspective was taken and a discount rate of 3% applied. Intervention effectiveness estimates came from a Cochrane Review.
The intervention generating the greatest health gain and costing the least was the home-based exercise programme intervention. Lifetime health gains were estimated at 47 100 QALYs (95%uncertainty interval (UI) 22 300 to 74 400). Cost-effectiveness was high (ICER: US$4640 per QALY gained; (95% UI US$996 to 10 500)), and probably more so than a home safety assessment and modification intervention using the same basic model (ICER: US$6060). The peer-led group-based exercise programme was estimated to generate 42 000 QALYs with an ICER of US$9490. The commercially provided group programme was more expensive and less cost-effective (ICER: US$34 500). Further analyses by sex, age group and ethnicity (Indigenous Māori and non-Māori) for the peer-led group-intervention showed similar health gains and cost-effectiveness.
Implementing any of these three types of exercise programme for falls prevention in older people could produce considerable health gain, but with the home-based version being likely to be the most cost-effective.
A case of botulism in New Zealand Smyth, Duncan; Deverall, Eamonn; Balm, Michelle ...
New Zealand medical journal,
2015-Nov-20, Volume:
128, Issue:
1425
Journal Article
Peer reviewed
Open access
We describe the first case of food-borne botulism seen in New Zealand for 30 years. Botulism is an important diagnosis to consider in a patient with rapidly progressive descending paralysis and ...normal sensorium. Early recognition, timely institution of intensive care support and administration of botulism antitoxin are the most important aspects of management.
To sample and analyse the number, type, length of stay and costs of admissions for children with spina bifida, and to review operations requiring general anaesthesia and radiological investigations ...of patients undergoing surgical management for spina bifida.
Six sequential adolescents with spina bifida managed through the paediatric surgical services at Wellington Regional Hospital (Wellington, New Zealand) from November 2008 to November 2009 were sampled for retrospective analysis. One neonatal case was also chosen. All hard copy notes, radiology packets, electronic notes and radiological studies were requested and reviewed for these seven patients covering all lifetime admissions. Inpatient length of stay and operation costs were also analysed.
Six adolescent patients(10-21 years) had undergone a total of 124 operations requiring general anaesthesia--average 20.67 (19-28). There were 125 admissions in total for this group--average 20.83 (14-34) with an average length of stay of 8.53 days per admission and an average cumulative length of stay of 177.67 days. As a group, the adolescents had spent 1066 days as inpatients. Adolescents received an average of 75.33 (36-164) radiological procedures, including an average of 7.5 CT scans (4-13). The neonate had 10 operations, four admissions, 67 radiological investigations and a total length of stay of 194 days. The average cumulative cost per adolescent was NZ$944,000 ($472,000-$1,202,000) with a total cost of NZ$5,664,000. The cost for the neonate was NZ$678,340.
This study found inpatient costs for paediatric spina bifida patients were significantly higher than the only previous estimate carried out in New Zealand. This study also shows the burden on patients and their families/whanau in the high numbers of admissions, major operations, long periods spent as inpatients and the high number of radiological investigations.
PDF