scholarly journals Protocol for the health economic evaluation of increasing the weekend specialist to patient ratio in hospitals in England

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e015561 ◽  
Author(s):  
Samuel I Watson ◽  
Yen-Fu Chen ◽  
Julian F Bion ◽  
Cassie P Aldridge ◽  
Alan Girling ◽  
...  
Keyword(s):  
Health Economic Evaluation ◽  
Care Quality ◽  
Expert Elicitation ◽  
Weekend Effect ◽  
Model Parameters ◽  
Risk Of Death ◽  
Causal Processes ◽  
Key Policy ◽  
The Uk ◽  
The Cost

IntroductionThis protocol concerns the evaluation of increased specialist staffing at weekends in hospitals in England. Seven-day health services are a key policy for the UK government and other health systems trying to improve use of infrastructure and resources. A particular motivation for the 7-day policy has been the observed increase in the risk of death associated with weekend admission, which has been attributed to fewer hospital specialists being available at weekends. However, the causes of the weekend effect have not been adequately characterised; many of the excess deaths associated with the ‘weekend effect’ may not be preventable, and the presumed benefits of improved specialist cover might be offset by the cost of implementation.Methods/designThe Bayesian-founded method we propose will consist of four major steps. First, the development of a qualitative causal model. Specialist presence can affect multiple, interacting causal processes. One or more models will be developed from the results of an expert elicitation workshop and probabilities elicited for each model and relevant model parameters. Second, systematic review of the literature. The model from the first step will provide search limits for a review to identify relevant studies. Third, a statistical model for the effects of specialist presence on care quality and patient outcomes. Fourth, valuation of outcomes. The expected net benefits of different levels of specialist intensity will then be evaluated with respect to the posterior distributions of the parameters.Ethics and disseminationThe study was approved by the Review Subcommittee of the South West Wales REC on 11 November 2013. Informed consent was not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings of this study will be published in peer-reviewed journals; the outputs from this research will also form part of the project report to the HS&DR Programme Board.

scholarly journals Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach

2020 ◽  
Vol 5 (9) ◽  
pp. e002716
Author(s):  
Jack Williams ◽  
Ian Roberts ◽  
Haleema Shakur-Still ◽  
Fiona E Lecky ◽  
Rizwana Chaudhri ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Tranexamic Acid ◽  
Randomised Trial ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Risk Of Death ◽  
Life Years ◽  
Markov Decision Model ◽  
The Uk ◽  
The Cost

IntroductionAn estimated 69 million traumatic brain injuries (TBI) occur each year worldwide, with most in low-income and middle-income countries. The CRASH-3 randomised trial found that intravenous administration of tranexamic acid within 3 hours of injury reduces head injury deaths in patients sustaining a mild or moderate TBI. We examined the cost-effectiveness of tranexamic acid treatment for TBI.MethodsA Markov decision model was developed to assess the cost-effectiveness of treatment with and without tranexamic acid, in addition to current practice. We modelled the decision in the UK and Pakistan from a health service perspective, over a lifetime time horizon. We used data from the CRASH-3 trial for the risk of death during the trial period (28 days) and patient quality of life, and data from the literature to estimate costs and long-term outcomes post-TBI. We present outcomes as quality-adjusted life years (QALYs) and 2018 costs in pounds for the UK, and US dollars for Pakistan. Incremental cost-effectiveness ratios (ICER) per QALY gained were estimated, and compared with country specific cost-effective thresholds. Deterministic and probabilistic sensitivity analyses were also performed.ResultsTranexamic acid was highly cost-effective for patients with mild TBI and intracranial bleeding or patients with moderate TBI, at £4288 per QALY in the UK, and US$24 per QALY in Pakistan. Tranexamic acid was 99% and 98% cost-effective at the cost-effectiveness thresholds for the UK and Pakistan, respectively, and remained cost-effective across all deterministic sensitivity analyses. Tranexamic acid was even more cost-effective with earlier treatment administration. The cost-effectiveness for those with severe TBI was uncertain.ConclusionEarly administration of tranexamic acid is highly cost-effective for patients with mild or moderate TBI in the UK and Pakistan, relative to the cost-effectiveness thresholds used. The estimated ICERs suggest treatment is likely to be cost-effective across all income settings globally.

Neither Victors nor Victims

2017 ◽  
Author(s):  
David Whetham
Keyword(s):  
First Century ◽  
National Interests ◽  
Civil Military Relations ◽  
High Street ◽  
National Survival ◽  
The Uk ◽  
Military Relations ◽  
The Cost ◽  
Realistic Goal

Between 2007 and 2011, Wootton Bassett, a small Wiltshire town in the UK, became the focus of national attention as its residents responded to the regular repatriations of dead soldiers through its High Street. The town’s response came to symbolize the way that broader attitudes developed and changed over that period. As such, it is a fascinating case study in civil–military relations in the twenty-first century. Success may be the same as victory, but victory, at least as it has been traditionally understood, is not a realistic goal in many types of contemporary conflict. Discretionary wars—conflicts in which national survival is not an issue and even vital national interests may not be at stake—pose particular challenges for any government which does not explain why the cost being paid in blood and treasure is ‘worth it’.

The political economy of and practical policies for inclusive growth—a case study of Scotland

2020 ◽  
Author(s):  
Donald Houston ◽  
Georgiana Varna ◽  
Iain Docherty
Keyword(s):  
Political Economy ◽  
Policy Development ◽  
Regional Governance ◽  
Community Empowerment ◽  
Inclusive Growth ◽  
Key Policy ◽  
Inclusive Governance ◽  
The Uk ◽  
Civic Institutions

Abstract The concept of ‘inclusive growth’ (IG) is discussed in a political economy framework. The article reports comparative analysis of economic and planning policy documents from Scotland, England and the UK and findings from expert workshops held in Scotland, which identify four key policy areas for ‘inclusive growth’: skills, transport and housing for young people; city-regional governance; childcare; and place-making. These policies share with the ‘Foundational Economy’ an emphasis on everyday infrastructure and services, but add an emphasis on inter-generational justice and stress the importance of community empowerment as much as re-municipalisation. Factors enabling IG policy development include: the necessary political powers; a unifying political discourse and civic institutions; and inclusive governance and participatory democracy.

scholarly journals Accommodating Taste and Scale Heterogeneity for Front-Seat Passenger’ Choice of Seat Belt Usage

Mathematics ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 460 ◽  
Author(s):  
Mahdi Rezapour ◽  
Khaled Ksaibati
Keyword(s):  
Mixed Model ◽  
Seat Belt ◽  
Model Fit ◽  
Model Parameters ◽  
Extended Model ◽  
Random Parameters ◽  
Front Seat ◽  
Scale Heterogeneity ◽  
Error Terms ◽  
The Cost

There is growing interest in implementation of the mixed model to account for heterogeneity across population observations. However, it has been argued that the assumption of independent and identically distributed (i.i.d) error terms might not be realistic, and for some observations the scale of the error is greater than others. Consequently, that might result in the error terms’ scale to be varied across those observations. As the standard mixed model could not account for the aforementioned attribute of the observations, extended model, allowing for scale heterogeneity, has been proposed to relax the equal error terms across observations. Thus, in this study we extended the mixed model to the model with heterogeneity in scale, or generalized multinomial logit model (GMNL), to see if accounting for the scale heterogeneity, by adding more flexibility to the distribution, would result in an improvement in the model fit. The study used the choice data related to wearing seat belt across front-seat passengers in Wyoming, with all attributes being individual-specific. The results highlighted that although the effect of the scale parameter was significant, the scale effect was trivial, and accounting for the effect at the cost of added parameters would result in a loss of model fit compared with the standard mixed model. Besides considering the standard mixed and the GMNL, the models with correlated random parameters were considered. The results highlighted that despite having significant correlation across the majority of the random parameters, the goodness of fits favors more parsimonious models with no correlation. The results of this study are specific to the dataset used in this study, and due to the possible fact that the heterogeneity in observations related to the front-seat passengers seat belt use might not be extreme, and do not require extra layer to account for the scale heterogeneity, or accounting for the scale heterogeneity at the cost of added parameters might not be required. Extensive discussion has been made in the content of this paper about the model parameters’ estimations and the mathematical formulation of the methods.

scholarly journals Seasonal Influenza and Low Flu Vaccination Coverage as Important Factors Modifying the Costs and Availability of Hospital Services in Poland: A Retrospective Comparative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5173
Author(s):  
Robert Susło ◽  
Piotr Pobrotyn ◽  
Lidia Brydak ◽  
Łukasz Rypicz ◽  
Urszula Grata-Borkowska ◽  
...  
Keyword(s):  
Influenza Season ◽  
Influenza Infection ◽  
Hospital Staff ◽  
University Hospital ◽  
Control Group ◽  
Admission Rates ◽  
Risk Of Death ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
The Cost

Introduction: Influenza infection is associated with potential serious complications, increased hospitalization rates, and a higher risk of death. Materials and Methods: A retrospective comparative analysis of selected indicators of hospitalization from the University Hospital in Wroclaw, Poland, was carried out on patients with confirmed influenza infection in comparison to a control group randomly selected from among all other patients hospitalized on the respective wards during the 2018–2019 influenza season. Results: The mean laboratory testing costs for the entire hospital were 3.74-fold higher and the mean imaging test costs were 4.02-fold higher for patients with confirmed influenza than for the control group; the hospital expenses were additionally raised by the cost of antiviral therapy, which is striking when compared against the cost of a single flu vaccine. During the 2018–2019 influenza season, influenza infections among the hospital patients temporarily limited the healthcare service availability in the institution, which resulted in reduced admission rates to the departments related to internal medicine; the mean absence among the hospital staff totaled approximately 7 h per employee, despite 7.3% of the staff having been vaccinated against influenza at the hospital’s expense. Conclusions: There were significant differences in the hospitalization indicators between the patients with confirmed influenza and the control group, which markedly increased the hospital care costs in this multi-specialty university hospital.

scholarly journals Protocol for a qualitative study to identify strategies to optimise hospital ePrescribing systems

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044622
Author(s):  
Catherine Heeney ◽  
Stephen Malden ◽  
Aziz Sheikh
Keyword(s):  
Qualitative Interviews ◽  
Geographical Area ◽  
Health Resources ◽  
Round Table ◽  
Developed Countries ◽  
Care Quality ◽  
Electronic Prescribing ◽  
Study Results ◽  
Electronic Health ◽  
The Uk

IntroductionElectronic prescribing (ePrescribing) is a key area of development and investment in the UK and across the developed world. ePrescribing is widely understood as a vehicle for tackling medication-related safety concerns, improving care quality and making more efficient use of health resources. Nevertheless, implementation of an electronic health record does not itself ensure benefits for prescribing are maximised. We examine the process of optimisation of ePrescribing systems using case studies to provide policy recommendations based on the experiences of digitally mature hospital sites.Methods and analysisQualitative interviews within six digitally mature sites will be carried out. The aim is to capture successful optimisation of electronic prescribing (ePrescribing) in particular health systems and hospitals. We have identified hospital sites in the UK and in three other developed countries. We used a combination of literature reviews and advice from experts at Optimising ePrescribing in Hospitals (eP Opt) Project round-table events. Sites were purposively selected based on geographical area, innovative work in ePrescribing/electronic health (eHealth) and potential transferability of practices to the UK setting. Interviews will be recorded and transcribed and transcripts coded thematically using NVivo software. Relevant policy and governance documents will be analysed, where available. Planned site visits were suspended due to the COVID-19 pandemic.Ethics and disseminationThe Usher Research Ethics Group granted approval for this study. Results will be disseminated via peer-reviewed journals in medical informatics and expert round-table events, lay member meetings and the ePrescribing Toolkit (http://www.eprescribingtoolkit.com/)—an online resource supporting National Health Service (NHS) hospitals through the ePrescribing process.

OP206 Expert Elicitation Of Probabilistic Distributions to Inform Survival Modelling of CD19 Chimeric Antigen Receptor T-Cell Therapies

2020 ◽  
Vol 36 (S1) ◽  
pp. 3-3
Author(s):  
Niamh Carey ◽  
Conor Hickey ◽  
Laura Mc Cullagh ◽  
Michael Barry
Keyword(s):  
T Cell ◽  
Chimeric Antigen Receptor ◽  
Antigen Receptor ◽  
Expert Elicitation ◽  
Cell Transplant ◽  
Major Advance ◽  
Cell Therapies ◽  
Risk Of Death ◽  
Car T Cell ◽  
Car T

IntroductionIn 2018, the National Centre for Pharmacoeconomics (NCPE) was commissioned to conduct a health technology assessment (HTA) of one of the first commercially available chimeric antigen receptor (CAR) T-cell therapies, tisagenlecleucel. CAR T-cells are a major advance in personalized cancer treatment, demonstrating promising outcomes in relapsed/refractory pediatric acute lymphoblastic leukemia (pALL). However, the results are based on short-term follow up, limiting their value in predicting long-term survival and leading to uncertainty about the most appropriate survival modeling method to employ. This study aimed to address these limitations by means of expert elicitation.MethodsAn expert elicitation method, the histogram technique, was employed. A predefined discrete numerical scale was presented in Microsoft Excel® and the expert was asked to place twenty crosses on a frequency chart. These crosses represented the expert's beliefs about the distribution of particular quantities. Each cross represented five percent of the probabilistic distribution. Individual distributions were then aggregated across experts using linear pooling.ResultsA total of seventeen experts were invited to take part; eight agreed to participate and five completed the exercise. Three experts did not consider tisagenlecleucel to be a “curative” therapy because patients had a higher risk of death, compared with the age- and sex-matched general population. The aggregated distributions indicated the five-year overall survival rate to be thirty-three percent (95% CI 8.65–56.88) in patients who do not receive a subsequent stem cell transplant and twenty percent (95% CI 2.38 -52.04) in those who do.ConclusionsThe results of this study will be used to calibrate CD19 CAR T-cell therapy survival estimates presented in HTA submissions to the NCPE to ensure more robust assessments. They will also be used to inform the construction of a de novo cost-utility model for examining the cost effectiveness of CD19 CAR T-cell therapies for relapsed/refractory pALL in the Irish healthcare setting.

scholarly journals ‘Rising demand and decreasing resources’: Theorising the ‘cost of austerity’ as a barrier to social worker discretion

2021 ◽  
pp. 1-18
Author(s):  
CIARÁN MURPHY
Keyword(s):  
Social Worker ◽  
Child Protection ◽  
Child Protection Services ◽  
Radical Reform ◽  
Critical Realist ◽  
Documentary Analysis ◽  
Effective System ◽  
The Individual ◽  
The Uk ◽  
The Cost

Abstract The Munro Review of Child Protection asserted that the English child protection system had become overly ‘defensive’, ‘bureaucratised’ and ‘standardised’, meaning that social workers were not employing their discretion in the interests of the individual child. This paper reports on the results of an ethnographic case study of one of England’s statutory child protection teams. The research sought to explore the extent of social worker discretion relative to Munro’s call for ‘radical reform’ and a move towards a more ‘child-centred’ system. Employing an iterative mixed methods design – encompassing documentary analysis, observation, focus group, questionnaire, interview and ‘Critical Realist Grounded Theory’ – the study positioned the UK Government’s prolonged policy of ‘austerity’ as a barrier to social worker discretion. This was because the policy was seen to be contributing to an increased demand for child protection services; and a related sense amongst practitioners that they were afforded insufficient time with the child to garner the requisite knowledge, necessary for discretionary behaviour. Ultimately, despite evidence of progress relative to assertions that social worker discretion had been eroded, the paper concludes that there may still be ‘more to do’ if we are to achieve the ‘child-centred’ and ‘effective’ system that Munro advocated.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals Routine use of immunosuppressants is associated with mortality in hospitalised patients with COVID-19

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  
Keyword(s):  
Medical Attention ◽  
Close Monitoring ◽  
Plain Language ◽  
Discharge Data ◽  
Specific Patient ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
The Uk ◽  
The Impact

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.

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