Does the use of patient decision aids lead to cost savings? a systematic review

ObjectivesTo update a previous systematic review to determine if patient decision aid (PDA) interventions generate savings in healthcare settings, and if so, from which perspective (ie, patient, organisation providing care, society).DesignSystematic review.Data sourcesMEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Embase, Campbell Collaboration Library, EconLit, Business Source Complete, Centre for Reviews and Dissemination: NHS Economic Evaluations Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA) from 15 March 2013 to 25 January 2019. The references of studies that met the eligibility criteria and any publications related to conference abstracts or registered clinical trials were reviewed to increase the sensitivity of the search.Eligibility criteriaFull and partial economic evaluations with an experimental, quasi-experimental or randomised controlled design were included. The intervention had to satisfy the pre-determined minimum conditions necessary to be defined as a PDA, and (for full evaluations) provide details on the comparator used.Data extraction and synthesisAll study outcomes and economic data were extracted. The reporting and quality of the economic analyses were independently assessed by two health economists.ResultsOf 5066 studies, 22 studies were included, including the 8 studies from the previous review. Twelve studies reported cost-savings (range=US$10 to US$81 156; US dollars in 2020), primarily from the organisational or health system perspective, and 10 studies did not. However, due to the quality of the economic analyses, and the related issues with the interpretative validity of results it would be inappropriate to say that PDAs will generate savings, from any perspective.ConclusionsIt is unclear whether PDAs will generate savings. Greater consensus on what constitutes a PDA and the need to compare them against usual care over a sufficient time horizon to allow valid assessment of costs and outcomes is required.PROSPERO registration numberCRD42019118457.

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Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-044472 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044472

Author(s):

Saar Hommes ◽

Ruben Vromans ◽

Felix Clouth ◽

Xander Verbeek ◽

Ignace de Hingh ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Decision Making ◽

Systematic Reviews ◽

Decision Aids ◽

Specific Treatment ◽

Cochrane Library ◽

Plain Language ◽

Patient Decision

ObjectivesTo assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.DesignSystematic review.Data sourcesDAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.Eligibility criteriaDAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I–III.Data extraction and synthesisAfter the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.ResultsIn total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.ConclusionsBoth instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

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Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120987538 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712098753

Author(s):

Cammille C. Go ◽

Cynthia Kyin ◽

Jeffrey W. Chen ◽

Benjamin G. Domb ◽

David R. Maldonado

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Nonoperative Treatment ◽

Cochrane Library ◽

System Perspective ◽

Labral Tears ◽

The Cost

Background: Hip arthroscopy has frequently been shown to produce successful outcomes as a treatment for femoroacetabular impingement (FAI) and labral tears. However, there is less literature on whether the favorable results of hip arthroscopy can justify the costs, especially when compared with a nonoperative treatment. Purpose: To systematically review the cost-effectiveness of hip arthroscopy for treating FAI and labral tears. Study Design: Systematic review; Level of evidence, 3. Methods: PubMed/MEDLINE, Embase, and Cochrane Library databases, and the Tufts University Cost-Effectiveness Analysis Registry were searched to identify articles that reported the cost per quality-adjusted life-year (QALY) generated by hip arthroscopy. The key terms used were “hip arthroscopy,” “cost,” “utility,” and “economic evaluation.” The threshold for cost-effectiveness was set at $50,000/QALY. The Methodological Index for Non-Randomized Studies instrument and Quality of Health Economic Studies (QHES) score were used to determine the quality of the studies. This study was prospectively registered on PROSPERO (CRD42020172991). Results: Six studies that reported the cost-effectiveness of hip arthroscopy were identified, and 5 of these studies compared hip arthroscopy to a nonoperative comparator. These studies were found to have a mean QHES score of 85.2 and a mean cohort age that ranged from 33-37 years. From both a health care system perspective and a societal perspective, 4 studies reported that hip arthroscopy was more costly but resulted in far greater gains than did nonoperative treatment. The preferred treatment strategy was most sensitive to duration of benefit, preoperative osteoarthritis, cost of the arthroscopy, and the improvement in QALYs with hip arthroscopy. Conclusion: In the majority of the studies, hip arthroscopy had a higher initial cost but provided greater gain in QALYs than did a nonoperative treatment. In certain cases, hip arthroscopy can be cost-effective given a long enough duration of benefit and appropriate patient selection. However, there is further need for literature to analyze willingness-to-pay thresholds.

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CUPPING THERAPY: A PRUDENT APPROACH IN PAIN MANAGEMENT-A SYSTEMATIC REVIEW

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.10.1/003 ◽

2021 ◽

Vol 10 (1) ◽

pp. 5-13

Author(s):

Hafiza Javeria ◽

Yusra Obaid ◽

Ismail Naseem

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

English Language ◽

Experimental Studies ◽

Spinal Pain ◽

Cupping Therapy ◽

Cochrane Library ◽

Group Differences ◽

Eligibility Criteria

BACKGROUND AND AIMS Cupping Therapy is an ancient form of alternative medicine for treating variety of musculoskeletal disorders. Number of studies indicated the efficacy of various cupping methods in decreasing neck or back pain intensity within short duration and improves quality of life. DATABASES AND ELIGIBILITY CRITERIA The experimental studies were searched on the electronic databases including Google Scholar, PEDro, PubMed and Cochrane Library from June 2015 to December 2019. It was ensured that all articles were full-text in English language whereas screening was executed on relevant titles and abstracts, evaluated on the basis of cupping therapy and its effects on musculoskeletal pain. RESULTS A total of eight out of ten experimental studies showed significant decrease (p<0.05) in spinal pain in result of cupping therapy except for the two studies that demonstrated no significant pre-post group differences (p>0.05).

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Effectiveness of interventions for the prevention of occupational violence against professionals in health services: a protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-036558 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036558

Author(s):

Caroline Vieira Cláudio Okubo ◽

Renata Cristina Campos Pereira Silveira ◽

Maria José Quina Galdino ◽

Daiane Rubinato Fernandes ◽

Aline Aparecida Oliveira Moreira ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Review ◽

Health Sector ◽

Risk Of Bias ◽

Cochrane Library ◽

Eligibility Criteria ◽

Occupational Violence

IntroductionOccupational violence affects several categories of workers; however, the health sector category has been considered at a high risk, exposing workers to physical and psychological abuse. Thus, occupational violence has decreased the quality of care in health service. This review aims to evaluate the effectiveness of interventions for the prevention and reduction of occupational violence against health professionals.Methods and analysisThis protocol is consistent with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Searches will be conducted in PubMed, Embase, Cochrane Library, LILACS, Web of Science, Scopus, CINAHL and LIVIVO along with a comprehensive review of grey literature. The search will be conducted on August 1 st 2020, without language and time restrictions. Following the eligibility criteria, two independent reviewers will select the titles and abstracts and subsequently screen the full articles. If necessary, a third reviewer will assess any disagreements. All references will be imported into EndNote, and any duplicates will be removed. The data will be extracted using an extraction-based form from Cochrane. Statistical analyses will be performed using the software Cochrane Review Manager, and a meta-analysis will be performed if possible for the statistical combination of at least two studies. The risk of bias of the randomised clinical trials will be evaluated by the Risk of Bias tool from Cochrane, and the risk of bias of the non-randomised intervention studies will be evaluated using the Downs and Black scale. The quality of the evidence and strength of the classification recommendations will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation.Ethics and disseminationThis review will not evaluate individual patient information and therefore does not require ethical approval. The results will be disseminated through publications in peer-reviewed journals, presentations at conferences and the doctoral thesis of the leading author.PROSPERO registration numberCRD42018111383.

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Protocol for a systematic review of instruments for the assessment of quality of life and well-being in children and adolescents with cerebral palsy

BMJ Open ◽

10.1136/bmjopen-2017-015924 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015924 ◽

Cited By ~ 4

Author(s):

Christine Mpundu-Kaambwa ◽

Gang Chen ◽

Elisabeth Huynh ◽

Remo Russo ◽

Julie Ratcliffe

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Cerebral Palsy ◽

Young People ◽

Children And Adolescents ◽

Well Being ◽

Measurement Properties ◽

Cochrane Library ◽

Economic Evaluations

IntroductionCerebral palsy is the most common cause of physical disability in children and adolescents and is associated with impairments that may reduce the quality of life (QOL) of this population. Patient-reported outcome measures (PROMs) can facilitate the assessment of the effect of disease and treatment on QOL, from a patient viewpoint. The purpose of this systematic review is to identify PROMs that are used to measure QOL and subjective well-being (SWB) outcomes in young people with cerebral palsy and to evaluate the suitability of these PROMs for application in economic evaluations within this population.Methods and analysisMEDLINE, Scopus, the Cochrane Library, Web of Science Core Collection, EconLit, PsycINFO, CINAHL, EMBASE and Informit will be systematically searched from inception to date of search. Published peer-reviewed, English-language articles reporting PROMs measuring QOL or SWB outcomes in children and adolescents with cerebral palsy will be included. One reviewer will conduct the initial search and screen titles and abstracts for potentially eligible studies. The search will be performed in November 2017. To reduce the likelihood of reviewer selection bias, two other reviewers will independently screen a randomly selected subsample (10%) of the citations. Two reviewers will then retrieve full texts of potentially eligible studies and assess them against predefined inclusion criteria. The suitability of selected PROMs for use in economic evaluations of young people with cerebral palsy will be assessed using the International Society of Quality of Life Research recommended Minimum Standards and the Patient-Centered Outcomes and Comparative Effectiveness Research checklist. A narrative synthesis of extracted data will be presented including study descriptive data, PROMs measurement properties, settings in which they were applied and the valuation methods. Recommendations for practice on the selection of PROMs for use in economic evaluations of children and adolescents with cerebral palsy will be presented.Ethics and disseminationEthical approval is not required as the proposed systematic review will not use primary data. The results of this study will be widely disseminated through publication in a peer-reviewed journal and conference presentation(s).Systematic review registration numberInternational Prospective Register of Systematic Reviews number: CRD42016049746.

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Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials

Pain Medicine ◽

10.1093/pm/pnaa331 ◽

2020 ◽

Author(s):

Javier Martinez-Calderon ◽

Mar Flores-Cortes ◽

Jose Miguel Morales-Asencio ◽

Alejandro Luque-Suarez

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Risk Of Bias ◽

Cochrane Library ◽

Secondary Outcome ◽

Full Detail ◽

Eligibility Criteria ◽

Fear Avoidance Beliefs

Abstract Objective This systematic review aimed to evaluate the effectiveness of different interventions at reducing pain-related fear in people with fibromyalgia and to analyze whether the included trials reported their interventions in full detail. Design Systematic review. Setting No restrictions. Methods The Cochrane Library, CINAHL, EMBASE, PsycINFO, PubMed, and Scopus were searched from their inception to April 2020, along with manual searches and a gray literature search. Randomized clinical trials were included if they assessed pain-related fear constructs as the primary or secondary outcome in adults with fibromyalgia. Two reviewers independently performed the study selection, data extraction, risk-of-bias assessment, Template for Intervention Description and Replication (TIDieR) checklist assessment, and grading the quality of evidence. Results Twelve randomized clinical trials satisfied the eligibility criteria, including 11 cohorts with a total sample of 1,441 participants. Exercise, multicomponent, and psychological interventions were more effective than controls were in reducing kinesiophobia. However, there were no differences in decreasing kinesiophobia when self-management and electrotherapy were used. There were also no differences between groups with regard to the rest of the interventions and pain-related constructs (fear-avoidance beliefs, fear of pain, and pain-related anxiety). However, a serious risk of bias and a very serious risk of imprecision were detected across the included trials. This caused the overall certainty of the judged evidence to be low and very low. Additionally, the included trials reported insufficient details to allow the full replication of their interventions. Conclusions This systematic review shows that there are promising interventions, such as exercise, multicomponent, and psychological therapies, that may decrease one specific type of fear in people with fibromyalgia, i.e., kinesiophobia. However, because of the low–very low certainty of the evidence found, a call for action is needed to improve the quality of randomized clinical trials, which will lead to more definitive information about the clinical efficacy of interventions in this field.

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A Systematic Review of Methods Used for Confounding Adjustment in Observational Economic Evaluations in Cardiology Conducted between 2013 and 2017

Medical Decision Making ◽

10.1177/0272989x20937257 ◽

2020 ◽

Vol 40 (5) ◽

pp. 582-595

Author(s):

Jason R. Guertin ◽

Blanchard Conombo ◽

Raphaël Langevin ◽

Frédéric Bergeron ◽

Anne Holbrook ◽

...

Keyword(s):

Systematic Review ◽

Cochrane Library ◽

Economic Evaluations ◽

Medical Subject Headings ◽

Treatment Allocation ◽

Confounding Bias ◽

Methodological Choices ◽

Confounding Adjustment ◽

Future Work

Background. Observational economic evaluations (i.e., economic evaluations in which treatment allocation is not randomized) are prone to confounding bias. Prior reviews published in 2013 have shown that adjusting for confounding is poorly done, if done at all. Although these reviews raised awareness on the issues, it is unclear if their results improved the methodological quality of future work. We therefore aimed to investigate whether and how confounding was accounted for in recently published observational economic evaluations in the field of cardiology. Methods. We performed a systematic review of PubMed, Embase, Cochrane Library, Web of Science, and PsycInfo databases using a set of Medical Subject Headings and keywords covering topics in “observational economic evaluations in health within humans” and “cardiovascular diseases.” Any study published in either English or French between January 1, 2013, and December 31, 2017, addressing our search criteria was eligible for inclusion in our review. Our protocol was registered with PROSPERO (CRD42018112391). Results. Forty-two (0.6%) out of 7523 unique citations met our inclusion criteria. Fewer than half of the selected studies adjusted for confounding ( n = 19 [45.2%]). Of those that adjusted for confounding, propensity score matching ( n = 8 [42.1%]) and other matching-based approaches were favored ( n = 8 [42.1%]). Our results also highlighted that most authors who adjusted for confounding rarely justified their methodological choices. Conclusion. Our results indicate that adjustment for confounding is often ignored when conducting an observational economic evaluation. Continued knowledge translation efforts aimed at improving researchers’ knowledge regarding confounding bias and methods aimed at addressing this issue are required and should be supported by journal editors.

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A systematic review of economic evaluation in fecal microbiota transplantation

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.371 ◽

2020 ◽

Vol 41 (4) ◽

pp. 458-466 ◽

Cited By ~ 1

Author(s):

Thomas Stalder ◽

Nathalie Kapel ◽

Sophie Diaz ◽

Frédéric Grenouillet ◽

Stéphane Koch ◽

...

Keyword(s):

Systematic Review ◽

Fecal Microbiota Transplantation ◽

Cost Effective ◽

Fecal Microbiota ◽

Cost Utility ◽

Economic Evaluations ◽

Measurement Tool ◽

Eligibility Criteria ◽

Cost Effective Treatment

AbstractBackground:Fecal microbiota transplantation (FMT) is an effective therapy in recurrent Clostridium difficile infection (rCDI). It is only recommended for this indication by European and American guidelines. Other indications of FMT are being studied, such as inflammatory bowel disease (IBD), and they have shown promising results.Objectives:To identify and review published FMT-related economic evaluations (EEs) to assess their quality and the economic impact of FMT in the treatment of these diseases.Data sources:The systematic literature research was conducted in both PubMed and Cochrane to identify EEs published before July 1, 2019.Study eligibility criteria:Articles were included if they concerned FMT (whatever the disease and its line of treatment), if they reported full or partial EEs, and if they were written in English. Articles were excluded if they did not concern FMT; if they did not report an EE; or if they were a systematic review, editorial, comment, letter to the editor, practice point, or poster.Methods:A measurement tool, AMSTAR, was used to optimize the quality of this systematic review. Based on the CHEERS checklist, data were identified and extracted from articles. The quality of each EE was assessed using the Drummond checklist.Results:Overall, 9 EEs were included: all EEs were full evaluations and 8 were cost-utility analyses (CUAs). All EEs had a Drummond score ≥ 7, which indicated high quality. All CUAs related to rCDI and IBD concluded that FMT was cost-effective compared with other reference treatments, at a threshold ≤$50,000/QALY. One EE about initial CDI showed that FMT was dominated by metronidazole.Conclusions:Despite a limited number of EEs, FMT seems to be a promising and cost-effective treatment for rCDI. More EE studies on other diseases like IBD are necessary to address FMT efficiency for new indications. Therefore, our systematic review provides a framework for healthcare decision making.

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User and family satisfaction with nursing homes: a systematic review

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa160 ◽

2020 ◽

Author(s):

Verena Vassimon-Barroso ◽

Camila Bianca Falasco Pantoni ◽

Marisa Silvana Zazzetta ◽

Daniela Lemes Ferreira ◽

Fernando Augusto Vasilceac ◽

...

Keyword(s):

Systematic Review ◽

Nursing Homes ◽

User Satisfaction ◽

Total Sample ◽

Family Satisfaction ◽

Cochrane Library ◽

Eligibility Criteria ◽

Cross Sectional ◽

Determinants Of Satisfaction

Abstract Background Implementation of person-directed care planning is a challenge for nursing home services. User satisfaction is indispensable to implement it. Objective The aim of this study was to address user and family satisfaction with nursing homes and the scales used and to identify the determinants of satisfaction with this service. Methods A systematic review was conducted, and the Cochrane Library, PubMed, Scopus, Web of Science and CINAHL databases were searched between December 2019 and April 2020. Studies involving assessment of user or family satisfaction with nursing homes and users ≥65 years old or their families were included in this review. The methodological quality of the included studies was assessed by the Joanna Briggs Institute reviewer’s manual. Results Eight articles were included based on the eligibility criteria, from a total of 2378 records found in the electronic search. All studies presented a cross-sectional design, and the total sample of this review was 57 214 older people. Most of the studies included showed positive overall satisfaction with nursing homes. There was no consensus about the best scale to assess satisfaction because of the huge variety of tools among studies. The most common determinants of satisfaction among studies were quality of life (mental and physical components), anxiety and social and health factors. Conclusion The findings of our review may contribute to a better view of satisfaction with nursing homes experienced by users and families and to an improvement of care in these institutions.

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Effectiveness of orofacial myofunctional therapy in orthodontic patients: A systematic review

Dental Press Journal of Orthodontics ◽

10.1590/2176-9451.19.4.094-099.oar ◽

2014 ◽

Vol 19 (4) ◽

pp. 94-99 ◽

Cited By ~ 10

Author(s):

Márcio Alexandre Homem ◽

Raquel Gonçalves Vieira-Andrade ◽

Saulo Gabriel Moreira Falci ◽

Maria Letícia Ramos-Jorge ◽

Leandro Silva Marques

Keyword(s):

Systematic Review ◽

Orthodontic Treatment ◽

Data Extraction ◽

Scientific Evidence ◽

Final Analysis ◽

Cochrane Library ◽

Eligibility Criteria ◽

Myofunctional Therapy ◽

Present Systematic Review

OBJECTIVE: The aim of the present systematic review was to determine the existence of scientific evidence demonstrating the effectiveness of orofacial myofunctional therapy (OMT) as an adjuvant to orthodontic treatment in individuals with orofacial disorders. A further aim was to assess the methodological quality of the studies included in the review. METHODS: An electronic search was performed in eight databases (Medline, BBO, LILACS, Web of Science, EMBASE, BIREME, Cochrane Library and SciELO) for papers published between January 1965 and March 2011, with no language restrictions. Selection of articles and data extraction were performed by two independent researchers. The quality of the selected articles was also assessed. RESULTS: Search strategy resulted in the retrieval of 355 publications, only four of which fulfilled the eligibility criteria and qualified for final analysis. All papers selected had a high risk of bias. CONCLUSIONS: The findings of the present systematic review demonstrate the scarcity of consistent studies and scientific evidence supporting the use of OMT in combination with orthodontic treatment to achieve better results in the correction of dentofacial disorders in individuals with orofacial abnormalities.

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