scholarly journals The (cost-)effectiveness and cost-utility of a novel integrative care initiative for patients with chronic musculoskeletal pain: the pragmatic trial protocol of Network Pain Rehabilitation Limburg

2020 ◽  
Author(s):  
Cynthia Lamper ◽  
Ivan PJ Huijnen ◽  
Mariëlle EJB Goossens ◽  
Bjorn Winkens ◽  
Dirk Ruwaard ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Musculoskeletal Pain ◽  
Healthcare Costs ◽  
Healthcare Professionals ◽  
Cost Utility ◽  
Chronic Musculoskeletal Pain ◽  
Local Networks ◽  
Quadruple Aim ◽  
The Cost

Abstract Background: Rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not optimally organized. The Network Pain Rehabilitation Limburg 2.0 (NPRL2.0) provides integrated care with a biopsychosocial approach and strives to improve the Quadruple Aim outcomes: pain-related disability of patients with CMP; experiences of care of patients with CMP; meaning in the work of healthcare professionals; and healthcare costs. Firstly, in this study, the effectiveness (with regard to the functioning and participation of patients) of primary care for patients with CMP will be assessed, comparing care organized following the NPRL2.0 procedure with usual care. Secondly, the cost-effectiveness and cost-utility with regard to health-related quality of life and healthcare costs will be assessed. And thirdly, the effect of duration of participation in a local network in primary care will be studied. Methods: In this pragmatic study, it is expected that two local networks with 105 patients will participate in the prospective cohort study and six local networks with 184 patients in the stepped-wedge based design. Healthcare professionals in the local networks will recruit patients. Inclusion criteria: age ≥ 18 years; having CMP; willing to improve functioning despite pain; and adequate Dutch literacy. Exclusion criteria: pregnancy; and having a treatable medical or psychiatric disease. Patients will complete questionnaires at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4). Questionnaires at T1 and T4 will include the Pain Disability Index and Short Form Health Survey. Questionnaires at T1, T2, T3, and T4 will include the EQ-5D-5L, and iMTA Medical Consumption and Productivity Cost Questionnaires. Outcomes will be compared using linear mixed-model analysis and costs will be compared using bootstrapping methods. Discussion: NPRL2.0 is a multidimensional, complex intervention, executed in daily practice, and therefore needing a pragmatic study design. The current study will assess the NPRL2.0 with respect to the Quadruple Aim’s outcomes of effectiveness of healthcare and economic consequences. The other two Quadruple Aim outcomes will be examined alongside this study, providing a broad scope of the performance of NPRL2.0. Trial registration: Netherlands Trial Register: NL7643; Registered 5 April 2019. https://www.trialregister.nl/trial/7643

scholarly journals The (cost-)effectiveness and cost-utility of a novel integrative care initiative for patients with chronic musculoskeletal pain: the pragmatic trial protocol of Network Pain Rehabilitation Limburg

2020 ◽  
Author(s):  
Cynthia Lamper ◽  
Ivan PJ Huijnen ◽  
Mariëlle EJB Goossens ◽  
Bjorn Winkens ◽  
Dirk Ruwaard ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Musculoskeletal Pain ◽  
Healthcare Costs ◽  
Healthcare Professionals ◽  
Cost Utility ◽  
Chronic Musculoskeletal Pain ◽  
Local Networks ◽  
Quadruple Aim ◽  
The Cost

Abstract Background: Rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not optimally organized. The Network Pain Rehabilitation Limburg 2.0 (NPRL2.0) provides integrated care with a biopsychosocial approach and strives to improve the Quadruple Aim outcomes: pain-related disability of patients with CMP; experiences of care of patients with CMP; meaning in the work of healthcare professionals; and healthcare costs. Firstly, in this study, the effectiveness (with regard to the functioning and participation of patients) of primary care for patients with CMP will be assessed, comparing care organized following the NPRL2.0 procedure with usual care. Secondly, the cost-effectiveness and cost-utility with regard to health-related quality of life and healthcare costs will be assessed. And thirdly, the effect of duration of participation in a local network in primary care will be studied. Methods: In this pragmatic study, it is expected that two local networks with 105 patients will participate in the prospective cohort study and six local networks with 184 patients in the stepped-wedge based design. Healthcare professionals in the local networks will recruit patients. Inclusion criteria: age ≥ 18 years; having CMP; willing to improve functioning despite pain; and adequate Dutch literacy. Exclusion criteria: pregnancy; and having a treatable medical or psychiatric disease. Patients will complete questionnaires at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4). Questionnaires at T1 and T4 will include the Pain Disability Index and Short Form Health Survey. Questionnaires at T1, T2, T3, and T4 will include the EQ-5D-5L, and iMTA Medical Consumption and Productivity Cost Questionnaires. Outcomes will be compared using linear mixed-model analysis and costs will be compared using bootstrapping methods. Discussion: NPRL2.0 is a multidimensional, complex intervention, executed in daily practice, and therefore needing a pragmatic study design. The current study will assess NPRL2.0 with respect to the Quadruple Aim outcomes: patient health and costs. This will provide more information on the (cost-) effectiveness of the organization of care in a network structure regarding patients with CMP. The other two Quadruple Aim outcomes will be examined alongside this study. Trial registration: Netherlands Trial Register: NL7643

scholarly journals The (cost-)effectiveness and cost-utility of a novel integrative care initiative for patients with chronic musculoskeletal pain: the pragmatic trial protocol of Network Pain Rehabilitation Limburg

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Cynthia Lamper ◽  
Ivan P. J. Huijnen ◽  
Mariëlle E. J. B. Goossens ◽  
Bjorn Winkens ◽  
Dirk Ruwaard ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Musculoskeletal Pain ◽  
Healthcare Costs ◽  
Healthcare Professionals ◽  
Cost Utility ◽  
Chronic Musculoskeletal Pain ◽  
Local Networks ◽  
Quadruple Aim ◽  
The Cost

Abstract Background Rehabilitation care for patients with chronic musculoskeletal pain (CMP) is not optimally organized. The Network Pain Rehabilitation Limburg 2.0 (NPRL2.0) provides integrated care with a biopsychosocial approach and strives to improve the Quadruple Aim outcomes: pain-related disability of patients with CMP; experiences of care of patients with CMP; meaning in the work of healthcare professionals; and healthcare costs. Firstly, in this study, the effectiveness (with regard to the functioning and participation of patients) of primary care for patients with CMP will be assessed, comparing care organized following the NPRL2.0 procedure with usual care. Secondly, the cost-effectiveness and cost-utility with regard to health-related quality of life and healthcare costs will be assessed. And thirdly, the effect of duration of participation in a local network in primary care will be studied. Methods In this pragmatic study, it is expected that two local networks with 105 patients will participate in the prospective cohort study and six local networks with 184 patients in the stepped-wedge based design. Healthcare professionals in the local networks will recruit patients. Inclusion criteria: age ≥ 18 years; having CMP; willing to improve functioning despite pain; and adequate Dutch literacy. Exclusion criteria: pregnancy; and having a treatable medical or psychiatric disease. Patients will complete questionnaires at baseline (T1), 3 months (T2), 6 months (T3), and 9 months (T4). Questionnaires at T1 and T4 will include the Pain Disability Index and Short Form Health Survey. Questionnaires at T1, T2, T3, and T4 will include the EQ-5D-5L, and iMTA Medical Consumption and Productivity Cost Questionnaires. Outcomes will be compared using linear mixed-model analysis and costs will be compared using bootstrapping methods. Discussion NPRL2.0 is a multidimensional, complex intervention, executed in daily practice, and therefore needing a pragmatic study design. The current study will assess NPRL2.0 with respect to the Quadruple Aim outcomes: patient health and costs. This will provide more information on the (cost-) effectiveness of the organization of care in a network structure regarding patients with CMP. The other two Quadruple Aim outcomes will be examined alongside this study. Trial registration Netherlands Trial Register: NL7643. https://www.trialregister.nl/trial/7643.

scholarly journals Integrating a brief mental health intervention into primary care services for patients with HIV and diabetes in South Africa: study protocol for a trial-based economic evaluation

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026973 ◽  
Author(s):  
Vimbayi Mutyambizi-Mafunda ◽  
Bronwyn Myers ◽  
Katherine Sorsdahl ◽  
Crick Lund ◽  
Tracey Naledi ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Economic Evaluation ◽  
Chronic Disease ◽  
Cost Effectiveness ◽  
Alcohol Use ◽  
Cost Utility ◽  
Care Services ◽  
Primary Care Services ◽  
The Cost

IntroductionDepression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness of such interventions in low-income and middle-income countries. This paper describes the proposed economic evaluation of a health systems intervention testing the effectiveness, cost-effectiveness and cost-utility of two task-sharing approaches to integrating services for common mental disorders with HIV and diabetes primary care services.Methods and analysisThis evaluation will be conducted as part of a three-armed cluster randomised controlled trial of clinical effectiveness. Trial clinical outcome measures will include primary outcomes for risk of depression and alcohol use, and secondary outcomes for risk of chronic disease (HIV and diabetes) treatment failure. The cost-effectiveness analysis will evaluate cost per unit change in Alcohol Use Disorder Identification Test and Centre for Epidemiological Studies scale on Depression scores as well as cost per unit change in HIV RNA viral load and haemoglobin A1c, producing results of provider and patient cost per patient year for each study arm and chronic disease. The cost utility analyses will provide results of cost per quality-adjusted life year gained. Additional analyses relevant for implementation including budget impact analyses will be conducted to inform the development of a business case for scaling up the country’s investment in mental health services.Ethics and disseminationThe Western Cape Department of Health (WCDoH) (WC2016_RP6_9), the South African Medical Research Council (EC 004-2/2015), the University of Cape Town (089/2015) and Oxford University (OxTREC 2–17) provided ethical approval for this study. Results dissemination will include policy briefs, social media, peer-reviewed papers, a policy dialogue workshop and press briefings.Trial registration numberPACTR201610001825405.

scholarly journals Cost-Utility Analysis of Hearing Aid Device for Older Adults in the Community: A Delayed Start Study

2020 ◽  
Author(s):  
Palvinder Kaur ◽  
Sheue Lih Chong ◽  
Palvannan Kannapiran ◽  
Kelvin WS Teo ◽  
Charis Ng Wei Ling ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Index Visit ◽  
Life Years ◽  
The Cost

Abstract BackgroundHearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community based mobile hearing clinic (MHC).MethodsParticipants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years.ResultsThere were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8,996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased.ConclusionsHA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.

scholarly journals Cost-utility analysis of hearing aid device for older adults in the community: a delayed start study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Palvinder Kaur ◽  
Sheue Lih Chong ◽  
Palvannan Kannapiran ◽  
W.-S. Kelvin Teo ◽  
Charis Ng Wei Ling ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Index Visit ◽  
Life Years ◽  
The Cost

Abstract Background Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community-based mobile hearing clinic (MHC). Methods Participants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥ 18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years. Results There were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased. Conclusions HA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.

scholarly journals Cost-Utility Analysis of Hearing Aid Device for Older Adults in the Community: A Delayed Start Study

2020 ◽  
Author(s):  
Palvinder Kaur ◽  
Sheue Lih Chong ◽  
Palvannan Kannapiran ◽  
Kelvin WS Teo ◽  
Charis Ng Wei Ling ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Index Visit ◽  
Life Years ◽  
The Cost

Abstract Background Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community based mobile hearing clinic (MHC).Methods Participants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years.Results There were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8,996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased.Conclusions HA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.

scholarly journals The Cost Effectiveness of Hand Held Ultrasound Scanning for Abdominal Aortic Aneurysm in Older Males with a History of Smoking

10.36469/9856 ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 96-107
Author(s):  
Denver Phiri ◽  
Peter J. Mallow ◽  
John A. Rizzo
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Surgical Intervention ◽  
Cost Effective ◽  
Cost Utility ◽  
Ultrasound Scanning ◽  
Abdominal Aortic ◽  
History Of ◽  
The Cost ◽  
Older Males

Objective: Abdominal aortic aneurysm (AAA) is a serious illness occurring in 1 of 20 older men. Guidelines emphasize the role of ultrasound scanning for patients at risk of AAA, yet the cost effectiveness of such scanning remains uncertain. New pocket mobile echocardiography (PME) devices may enhance the cost effectiveness of such scanning due to its low cost, ability to be used in primary care settings, and high degree of accuracy. This study performs cost utility analyses (CUAs) comparing opportunistic scanning for AAA using a PME to usual care for a hypothetical cohort of 10,000 male smokers age 65+. Methods: The study compares the incremental cost per quality-adjusted life year (QALY) gained for three alternative strategies over a 5-year time horizon. The study used a decision analytic simulation model to calculate the incremental cost utility for the different strategies. Three alternative criteria for surgical intervention were considered via scanning according to aneurysm size. These treatment strategies were compared to a control group that received no scanning. Model input values are taken from the literature. Sensitivity analysis was performed to gauge the robustness of the results. Results: Opportunistic scanning is cost effective. Indeed, when surgical intervention is limited to medium (5.0-5.4 cm) or large (≥5.5 cm) aneurysms, such scanning is dominant; that is, it costs less and increases QALYs compared to usual care. When surgical intervention is extended to small (4.0-4.9 cm) aneurysms, scanning remains cost effective ($64,156 per QALY vs. $100,000 threshold). The results are robust to alternative plausible model input values. Conclusion: These findings suggest that primary care physicians with proper training should consider PMEs as a cost effective method to opportunistically scan and manage AAA patients among older males who have a history of smoking.

scholarly journals Cost-utility analysis of a consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mireia Massot Mesquida ◽  
Frans Folkvord ◽  
Gemma Seda ◽  
Francisco Lupiáñez-Villanueva ◽  
Pere Torán Monserrat
Keyword(s):  
Cost Effectiveness ◽  
Psychotropic Drugs ◽  
Medication Review ◽  
Standard Care ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Current Standard ◽  
Dementia Patients ◽  
The Cost

Abstract Background Growing evidence shows the effects of psychotropic drugs on the evolution of dementia. Until now, only a few studies have evaluated the cost-effectiveness of psychotropic drugs in institutionalized dementia patients. This study aims to assess the cost-utility of intervention performed in the metropolitan area of Barcelona (Spain) (MN) based on consensus between specialized caregivers involved in the management of dementia patients for optimizing and potentially reducing the prescription of inappropriate psychotropic drugs in this population. This analysis was conducted using the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing (MAFEIP) tool. Methods The MAFEIP tool builds up from a variety of surrogate endpoints commonly used across different studies in order to estimate health and economic outcomes in terms of incremental changes in quality adjusted life years (QALYs), as well as health and social care utilization. Cost estimates are based on scientific literature and expert opinion; they are direct costs and include medical visits, hospital care, medical tests and exams and drugs administered, among other concepts. The healthcare costs of patients using the intervention were calculated by means of a medication review that compared patients’ drug-related costs before, during and after the use of the intervention conducted in MN between 2012 and 2014. The cost-utility analysis was performed from the perspective of a health care system with a time horizon of 12 months. Results The tool calculated the incremental cost-effectiveness ratio (ICER) of the intervention, revealing it to be dominant, or rather, better (more effective) and cheaper than the current (standard) care. The ICER of the intervention was in the lower right quadrant, making it an intervention that is always accepted even with the lowest given Willingness to Pay (WTP) threshold value (€15,000). Conclusions The results of this study show that the intervention was dominant, or rather, better (more effective) and cheaper than the current (standard) care. This dominant intervention is therefore recommended to interested investors for systematic application.

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