Gregory Merlo

Economic Evaluation of Fecal Microbiota Transplantation for the Treatment of Recurrent Clostridium Difficile Infection in Australia.

Clostridium difficile is the most common cause of hospital‐acquired diarrhea in Australia. In 2013, a randomized controlled trial demonstrated the effectiveness of fecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). The aim of this study is to evaluate the cost‐effectiveness of fecal microbiota transplantation—via either nasoduodenal or colorectal delivery—compared with vancomycin for the treatment of recurrent CDI in Australia.

Bridging the Gap: Exploring the Barriers to Using Economic Evidence in Healthcare Decision Making and Strategies for Improving Uptake

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

Cost-effectiveness of bone-anchored prostheses using osseointegrated fixation: Myth or reality?

Background: In principle, lower limb bone-anchored prostheses could alleviate expenditure associated with typical socket manufacturing and residuum treatments due to socket-suspended prostheses. Objective: This study reports (a) the incremental costs and (b) heath gain as well as (c) cost-effectiveness of bone-anchored prostheses compared to socket-suspended prostheses. Study design: Retrospective individual case-controlled observations and systematic review. Methods: Actual costs were extracted from financial records and completed by typical costs when needed over 6-year time horizon for a cohort of 16 individuals. Health gains corresponding to quality-adjusted life-year were calculated using health-related quality-of-life data presented in the literature. Results: The provision of bone-anchored prostheses costed 21% ± 41% more but increased quality-adjusted life-years by 17% ± 5% compared to socket-suspended prostheses. The incremental cost-effectiveness ratio ranged between –

Cost Comparison of Socket-Suspended and Bone-Anchored Transfemoral Prostheses

25,700 per quality-adjusted life-year and

A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

53,500 per quality-adjusted life-year with indicative incremental cost-effectiveness ratio of approximately

Going over the parapet: The development of a framework for understanding the translation of evidence from economic evaluations

17,000 per quality-adjusted life-year. Bone-anchored prosthesis was cost-saving and cost-effective for 19% and 88% of the participants, respectively. Conclusion: This study indicated that bone-anchored prostheses might be an acceptable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Altogether, this initial evidence-based economic evaluation provided a working approach for decision makers responsible for policies around care of individuals with lower limb amputation worldwide. Clinical relevance For the first time, this study provided evidence-based health economic benefits of lower limb bone-anchored prostheses compared to typical socket-suspended prostheses from a prosthetic care perspective that is essential to clinicians and decision makers responsible for policies.

The Queensland Health’s experience in provision of bone-anchored prostheses: The hidden treasure of health services and economic evaluations

Introduction This observational study compared historical costs for provision of socket prostheses with simulated costs for bone-anchored prostheses (BAPs). Materials and Methods The costs of transfemoral socket prostheses and BAP were extracted from the Queensland Artificial Limb Services regulatory documentation according to K-levels and estimated for low-cost, budget, and high-cost limb options. Total costs including labor and parts after 6-year funding cycles were cross-compared for each socket and BAP fitting option. Results Labor and attachment costs were reduced by 18% and 79%, respectively, for all BAP options compared with any socket fitting. BAP was more economical by

Cost-comparison of socket-suspended and bone-anchored transfemoral prostheses

18,200,

Development of a procedure for the government provision of bone-anchored prosthesis using osseointegration in Australia

7,000, and

Governmental perspective on fair and equitable provision of bone-anchored prostheses: Barriers and facilitators

1,600 when fitted with low-cost, budget, and high-cost options, respectively, compared with sockets for K4. The low-cost limb was the only economical option compared with all sockets above K2. Other BAP options were uneconomical compared with socket fitting below K4. Discussion Suppliers of conventional prosthetic components can strongly impact the overall costs. Interestingly, manufacturers of BAP could play a decisive role given the cost of specific parts (e.g., connectors, protective devices). Conclusions The proposed approach for cost assessments could assist funding organizations worldwide working toward the development of fair and equitable financial assistance programs for individuals choosing BAP.