Janelle Seymour

Prospective epidemiologic study of the outcome and cost‐effectiveness of antenatal screening to detect neonatal alloimmune thrombocytopenia due to anti‐HPA‐1a

BACKGROUND: To assess the value of antenatal screening to detect neonatal alloimmune thrombocytopenia (NAIT) due to anti‐HPA‐1a, a prospective study was carried out to quantify the potential clinical benefits and determine whether screening would be cost‐effective.

Immediate Computed Tomography Scanning of Acute Stroke Is Cost-Effective and Improves Quality of Life

Background and Purpose— Stroke is very common, but computed tomography (CT) scanning, an expensive and finite resource, is required to differentiate cerebral infarction, hemorrhage, and stroke mimics. We determined whether, and in what circumstances, CT is cost-effective in acute stroke. Methods— We developed a decision tree representing acute stroke care pathways populated with data from multiple sources. We determined the effect of diagnostic information from CT scanning on functional outcome, length of stay, costs, and quality of life during 5 years for 13 alternative CT strategies (varying proportions and types of patients and rapidity of scanning). Results— For 1000 patients aged 70 to 74 years, the policy “scan all strokes within 48 hours” cost £10 279 728 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was “scan all immediately” (£9 993 676 and 1982.4 QALYs). The least cost-effective was “scan patients on anticoagulants and those in a life-threatening condition immediately and the rest within 14 days” (£12 592 666 and 1931.8 QALYs). “Scan no patients” reduced QALYs (1904.2) and increased cost (£10 544 000). Conclusion— Immediate CT scanning is the most cost-effective strategy. For the majority of acute stroke patients, increasing independent survival by correct early diagnosis, ensuring appropriate subsequent treatment and management decisions, reduced costs of stroke and increased QALYs.

A randomised controlled trial of microwave endometrial ablation without endometrial preparation in the outpatient setting: patient acceptability, treatment outcome and costs

Objective  To compare outpatient microwave endometrial ablation (MEA) in the postmenstrual phase to standard MEA treatment after drug preparation in a day case theatre environment.

Shedding new light onto the ceiling and floor? A quantile regression approach to compare EQ-5D and SF-6D responses

An important issue in the measurement of health status concerns the extent to which an instrument displays lack of sensitivity to changes in health status at the extremes of the distribution, known as floor and ceiling effects. Previous studies use relatively simple methods that focus on the mean of the distribution to examine these effects. The aim of this paper is to determine whether quantile regression using longitudinal data improves our understanding of the relationship between quality of life instruments. The study uses EQ-5D and SF-36 (converted to SF-6D values) instruments with both baseline and follow-up data. Relative to ordinary least least-squares (OLS), a first difference model shows much lower association between the measures, suggesting that OLS methods may lead to biased estimates of the association, due to unobservable patient characteristics. The novel finding, revealed by quantile regression, is that the strength of association between the instruments is different across different parts of the health distribution, and is dependent on whether health improves or deteriorates. The results suggest that choosing one instrument at the expense of another is difficult without good prior information surrounding the expected magnitude and direction of health improvement related to a health-care intervention.

A tool to improve quality of reporting published economic analyses.

OBJECTIVES To test the feasibility of obtaining a baseline level of quality of reporting for cost-utility analysis (CUA) studies using the British Medical Journal economic submissions checklist, test interrater reliability of this tool, and discuss its longer term implications. METHODS CUA studies in peer-reviewed English language journals in 1996, assessed using the British Medical Journal checklist, a quality index, and interrater reliability correlations. RESULTS Forty-three CUA studies were assessed, with 23 checklist items acceptable and 10 items inadequate. Lowest quality scores were reported in specialist medical journals. Proportional agreement between assessors was over 80%. CONCLUSIONS The British Medical Journal checklist is a feasible tool to collect baseline information on the quality of reporting in journals other than the British Medical Journal. Editors of specialist medical journals are in greatest need of economic guidance. If handled carefully, they might consider adopting the British Medical Journal checklist.

Incorporation of Process Preferences within the QALY Framework: A Study of Alternative Methods:

Objective. This article explores the implications of incorporating process preferences using time tradeoff and standard gamble methods to assess the benefits of health care. Methods. Data were derived from 2 sources: a randomized controlled trial of alternative palliative care treatments (plastic stents, thermal ablation, or brachytherapy) for esophageal cancer, and a valuation survey conducted among individuals who had previously undergone curative treatment for such cancer. Costs and quality-adjusted life years (QALYs) associated with different palliative treatments in terms of health outcome values were compared to costs and QALYs based on process values derived from 3 different treatment allocation methods: 1) receipt of most preferred treatment; 2) receipt of least preferred treatment; and 3) mean process values. Results. Process values produced a different number of QALYs and QALY gains compared to those derived from health outcome values. However, treatment recommendations based on process values corresponded with those based on health outcome values: brachytherapy was identified as the more cost-effective treatment in terms of the incremental cost-per-QALY ratio by both the standard health outcome values approach and methods based on process values. These findings were supported by probabilistic analysis using the net monetary benefit framework. Conclusions. Estimation of process preferences provides additional information to policy makers in judgments over the cost-effectiveness of health care programs. These methods offer a promising alternative to standard cost-per-QALY estimation using health outcomes. However, further research examining the role of process preferences in decision making in other clinical applications appears warranted.

The cost of microwave endometrial ablation under different anaesthetic and clinical settings

Objective To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting.

Comparing generic preference-based health-related quality-of-life measures: advancing the research agenda.

Interest in generic preference-based health-related quality-of-life measures has grown considerably in recent years. Given the availability of several different measures, there is a question over the extent to which different measures produce different results. To determine the interchangeability between measures, a number of head-to-head comparisons have been undertaken to assess levels of agreement or association. However, the assessment of interchangeability may be addressed using a number of different methods. This paper reviews the methods that have been employed to examine the degree of interchangeability between the Assessment of Quality of Life, EuroQol-5D, Health Utilities Index Mark III, Short-Form-6D, Quality of Wellbeing and 15-dimension measures. It suggests a need to develop alternative econometric strategies and to explore, more fully, economic concepts of validity.

Preferences for public health insurance: egotism or altruism?

This paper reports the results of a telephone survey to elicit preferences for public or private health insurance. The survey adopted a method described by Hudson and Jones that allows respondents to distinguish between self‐interest and altruistic motivations. A random sample of 403 people drawn from the central Sydney area participated in the survey. The results suggest strong altruistic support for publicly funded health care even among those whose self‐interest is better served by tax‐financed incentives to take out private insurance. This result undermines the assumption in the public choice literature that people will vote for a tax policy only if it is in their self‐interest.

Feasibility and acceptability of nurse-led youth clinics in Australian general practice

Internationally, youth access to primary health care is problematic due to documented barriers such as cost, concerns about confidentiality, and knowledge about when to attend and available services. The treatment of health problems earlier in life together with engagement in prevention and health education can optimise youth health and maximise the potential of future wellbeing. This study investigated the feasibility, acceptability and cost of establishing nurse-led youth clinics in Victoria, Australia. Three general practices in rural and regional areas of Victoria implemented the nurse-led youth health clinics. The clinics were poorly attended by young people. Practice nurses identified several barriers to the clinic attendance including the short timeframe of the study, set times of the clinics and a lack of support for the clinics by some GPs and external youth health clinics, resulting in few referrals. The clinics cost from