Kim Dalziel

Endoscopic Sinus Surgery for the Excision of Nasal Polyps: A Systematic Review of Safety and Effectiveness:

Background Functional endoscopic sinus surgery (FESS) has been used for >20 years for the management of sinus disease including the excision of nasal polyps. Our objective was to perform a systematic review of safety and effectiveness of FESS for the removal of nasal polyps. Methods The Cochrane Library, MEDLINE, Embase, Science Citation Index, other databases, and websites were searched in January and December 2005 using key words for nasal polyps and endoscopic surgery. All randomized controlled trials, nonrandomized comparative studies, and case series studies that described outcomes associated with FESS for the excision of nasal polyps were included. Forty-two publications were included from the 632 (6.6%) articles initially identified. Two reviewers assessed validity of included studies and extracted relevant data. Results Three randomized controlled trials, 4 nonrandomized comparative studies, and 35 case series studies were included in the review. FESS was compared with endoscopic polypectomy, Caldwell-Luc, radical nasalization, and intranasal ethmoidectomy. In general, studies were of poor quality and lacked description of important variables influencing surgical outcome. Overall complications for FESS from case series studies ranged from 0.3 to 22.4% (median, 7.0%). Major complications ranged from 0 to 1.5% (median, 0%) and minor complications ranged from 1.1 to 20.8% (median, 7.5%). The potentially most serious complications were cerebrospinal fluid leaks, injury to the internal carotid artery, dural exposure, meningitis, bleeding requiring transfusion, periorbital/orbital fat exposure, and orbital penetration. Symptomatic improvement ranged from 78 to 88% for FESS compared with 43 to 84% for comparative procedures. From case series, symptomatic improvement ranged from 40 to 98% (median, 88%). Conclusion FESS may offer some advantages in safety and effectiveness over comparative techniques, but wide variation in reported results and methodological shortcomings of studies limit the certainty of these conclusions. Wide variation in complication rates suggests the need for audit of existing practice. Additional high-quality studies with a fuller description of potential confounding factors and effect modifiers will help to define the effectiveness of FESS more clearly.

Cost utility analysis of physical activity counselling in general practice

Objective:To evaluate the economic performance of the ‘Green Prescription’ physical activity counselling program in general practice.

Theory! The Missing Link in Understanding the Performance of Neonate/Infant Home‐Visiting Programs to Prevent Child Maltreatment: A Systematic Review

CONTEXT Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment. METHODS We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis. FINDINGS Having a stated objective of reducing child maltreatment-a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change-considerably increased the chance of success. We found that only seven of fifty-three programs demonstrated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Programs with a partial match had an intermediate success rate. The relationship between program success and full, partial or no match was statistically significant. CONCLUSIONS Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic framework provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory of change, target population, and program components is critical.

Cost effectiveness of imatinib compared with interferon-α or hydroxycarbamide for first-line treatment of chronic myeloid leukaemia

AbstractObjective: To evaluate the cost utility of imatinib compared with interferon (IFN)-α or hydroxycarbamide (hydroxyurea) for first-line treatment of chronic myeloid leukaemia. Design and Setting: A cost-utility (Markov) model within the setting of the UK NHS and viewed from a health system perspective was adopted. Transition probabilities and relative risks were estimated from published literature. Costs of drug treatment, outpatient care, bone marrow biopsies, radiography, blood transfusions and inpatient care were obtained from the British National Formulary and local hospital databases. Costs (£, year 2001–03 values) were discounted at 6%. Quality-of-life (QOL) data were obtained from the published literature and discounted at 1.5%. The main outcome measure was cost per QALY gained. Extensive one-way sensitivity analyses were performed along with probabilistic (stochastic) analysis. Results: The incremental cost-effectiveness ratio (ICER) of imatinib, compared with IFNα, was £26 180 per QALY gained (one-way sensitivity analyses ranged from £19 449 to £51 870) and compared with hydroxycarbamide was £86 934 per QALY (one-way sensitivity analyses ranged from £69 701 to £147 095) [£1 =

Review of Australian health economic evaluation – 245 interventions: what can we say about cost effectiveness?

US1.691 = €1.535 as at 31 December 2002].Based on the probabilistic sensitivity analysis, 50% of the ICERs for imatinib, compared with IFNα, fell below a threshold of approximately £31 000 per QALY gained. Fifty percent of ICERs for imatinib, compared with hydroxycarbamide, fell below approximately £95 000 per QALY gained. Conclusions: This model suggests, given its underlying data and assumptions, that imatinib may be moderately cost effective when compared with IFNα but considerably less cost effective when compared with hydroxycarbamide. There are, however, many uncertainties due to the lack of long-term data.

Nasal high-flow therapy for primary respiratory support in preterm infants

BackgroundThere is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy.MethodsTo achieve consistency in costing base and policy context, study scope was limited to Australian-based cost-effectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria.ResultsThe median cost-effectiveness ratio was A

The Fontan epidemic: Population projections from the Australia and New Zealand Fontan Registry

18,100 (~US

Cost-effectiveness of mandatory folate fortification v . other options for the prevention of neural tube defects: results from Australia and New Zealand

13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY

Fixing the game: are between-silo differences in funding arrangements handicapping some interventions and giving others a head-start?

58,000 and

Screening for hepatitis C in genito-urinary medicine clinics: a cost utility analysis

68,000 respectively), than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at ~A