Morgan Lim

A review of the cost of cardiovascular disease

In Canada, 74,255 deaths (33% of all deaths) in 2003 were due to cardio-vascular disease (CVD). As one of the most costly diseases, CVD represents a major economic burden on health care systems. The purpose of the present study was to review the literature on the economic costs of CVD in Canada and other developed countries (United States, Europe and Australia) published from 1998 to 2006, with a focus on Canada. Of 1656 screened titles and abstracts, 34 articles were reviewed including six Canadian studies and 17 American studies. While considerable variation was observed among studies, all studies indicated that the costs of treating CVD-related conditions are significant, outlining a convincing case for CVD prevention programs.

Transferability of health technology assessments and economic evaluations: a systematic review of approaches for assessment and application

Background: Health technology assessments (HTA) generally, and economic evaluations (EE) more specifically, have become an integral part of health care decision making around the world. However, these assessments are time consuming and expensive to conduct. Evaluation resources are scarce and therefore priorities need to be set for these assessments and the ability to use information from one country or region in another (geographic transferability) is an increasingly important consideration. Objectives: To review the existing approaches, systems, and tools for assessing the geographic transferability potential or guiding the conduct of transferring HTAs and EEs. Methods: A systematic literature review was conducted of several databases, supplemented with web searching, hand searching of journals, and bibliographic searching of identified articles. Systems, tools, checklists, and flow charts to assess, evaluate, or guide the conduct of transferability of HTAs and EEs were identified. Results: Of 282 references identified, 27 articles were reviewed in full text and of these, seven proposed unique systems, tools, checklists, or flow charts specifically for geographic transferability. All of the seven articles identified a checklist of transferability factors to consider, and most articles identified a subset of ‘critical’ factors for assessing transferability potential. Most of these critical factors related to study quality, transparency of methods, the level of reporting of methods and results, and the applicability of the treatment comparators to the target country. Some authors proposed a sequenced flow chart type approach, while others proposed an assessment of critical criteria first, followed by an assessment of other noncritical factors. Finally some authors proposed a quantitative score or index to measure transferability potential. Conclusion: Despite a number of publications on the topic, the proposed approaches and the factors used for assessing geographic transferability potential have varied substantially across the papers reviewed. Most promising is the identification of an extensive checklist of critical and noncritical factors in determining transferability potential, which may form the basis for consensus of a future tool. Due to the complexities of identifying appropriate weights for each of the noncritical factors, it is still uncertain whether the assessment and calculation of an overall transferability score or index will be practical or useful for transferability considerations in the future.

Prevalence, Total and Excess Costs of Diabetes and Related Complications in Ontario, Canada

ABSTRACT BACKGROUND Diabetes costing studies often do not identify the marginal costs directly attributable to the disease. The objective of this study is to estimate the prevalence, total and excess costs attributable to diabetes and its complications in Ontario over 11 years (1995 to 2005). METHODS Incident type 1 and type 2 diabetes cases, with and without the following complications, were identified from the Ontario Diabetes Database: myocardial infarction, stroke, angina, heart failure, blindness in 1 eye, amputation, nephropathy and cataracts. Patients were matched 2:1 with controls. Excess costs of diabetes were estimated as the difference between costs attributed to patients with diabetes vs. those attributed to patients without diabetes. Another control group consisting of all patients in Ontario older than 35 years was used to compare the cost of complications for patients with and without diabetes. RESULTS The prevalence of diabetes rose drastically, from 6.5 to 10.5%. Excess costs were

Simulating an emergency department: the importance of modeling the interactions between physicians and delegates in a discrete event simulation

2930 in the year of diabetes diagnosis and

Approaches for Economic Evaluations of Health Care Technologies

1240 in subsequent years. In the year of the event, cost differences were greatest for patients with diabetes who had an amputation (

Access to surgery for paediatric patients with medically refractory epilepsy: A systems analysis

5133), followed closely by nephropathy (

Cost-effectiveness of reducing wait times for cataract surgery in Ontario

4117) and stroke cases (

Health technology assessment from a Canadian device industry perspective.

3965). CONCLUSIONS Findings from this study illustrate that the prevalence of diabetes has almost doubled between 1995 and 2005; that researchers can overestimate total costs if excess costs directly attributable to diabetes are not considered; and that they can underestimate total costs if disease-specific complication costs are not considered.

General population versus disease-specific event rate and cost estimates: potential bias for economic appraisals.

BackgroundComputer simulation studies of the emergency department (ED) are often patient driven and consider the physician as a human resource whose primary activity is interacting directly with the patient. In many EDs, physicians supervise delegates such as residents, physician assistants and nurse practitioners each with different skill sets and levels of independence. The purpose of this study is to present an alternative approach where physicians and their delegates in the ED are modeled as interacting pseudo-agents in a discrete event simulation (DES) and to compare it with the traditional approach ignoring such interactions.MethodsThe new approach models a hierarchy of heterogeneous interacting pseudo-agents in a DES, where pseudo-agents are entities with embedded decision logic. The pseudo-agents represent a physician and delegate, where the physician plays a senior role to the delegate (i.e. treats high acuity patients and acts as a consult for the delegate). A simple model without the complexity of the ED is first created in order to validate the building blocks (programming) used to create the pseudo-agents and their interaction (i.e. consultation). Following validation, the new approach is implemented in an ED model using data from an Ontario hospital. Outputs from this model are compared with outputs from the ED model without the interacting pseudo-agents. They are compared based on physician and delegate utilization, patient waiting time for treatment, and average length of stay. Additionally, we conduct sensitivity analyses on key parameters in the model.ResultsIn the hospital ED model, comparisons between the approach with interaction and without showed physician utilization increase from 23% to 41% and delegate utilization increase from 56% to 71%. Results show statistically significant mean time differences for low acuity patients between models. Interaction time between physician and delegate results in increased ED length of stay and longer waits for beds.ConclusionThis example shows the importance of accurately modeling physician relationships and the roles in which they treat patients. Neglecting these relationships could lead to inefficient resource allocation due to inaccurate estimates of physician and delegate time spent on patient related activities and length of stay.

Excess Risk of Mortality and Complications Associated with Newly Diagnosed Cases of Diabetes in Ontario, Canada

Economic evaluations involve the comparison of alternative courses of action in terms of both their costs and their consequences. In response to increasing health care costs, economic evaluations of competing technologies, including radiologic interventions, are increasingly used to inform resource allocation decisions. It is therefore crucial that radiologists have a thorough understanding of the methods. The objective of this paper is to present a detailed overview of the principles and methods of economic evaluations of health technologies, including recent methodologic developments. For the purpose of this paper, the key elements of an economic evaluation are divided into 5 broad sections: 1) types of economic evaluations (eg, cost-effectiveness analysis, cost-utility analysis), 2) study perspectives (ie, temporal and cost perspectives), 3) analysis of costs and effects (eg, incremental cost-effectiveness ratios, cost-effectiveness planes), 4) conducting economic evaluations alongside trials or using decision-analytic models, and 5) dealing with the different forms of uncertainty in economic evaluations (eg, sampling uncertainty in trials, parameter uncertainty in models). Examples from the recent radiology literature are used to explain the key concepts. This review improves upon the previous educational papers published in radiologic journals, as it covers recent methodologic advances regarding the treatment of uncertainty.