Found 11181 matches for
Measuring, valuing and including forgone childhood education and leisure time costs in economic evaluation: Methods, challenges and the way forward.
Economic evaluations carried out to inform the allocation of finite public funds ought to take into account all relevant costs and benefits. When such evaluations adopt a societal perspective, it is important that they include 'time-related' costs arising from productivity and leisure time losses due to receipt of care, ill health or both. For programmes that relate to children, similar costs arise from forgone time, though there is a distinct lack of insights into how such costs should be identified, measured and valued. We set out to explore how forgone time-including absence from formal education and childhood leisure time-can be estimated and incorporated into economic evaluations. To do so, we look at theories and approaches to time valuation proposed in different disciplines and we discuss their suitability for use in health economics research. We find that, while there is a sizeable literature on time valuation methods in education, labour and transportation economics, much of this is not directly applicable to economic evaluation of health care interventions for children. We identify gaps in existing methods and practice, we outline challenges in moving forwards and we provide a list of considerations aiming to assist researchers in deciding whether, and how, to include foregone time-related costs in economic evaluation.
The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort
© 2019 The Author(s). Background: The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions. Methods: We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation. Results: More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics. Conclusions: Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
Using out-of-office blood pressure measurements in established cardiovascular risk scores: a secondary analysis of data from two blood pressure monitoring studies
© British Journal of General Practice 2019. BACKGROUND: Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinics. AIM: To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings. DESIGN AND SETTING: Secondary analysis of data from adults aged 25-84 years in the UK and the Netherlands without prior history of cardiovascular disease (CVD) in two BP monitoring studies: the Blood Pressure in different Ethnic groups (BP-Eth) study and the Home versus Office blood pressure MEasurements: Reduction of Unnecessary treatment Study (HOMERUS). METHOD: The primary comparison was Framingham risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements. Statistical significance was determined using non-parametric tests. RESULTS: In 442 BP-Eth patients (mean age = 58 years, 50% female [n = 222]) the median absolute difference in 10-year Framingham cardiovascular risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements was 1.84% (interquartile range [IQR] 0.65-3.63, P = 0.67). In 165 HOMERUS patients (mean age = 56 years, 46% female) the median absolute difference in 10-year risk for daytime ambulatory BP was 2.76% (IQR 1.19-6.39, P<0.001) and only 8 out of 165 (4.8%) of patients were reclassified. CONCLUSION: Estimates of cardiovascular risk are similar when calculated using BP measurements obtained as in the risk score derivation study or through ambulatory monitoring. Further research is required to determine if differences in estimated risk would meaningfully influence risk score accuracy.
The lived experience of chronic headache: a systematic review and synthesis of the qualitative literature
<jats:sec><jats:title>Objective</jats:title><jats:p>To systematically review the qualitative literature of the lived experience of people with a chronic headache disorder.</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>Chronic headaches affect 3%–4% of the population. The most common chronic headache disorders are chronic migraine, chronic tension-type headache and medication overuse headache. We present a systematic review and meta-ethnographic synthesis of the lived experience of people with chronic headache.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We searched seven electronic databases, hand-searched nine journals and used a modified Critical Appraisal Skills Programme checklist to appraise study quality. Following thematic analysis we synthesised the data using a meta-ethnographic approach.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 3586 unique citations; full texts were examined for 86 studies and 4 were included in the review. Included studies differed in their foci: exploring, patient-centred outcomes, chronic headache as a socially invisible disease, psychological processes mediating impaired quality of life, and the process of medication overuse. Initial thematic analysis and subsequent synthesis gave three overarching themes: ‘headache as a driver of behaviour’ (directly and indirectly), ‘the spectre of headache’ and ‘strained relationships’.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This meta-synthesis of published qualitative evidence demonstrates that chronic headaches have a profound effect on people’s lives, showing similarities with other pain conditions. There were insufficient data to explore the similarities and differences between different chronic headache disorders.</jats:p></jats:sec>
Validity of neurodevelopmental outcomes of children born very preterm assessed during routine clinical follow-up in England
<jats:sec><jats:title>Objective</jats:title><jats:p>To determine the validity of assessing and recording the neurodevelopmental outcome of very preterm infants during routine clinical follow-up in England.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Children born <30 weeks gestation, attending routine clinical follow-up at post-term ages 20–28 months, were recruited. Data on neurodevelopmental outcomes were recorded by the reviewing clinician in a standardised format in the child’s electronic patient record, based on a set of key questions designed to be used without formal training or developmental testing. Using a predefined algorithm, each participant was classified as having ‘no’, ‘mild/moderate’ or ‘severe’ impairment in cognitive, communication and motor domains. All participants also received a research assessment by a single assessor using the Bayley Scales of Infant Development, third edition (Bayley-III). The sensitivity and specificity of routine data in capturing impairment (any Bayley-III score <85) or severe impairment (any Bayley-III score <70) was calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>190 children participated. The validity of routine assessments in identifying children with no impairment and no severe impairment was high across all domains (specificities 83.9%–100.0% and 96.6%–100.0%, respectively). However, identification of impairments, particularly in the cognitive (sensitivity 69.7% (55.1%–84.3%)) and communication (sensitivity (53.2% (42.0%–64.5%)) domains, was poor.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Neurodevelopmental status determined during routine clinical assessment lacks adequate sensitivity in cognitive and communication domains. It is uncertain whether this reflects the assessment or/and the recording of findings. As early intervention may improve education and social outcomes, this is an important area for healthcare quality improvement research.</jats:p></jats:sec>
Survival of very preterm infants admitted to neonatal care in England 2008–2014: time trends and regional variation
<jats:sec><jats:title>Objective</jats:title><jats:p>To analyse survival trends and regional variation for very preterm infants admitted to neonatal care.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>All neonatal units in England.</jats:p></jats:sec><jats:sec><jats:title>Patients</jats:title><jats:p>Infants born at 22<jats:sup>+0</jats:sup>–31<jats:sup>+6</jats:sup> weeks<jats:sup>+days</jats:sup>gestational age (GA) over 2008–2014 and admitted to neonatal care; published data for admitted infants 22<jats:sup>+0</jats:sup>–25<jats:sup>+6</jats:sup> weeks<jats:sup>+days</jats:sup> GA in 1995 and 2006, and for live births at 22<jats:sup>+0</jats:sup>–31<jats:sup>+6</jats:sup> weeks<jats:sup>+days</jats:sup> GA in 2013.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We obtained data from the National Neonatal Research Database. We used logistic regression to model survival probability with birth weight, GA, sex, antenatal steroid exposure and multiple birth included in the risk adjustment model and calculated annualpercentage change (APC) for trends using joinpoint regression. We evaluated survival over a 20-year period for infants <26 weeks’ GA using additional published data from the EPICure studies.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 50 112 eligible infants. There was an increase in survival over 2008–2014 (2008: 88.0%; 2014: 91.3%; adjusted APC 0.46% (95% CI 0.30 to 0.62) p<0.001). The greatest improvement was at 22<jats:sup>+0</jats:sup>–23<jats:sup>+6</jats:sup> weeks (APC 6.03% (95% CI 2.47 to 3.53) p=0.002). Improvement largely occurred in London and South of England (APC: London 1.26% (95% CI 0.60 to 1.96); South of England 1.09% (95% CI 0.36 to 1.82); Midlands and East of England 0.15% (95% CI −0.56 to 0.86); and North of England 0.26% (95% CI −0.54 to 1.07)). Survival at the earliest gestations improved at a similar rate over 1995–2014 (22<jats:sup>+0</jats:sup>–25<jats:sup>+6</jats:sup> weeks, APC 2.73% (95% CI 2.35 to 3.12), p value for change=0.25).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Continued national improvement in the survival of very preterm admissions masks important regional variation. Timely assessment of preterm survival is feasible using electronic records.</jats:p></jats:sec>