2 research outputs found
Assessing direct healthcare costs when restricted to self-reported data: a scoping review
Background: In the absence of electronic health records, analysis of direct healthcare costs often relies on resource utilisation data collected from patient-reported surveys. This scoping review explored the availability, use and methodological details of self-reported healthcare service utilisation and cost data to assess healthcare costs in Ireland.
Methods: Population health surveys were identified from Irish data repositories and details were collated in an inventory to inform the literature search. Irish cost studies published in peer-reviewed and grey sources from 2009 to 2019 were included if they used self-reported data on healthcare utilisation or cost. Two independent researchers extracted studies' details and the PRISMA-ScR guidelines were used for reporting.
Results: In total, 27 surveys were identified containing varying details of healthcare utilisation/cost, health status, demographic characteristics and health-related risk and behaviour. Of those surveys, 21 were general population surveys and six were study-specific ad-hoc surveys. Furthermore, 14 cost studies were identified which used retrospective self-reported data on healthcare utilisation or cost from ten of the identified surveys. Nine of these cost studies used ad-hoc surveys and five used data from pre-existing population surveys. Compared to population surveys, ad-hoc surveys contained more detailed information on resource use, albeit with smaller sample sizes. Recall periods ranged from 1 week for frequently used services to 1 year for rarer service use, or longer for once-off costs. A range of perspectives (societal, healthcare and public sector) and costing approaches (bottom-up costing and a mix of top-down and bottom-up) were used. The majority of studies (n = 11) determined unit prices using multiple sources, including national healthcare tariffs, literature and expert views. Moreover, most studies (n = 13) reported limitations concerning data availability, risk of bias and generalisability. Various sampling, data collection and analysis strategies were employed to minimise these.
Conclusion: Population surveys can aid cost assessments in jurisdictions that lack electronic health records, unique patient identifiers and data interoperability. To increase utilisation, researchers wanting to conduct cost analyses need to be aware of and have access to existing data sources. Future population surveys should be designed to address reported limitations and capture comprehensive health-related, demographic and resource use data.</p
PARROT Ireland: placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial research study protocol
Introduction Women presenting with suspected
pre-eclampsia are currently triaged on the basis of
hypertension and dipstick proteinuria. This may result in
significant false positive and negative diagnoses resulting
in increased morbidity or unnecessary intervention. Recent
data suggest that placental growth factor testing may be
a useful adjunct in the management of women presenting
with preterm pre-eclampsia. The primary objective of this
trial is to determine if the addition of placental growth
factor testing to the current clinical assessment of women
with suspected preterm pre-eclampsia, is beneficial for
both mothers and babies.
Methods and analysis This is a multicentre, stepped
wedge cluster, randomised trial aiming to recruit 4000
women presenting with symptoms suggestive of
preterm pre-eclampsia between 20 and 36+6 weeks’
gestation. The intervention of an unblinded point of care
test, performed at enrolment, will quantify maternal
levels of circulating plasma placental growth factor. The
intervention will be rolled out sequentially, based on
randomisation, in the seven largest maternity units on the
island of Ireland. Primary outcome is a composite outcome
of maternal morbidity (derived from the modified fullPIERS
model). To ensure we are not reducing maternal morbidity
at the expense of earlier delivery and worse neonatal
outcomes, we have established a co-primary outcome
which will examine the effect of the intervention on
neonatal morbidity, assessed using a composite neonatal
score. Secondary analyses will examine further clinical
outcomes (such as mode of delivery, antenatal detection
of growth restriction and use of antihypertensive agents)
as well as a health economic analysis, of incorporation of
placental growth factor testing into routine care.
Ethics and dissemination Ethical approval has been
granted from each of the seven maternity hospitals
involved in the trial. The results of the trial will be
presented both nationally and internationally at conference
and published in an international peer-reviewed journal