Systematic literature review of methodologies and data sources of existing economic models across the full spectrum of Alzheimer’s disease and dementia from apparently healthy through disease progression to end of life care: a systematic review protocol

Introduction Dementia is one of the greatest health challenges the world will face in the coming decades, as it is one of the principal causes of disability and dependency among older people. Economic modelling is used widely across many health conditions to inform decisions on health and social care policy and practice. The aim of this literature review is to systematically identify, review and critically evaluate existing health economics models in dementia. We included the full spectrum of dementia, including Alzheimer’s disease (AD), from preclinical stages through to severe dementia and end of life. This review forms part of the Real world Outcomes across the Alzheimer’s Disease spectrum for better care: multimodal data Access Platform (ROADMAP) project. Methods and analysis Electronic searches were conducted in Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, Economic Literature Database, NHS Economic Evaluation Database, Cochrane Central Register of Controlled Trials, Cost-Effectiveness Analysis Registry, Research Papers in Economics, Database of Abstracts of Reviews of Effectiveness, Science Citation Index, Turning Research Into Practice and Open Grey for studies published between January 2000 and the end of June 2017. Two reviewers will independently assess each study against predefined eligibility criteria. A third reviewer will resolve any disagreement. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed using the Phillips checklist for decision analytic modelling. A narrative synthesis will be used. Ethics and dissemination The results will be made available in a scientific peer-reviewed journal paper, will be presented at relevant conferences and will also be made available through the ROADMAP project

Resource utilisation and costs in predementia and dementia: a systematic review protocol

Introduction Dementia is the fastest growing major cause of disability globally with a mounting social and financial impact for patients and their families but also to health and social care systems. This review aims to systematically synthesise evidence on the utilisation of resources and costs incurred by patients and their caregivers and by health and social care services across the full spectrum of dementia, from its preceding preclinical stage to end of life. The main drivers of resources used and costs will also be identified. Methods and analysis A systematic literature review was conducted in MEDLINE, EMBASE, CDSR, CENTRAL, DARE, EconLit, CEA Registry, TRIP, NHS EED, SCI, RePEc and OpenGrey between January 2000 and beginning of May 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. The reporting of costing methodology will be assessed using the British Medical Journal checklist. A narrative synthesis of all studies will be presented for resources used and costs incurred, by level of disease severity when available. If feasible, the data will be synthesised using appropriate statistical techniques. Ethics and dissemination Included articles will be reviewed for an ethics statement. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer’s disease spectrum for better care: multi-modal data access platform (ROADMAP)

The cost of social isolation in older people in the English and Portuguese National Health Services

In this thesis I explore the impact of social isolation on delayed hospital discharges of older proximal femoral fracture (PFF) patients in Portugal and in England, and estimate the costs associated with these delays. A delayed discharge occurs when a patient remains in hospital after being deemed medically fit for discharge, and a better understanding of them will help when designing policies to reduce them and improve the allocation of scarce healthcare resources. Although the literature reports that delayed hospital discharges are prevalent and costly, I found limited knowledge about the impact of pre-admission patient characteristics, including social isolation, on these delays; the significant variability in prevalence of delayed discharges, which could be better understood if estimated by disease area; and the costs associated with such delays. To address these knowledge gaps, I assessed the impact of social isolation, measured with a validated tool, on delayed hospital discharges in older patients using two case studies: PFF patients admitted to the Hospital de Santa Maria (HSM) in Portugal and to the John Radcliffe Hospital (JRH) in England. My research showed that social isolation is a predictor of the number of days of delayed hospital discharges. However, whereas in Portugal the number of days of delayed discharges increased progressively with the level of social isolation, in England no such dose-response relationship was observed, indicating that any social isolation leads to delayed discharge but the level of social isolation has little effect. The costs of delayed discharges were found to be significant in both countries. Preventing delayed discharges could have led to a â¬2,352 saving in hotel costs per PFF patient with a delay in discharge in Portugal, and £2,328 in England. When extrapolated to a national level, the annual costs of delayed discharges were estimated to vary between 5.4% and 11.2% of total acute inpatient costs for PFF patients aged 75 and above in Portugal, and between 2.9% and 4.4% of total acute inpatient costs for PFF patients aged 70 and above in England. Two interventions aiming at alleviating social isolation were identified through a systematic review and were incorporate in the delayed discharge models at the HSM and the JRH. The case studies show potential for these interventions to reduce the number of days of delayed discharge.</p

Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation—A Prospective Observational Study

Objectives:. The current standard of care to deliver invasive mechanical ventilation support is the protective ventilation approach. One pillar of this approach is the limitation of tidal volume to less than 6 mL/Kg of predicted body weight. Predicted body weight is calculated from patient’s height. Yet, little is known about the potential impact of errors arising from visual height estimation, a common practice, to calculate tidal volumes. The aim of this study was to evaluate that impact on tidal volume calculation to use during protective ventilation. Design:. Prospective observational study. Setting:. An eight-bed polyvalent ICU. Patients:. Adult patients (≥ 18 yr). Interventions:. None. Measurements and Main Results:. Tidal volumes were calculated from visual height estimates made by physicians, nurses, and patients themselves and compared with tidal volumes calculated from measured heights. Comparisons were made using the paired t test. Modified Bland-Altman plots were used to assess agreement between height estimates and measurements. One-hundred patients were recruited. Regardless of the height estimator, all the mean tidal volumes would be greater than 6 mL/Kg predicted body weight (all p < 0.001). Additionally, tidal volumes would be greater than or equal to 6.5 mL/Kg predicted body weight in 18% of patients’ estimates, 25% of physicians’ estimates, and 30% of nurses’ estimates. Patients with lower stature (< 165 cm), older age, and surgical typology of admission were at increased risk of being ventilated with tidal volumes above protective threshold. Conclusions:. The clinical benefit of the protective ventilation strategy can be offset by using visual height estimates to calculate tidal volumes. Additionally, this approach can be harmful and potentially increase mortality by exposing patients to tidal volumes greater than or equal to 6.5 mL/Kg predicted body weight. In the interest of patient safety, every ICU patient should have his or her height accurately measured

Protocol for open-label randomized clinical trial of intensive surveillance versus standard postoperative follow-up in patients undergoing surgical resection for oesophageal and gastric cancer

Despite recent improvements in oncological and surgical treatment for patients with oesophageal and gastric cancer, 60 per cent of those with locally advanced disease who are treated with curative intent will develop tumour recurrence and die within 3 years of completing treatment. In the absence of robust scientific evidence, national or international guidelines have failed to reach consensus on the optimal surveillance strategy after primary treatment of oesophageal or gastric cancer.The primary research question of the proposed RCT is: does the routine use of a structured follow-up programme with regular radiological and endoscopic investigations improve survival in patients who have had surgical treatment for oesophageal or gastric cancer with curative intent

Obtaining EQ-5D-5L utilities from the disease specific quality of life Alzheimer’s disease scale: development and results from a mapping study

Abstract Purpose The Quality of Life Alzheimer’s Disease Scale (QoL-AD) is commonly used to assess disease specific health-related quality of life (HRQoL) as rated by patients and their carers. For cost-effectiveness analyses, utilities based on the EQ-5D are often required. We report a new mapping algorithm to obtain EQ-5D indices when only QoL-AD data are available. Methods Different statistical models to estimate utility directly, or responses to individual EQ-5D questions (response mapping) from QoL-AD, were trialled for patient-rated and proxy-rated questionnaires. Model performance was assessed by root mean square error and mean absolute error. Results The response model using multinomial regression including age and sex, performed best in both the estimation dataset and an independent dataset. Conclusions The recommended mapping algorithm allows researchers for the first time to estimate EQ-5D values from QoL-AD data, enabling cost-utility analyses using datasets where the QoL-AD but no utility measures were collected