Essential inputs for studies of cost-effectiveness analysis in melanoma

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Essential inputs for studies of cost-effectiveness analysis in melanoma

Health-related quality of life, measured in either ‘utilities’ or ‘disability weights’ is an essential component of cost-effectiveness analysis and burden of disease studies

Home hemodialysis: a comprehensive review of patient-centered and economic considerations

Internationally, the number of patients requiring treatment for end-stage kidney disease (ESKD) continues to increase, placing substantial burden on health systems and patients. Home hemodialysis (HD) has fluctuated in its popularity, and the rates of home HD vary considerably between and within countries although there is evidence suggesting a number of clinical, survival, economic, and quality of life (QoL) advantages associated with this treatment. International guidelines encourage shared decision making between patients and clinicians for the type of dialysis, with an emphasis on a treatment that aligned to the patients’ lifestyle. This is a comprehensive literature review of patient-centered and economic impacts of home HD with the studies published between January 2000 and July 2016. Data from the primary studies representing both efficiency and equity of home HD were presented as a narrative synthesis under the following topics: advantages to patients, barriers to patients, economic factors influencing patients, cost-effectiveness of home HD, and inequities in home HD delivery. There were a number of advantages for patients on home HD including improved survival and QoL and flexibility and potential for employment, compared to hospital HD. Similarly, there were several barriers to patients preferring or maintaining home HD, and the strategies to overcome these barriers were frequently reported. Good evidence reported that indigenous, low-income, and other socially disadvantaged individuals had reduced access to home HD compared to other forms of dialysis and that this situation compounds already-poor health outcomes on renal replacement therapy. Government policies that minimize barriers to home HD include reimbursement for dialysis-related out-of-pocket costs and employment-retention interventions for home HD patients and their family members. This review argues that home HD is a cost-effective treatment, and increasing the proportion of patients on this form of dialysis compared to hospital HD will result in a more equitable distribution of good health outcomes for individuals with ESKD

Renal unit characteristics and patient education practices that predict a high prevalence of home-based dialysis in Australia

Abstract AIM: The proportion of patients using home dialysis in Australia varies from 6% to 62% between renal units. The aim of this study was to determine if the variance is attributed to any underlying renal unit factors including pre-end stage education practices. METHODS: An online survey was distributed to all Australian units that offered home dialysis. Logistic regression was performed to estimate the effects of renal unit characteristics on the binary outcome of 1 h of pre-end stage education per patient, compared with ≤ 1 h predicted more than 10% of patients on HHD (OR 2.84, 95% CI 1.17-6.90). CONCLUSION: Our data suggest certain pre-end stage education practices are significantly associated with home dialysis rates above the national average. The consistent above average home dialysis rates witnessed in New South Wales appear to be the result of renal unit culture, education strategies and policies that support 'home dialysis first'. © 2014 Asian Pacific Society of Nephrology

The impact of socio-economic status on melanoma clinical trial participation: an observational cohort study from Australia.

Low socio-economic status (SES) is reported to be a barrier to participation in cancer clinical trials due to out-of-pocket costs associated with trial participation, logistical barriers to attend screening services in different diagnostic and treatment centers, and associated cultural or linguistic barriers. One study of clinical trial participation in the ocular melanoma population, reported somewhat different results, whereby people of an older age (≥60 years), lower education level, and those with non-managerial jobs were more likely to participate in a clinical trial, than their younger, more educated counterparts. The aim of the present study was to determine whether SES was associated with participation in clinical trials for people with cutaneous melanoma

The impact of socio-economic status on melanoma clinical trial participation: an observational cohort study from Australia.

Low socio-economic status (SES) is reported to be a barrier to participation in cancer clinical trials due to out-of-pocket costs associated with trial participation, logistical barriers to attend screening services in different diagnostic and treatment centers, and associated cultural or linguistic barriers. One study of clinical trial participation in the ocular melanoma population, reported somewhat different results, whereby people of an older age (≥60 years), lower education level, and those with non-managerial jobs were more likely to participate in a clinical trial, than their younger, more educated counterparts. The aim of the present study was to determine whether SES was associated with participation in clinical trials for people with cutaneous melanoma

Anti-coagulation, anti-platelets or no therapy in haemodialysis patients with atrial fibrillation: a decision analysis

BACKGROUND: Optimal treatment of atrial fibrillation (AF) in the haemodialysis population is uncertain due to the exclusion of this group from randomized trials. The risk-benefit profile for anticoagulation and anti-platelet therapy in haemodialysis differs from the general population due to platelet dysfunction from uraemia, altered pharmacokinetics and increased falls risk. METHODS: This decision analysis used a Markov-state transition model that took a patient perspective over a 5 year timeframe. The Markov model compared life-years gained and quality-adjusted life-years gained (QALY) for three AF treatment strategies: warfarin, aspirin and no treatment. The base case was a 70-year-old man on haemodialysis with non-valvular AF. RESULTS: In the base case, the total health outcomes in life-years and QALY were 2.37 and 1.47 respectively for warfarin, 2.38 and 1.61 respectively for aspirin, and 2.39 and 1.61 respectively for no treatment. Thus, warfarin led to 0.14 fewer QALY or 1.7 fewer months of life lived in full health, compared with either aspirin or no therapy. The finding that warfarin generated the lowest expected QALY was robust to one-way, two-way and probabilistic sensitivity analyses. CONCLUSIONS: Our results suggest that warfarin should not be the default choice for older haemodialysis patients with non-valvular AF as it provides the fewest QALY compared with aspirin or no therapy

Anti-coagulation, anti-platelets or no therapy in haemodialysis patients with atrial fibrillation: A decision analysis

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