ASPIRIN IN COLORECTAL CANCER PREVENTION: A LOOK AT ITS COST-EFFECTIVENESS ANALYSES IN THE UNITED STATES, WITH EMPIRICAL INVESTIGATIONS TO SUPPORT MODEL ADAPTATIONS FOR SINGAPORE

Ph.DDOCTOR OF PHILOSOPH

Cost-effectiveness analysis of bilateral cochlear implants for children with severe-to-profound sensorineural hearing loss in both ears in Singapore.

A cochlear implant is a small electronic device that provides a sense of sound for the user, which can be used unilaterally or bilaterally. Although there is advocacy for the benefits of binaural hearing, the high cost of cochlear implant raises the question of whether its additional benefits over the use of an acoustic hearing aid in the contralateral ear outweigh its costs. This cost-effectiveness analysis aimed to separately assess the cost-effectiveness of simultaneous and sequential bilateral cochlear implantations compared to bimodal hearing (use of unilateral cochlear implant combined with an acoustic hearing aid in the contralateral ear) in children with severe-to-profound sensorineural hearing loss in both ears from the Singapore healthcare payer perspective. Incremental quality-adjusted life year (QALYs) gained and costs associated with bilateral cochlear implants over the lifetime horizon were estimated based on a four-state Markov model. The analysis results showed that, at the 2017 mean cost, compared to bimodal hearing, patients receiving bilateral cochlear implants experienced more QALYs but incurred higher costs, resulting in an incremental cost-effectiveness ratio (ICER) of USD$60,607 per QALY gained for simultaneous bilateral cochlear implantation, and USD$81,782 per QALY gained for sequential bilateral cochlear implantation. The cost-effectiveness of bilateral cochlear implants is most sensitive to utility gain associated with second cochlear implant, and cost of bilateral cochlear implants. ICERs increased when the utility gain from bilateral cochlear implants decreased; ICERs exceeded USD$120,000 per QALY gained when the utility gain was halved from 0.03 to 0.015 in both simultaneous and sequential bilateral cochlear implantations. The choice of incremental utility gain associated with the second cochlear implant is an area of considerable uncertainty

DARE Train-the-Trainer Pedagogy Development Using 2-Round Delphi Methodology

The Dispatcher-Assisted first REsponder programme aims to equip the public with skills to perform hands-only cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator (AED). By familiarising them with instructions given by a medical dispatcher during an out-of-hospital cardiac arrest call, they will be prepared and empowered to react in an emergency. We aim to formalise curriculum and standardise the way information is conveyed to the participants. A panel of 20 experts were chosen. Using Delphi methodology, selected issues were classified into open-ended and close-ended questions. Consensus for an item was established at a 70% agreement rate within the panel. Questions that had 60%–69% agreement were edited and sent to the panel for another round of voting. After 2 rounds of voting, 70 consensus statements were agreed upon. These covered the following: focus of CPR; qualities and qualifications of trainers; recognition of agonal breathing; head-tilt-chin lift; landmark for chest compression; performance of CPR when injuries are present; trainers’ involvement in training lay people; modesty of female patients during CPR; AED usage; content of trainer’s manual; addressing of questions and answers; updates-dissemination to trainers and attendance of refresher courses. Recommendations for pedagogy for trainers of dispatcher-assisted CPR programmes were developed

Audit of Diabetes-Dependent Quality of Life (ADDQoL) [Chinese Version for Singapore] Questionnaire: Reliability and Validity among Singaporeans with Type 2 Diabetes Mellitus

Background: The Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire is an individualized instrument that measures the impact of diabetes mellitus on quality of life (QOL). With the worldwide increase in the number of Chinese people diagnosed with diabetes, we anticipated that a Chinese-language version of the ADDQoL would be urgently needed. Objective: To evaluate the reliability and validity of the ADDQoL (Chinese version for Singapore) among Chinese-speaking Singaporeans with type 2 diabetes mellitus (T2DM). Methods: Chinese versions of the ADDQoL, EuroQoL-Visual Analogue Scale (EQ-VAS), EQ-5D and SF-6D were administered to Chinese-speaking participants with T2DM (aged ≥21 years) at a tertiary acute-care hospital by convenience sampling. The ADDQoL was assessed for the following: internal consistency (Cronbach's alpha); test-retest reliability (intraclass correlation coefficient [ICC]); factor structure; known-groups validity (insulin requiring vs non-insulin requiring, with vs without diabetes-related complications, overweight/obese vs not overweight/obese); and convergent and divergent validity (with EQ-VAS, EQ-5D and SF-6D). The usefulness of weighting and 'not applicable' (NA) options (key features of ADDQoL) were also evaluated. Results: In 88 participants (58% male, mean [SD] age 56.6 [11.74] years), the mean (SD) ADDQoL average weighted impact (AWI) score was -2.613 (1.899). Cronbach's alpha was 0.941 and the ICC was 0.955 (95% CI 0.812, 0.990). In confirmatory factor analysis, the hypothesized one-factor solution was supported. ADDQoL AWI scores correlated strongly with ADDQoL diabetes-dependent global QOL scores (Spearman's rank correlation coefficient [rs] - 0.5983) and weakly with generic measures (rs - -0.028 for ADDQoL present global QOL scores, 0.310 for EQ-VAS, 0.164 for EQ-5D and 0.281 for SF-6D). Participants who required insulin, those with diabetes-related complications and those who were overweight/obese reported lower AWI scores, but the differences were not statistically significant. Importance scores of zero were assigned 1-28% of the time and the NA options were selected 3-49% of the time. Conclusions: The ADDQoL is reliable and probably valid for assessing QOL among Chinese-speaking Singaporeans with T2DM, although known-groups validity warrants further investigation.Quality-of-life-rating-scales, Type-2-diabetes-mellitus

Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore

To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective.Published versio

Cost-effectiveness of MRI targeted biopsy strategies for diagnosing prostate cancer in Singapore

10.1186/s12913-021-06916-0BMC HEALTH SERVICES RESEARCH21

Audit of diabetes-dependent quality of life (ADDQoL) Chinese version for Singapore questionnaire: reliability and validity among Singaporeans with type 2 diabetes mellitus

Background: The Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire is an individualized instrument that measures the impact of diabetes mellitus on quality of life (QOL). With the worldwide increase in the number of Chinese people diagnosed with diabetes, we anticipated that a Chinese-language version of the ADDQoL would be urgently needed. Objective: To evaluate the reliability and validity of the ADDQoL (Chinese version for Singapore) among Chinese-speaking Singaporeans with type 2 diabetes mellitus (T2DM). Methods: Chinese versions of the ADDQoL, EuroQoL-Visual Analogue Scale (EQ-VAS), EQ-5D and SF-6D were administered to Chinese-speaking participants with T2DM (aged ≥21 years) at a tertiary acute-care hospital by convenience sampling. The ADDQoL was assessed for the following: internal consistency (Cronbach’s alpha); test-retest reliability (intraclass correlation coefficient [ICC]); factor structure; known-groups validity (insulin requiring vs non-insulin requiring, with vs without diabetes-related complications, overweight/obese vs not overweight/obese); and convergent and divergent validity (with EQ-VAS, EQ-5D and SF-6D). The usefulness of weighting and ‘not applicable’ (NA) options (key features of ADDQoL) were also evaluated. Results: In 88 participants (58% male, mean [SD] age 56.6 [11.74] years), the mean (SD) ADDQoL average weighted impact (AWI) score was -2.613 (1.899). Cronbach’s alpha was 0.941 and the ICC was 0.955 (95% CI 0.812, 0.990). In confirmatory factor analysis, the hypothesized one-factor solution was supported. ADDQoL AWI scores correlated strongly with ADDQoL diabetes-dependent global QOL scores (Spearman’s rank correlation coefficient [r_s] = 0.5983) and weakly with generic measures (r_s=-0.028 for ADDQoL present global QOL scores, 0.310 for EQ-VAS, 0.164 for EQ-5D and 0.281 for SF-6D). Participants who required insulin, those with diabetes-related complications and those who were overweight/obese reported lower AWI scores, but the differences were not statistically significant. Importance scores of zero were assigned 1–28% of the time and the NA options were selected 3–49% of the time. Conclusions: The ADDQoL is reliable and probably valid for assessing QOL among Chinese-speaking Singaporeans with T2DM, although known-groups validity warrants further investigation

Cost-Effectiveness of Aspirin Adjuvant Therapy in Early Stage Colorectal Cancer in Older Patients

<div><p>Background & Aims</p><p>Recent observational studies showed that post-operative aspirin use reduces cancer relapse and death in the earliest stages of colorectal cancer. We sought to evaluate the cost-effectiveness of aspirin as an adjuvant therapy in Stage I and II colorectal cancer patients aged 65 years and older.</p><p>Methods</p><p>Two five-state Markov models were constructed separately for Stage I and II colorectal cancer using TreeAge Pro 2014. Two hypothetical cohorts of 10,000 individuals at a starting age of 65 years and with colorectal cancer in remission were put through the models separately. Cost-effectiveness of aspirin was evaluated against no treatment (Stage I and II) and capecitabine (Stage II) over a 20-year period from the United States societal perspective. Extensive one-way sensitivity analyses and multivariable Probabilistic Sensitivity Analyses (PSA) were performed.</p><p>Results</p><p>In the base case analyses, aspirin was cheaper and more effective compared to other comparators in both stages. Sensitivity analyses showed that no treatment and capecitabine (Stage II only) can be cost-effective alternatives if the utility of taking aspirin is below 0.909, aspirin’s annual fatal adverse event probability exceeds 0.57%, aspirin’s relative risk of disease progression is 0.997 or more, or when capecitabine’s relative risk of disease progression is less than 0.228. Probabilistic Sensitivity Analyses (PSA) further showed that aspirin could be cost-effective 50% to 80% of the time when the willingness-to-pay threshold was varied from USD20,000 to USD100,000.</p><p>Conclusion</p><p>Even with a modest treatment benefit, aspirin is likely to be cost-effective in Stage I and II colorectal cancer, thus suggesting a potential unique role in secondary prevention in this group of patients.</p></div

Model Inputs for One-way Sensitivity Analyses.

a<p>Transition probabilities were derived from Stage I and II colorectal cancer patients (aged 65–69 when diagnosed) who were diagnosed between 1989 to 1993 to give 18–22 years of follow-up data. More details can be found in the <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107866#pone.0107866.s001" target="_blank">File S1</a>.</p>b<p>For aspirin, the probabilities of fatal and non-fatal adverse events are applied only for the first five years; for capecitabine, probability of 0.0291 for non-fatal adverse events is applied only in the first year. An annual probability of 0 is applied for all other years.</p>c<p>Cost of aspirin is applied only in the first five years; cost of capecitabine is applied only in the first year.</p>d<p>The range for indirect cost is derived by multiplying the lower (−20%) or upper limits (+20%) of the time estimate by the respective applicable lower or upper limits of the median hourly wage.</p><p>Model Inputs for One-way Sensitivity Analyses.</p