Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review.

Background: Sepsis is a global health priority. Interventions to reduce the burden of sepsis need to be both effective and cost-effective. We performed a systematic review of the literature on health economic evaluations of sepsis treatments in critically ill adult patients and summarised the evidence for cost-effectiveness.

Quality of Life and 1-Year Survival in Patients With Early Septic Shock: Long-Term Follow-Up of the Australasian Resuscitation in Sepsis Evaluation Trial.

Objectives: To examine long-term survival and quality of life of patients with early septic shock.

Design: Prospective, randomized, parallel-group trial.

Setting: Fifty-one hospitals in Australia, New Zealand, Finland, Hong Kong, and the Republic of Ireland.

Stated and Revealed Preferences for Funding New High-Cost Cancer Drugs: A Critical Review of the Evidence from Patients, the Public and Payers.

Background: The growing focus on patient-centred care has encouraged the inclusion of patient and public input into payer drug reimbursement decisions. Yet, little is known about patient/public priorities for funding high-cost medicines, and how they compare to payer priorities applied in public funding decisions for new cancer drugs.

Objectives: The aim was to identify and compare the funding preferences of cancer patients and the general public against the criteria used by payers making cancer drug funding decisions.

A comparison of directly elicited and pre-scored preference-based measures of quality of life: the case of adhesive capsulitis.

Purpose: To assess the convergent validity and comparative responsiveness in measuring the health-related quality of life associated with adhesive capsulitis of a disease-specific measure (Shoulder Pain and Disability Index), a generic quality of life measure (SF-36), a preference-based multi-attribute utility scale (assessment of quality of life), and two direct patient preference elicitation methods (willingness to pay and time trade-off).

Method: Instruments administered to all 156 participants in both arms of a randomized placebo-controlled trial of physiotherapy following arthrographic joint distension at baseline were reported at 6, 12, and 26 weeks. Convergent validity was measured using both pooled correlation between instruments and within subjects over time.

Health economic methods: cost-minimization, cost-effectiveness, cost-utility, and cost-benefit evaluations.

Health care resources are limited, and health care providers must strive to maximize health benefits to patients within available resources. This is becoming increasingly important in critical care as demand for services grows and costs associated with treatment increase. Economic evaluations enable comparisons of both the costs and effects of an intervention.

Expensive care - a rationale for economic evaluations in intensive care.

The demand for intensive care services is growing, and the cost of these services is increasing, with newer technologies consuming larger portions of the health care budget. We contend that both the costs and benefits of interventions must be considered to truly understand their value in critical care. Economic evaluations provide an explicit framework to compare the costs and benefits of an intervention.

The role of value for money in public insurance coverage decisions for drugs in Australia: a retrospective analysis 1994-2004.

Objective: To analyze the relative influence of factors in decisions for public insurance coverage of new drugs in Australia.

Data Sources: Evidence presented at meetings of the Australian Pharmaceutical Benefits Advisory Committee (PBAC) that makes recommendations on coverage of drugs under Pharmaceutical Benefits Scheme.

Study Selection: All major submissions to the PBAC between February 1994 and December 2004 (n = 858) if one of the outcomes measured was life year gained (n=138) or quality-adjusted life years (QALYs) gained (n=116).

Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism.

Background: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002.

Methods: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. The number and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspected PE during an eight month period prior to the clinical trial (January 2002-August 2002) were compared with the number and type of diagnostic tests in 745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003.

How are solar keratoses treated by general practitioners in Australia?

Background: This study aimed to obtain clinical and economic information about patterns of treatment of solar keratoses (SKs) by general practitioners in Australia. The study design was a retrospective survey relating to the treatment of patients presenting to their doctor with previously untreated SKs.

Methods: Data were collected between May and June 2000, from a sample of doctors who were asked to randomly select two SK patients from their medical records and complete a self-administered postal questionnaire.

A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting.

Background And Aim: Buprenorphine offers an alternative to methadone in the treatment of heroin dependence, and has the advantage of allowing alternate-day dosing. This study is the first to examine the cost effectiveness of buprenorphine as maintenance treatment for heroin dependence in a primary care setting using economic and clinical data collected within a randomised trial.

Study Design And Methods: The study was a randomised, open-label, 12-month trial of 139 heroin-dependent patients in a community setting receiving individualised treatment regimens of buprenorphine or methadone.

The cost effectiveness of prenatal ultrasound screening for trisomy 21.

Objectives: The cost-effectiveness of opportunistic nuchal translucency ultrasound screening in pregnancy was compared with alternative screening strategies for trisomy 21 in Australia.

Methods: A decision analytic model was used of various pregnancy screening strategies based on a systematic review of the literature on the effectiveness of nuchal translucency ultrasound and serum screening and costs based on current reimbursement fees. The model included the likelihood and cost of terminations after diagnostic testing and the associated risk of fetal loss.

Cost of community gastroenteritis.

Background And Aim: Gastroenteritis is a common illness that causes considerable morbidity in developed countries. Endemic gastroenteritis that is not associated with outbreaks causes the greatest number of cases, but information is limited about the burden of this disease, and the resources required to manage its impact on society. In the present study, we estimated the rate of endemic gastroenteritis, the number of visits to the local doctor, use of medication, and the cost of gastroenteritis in Australia.

Quality of life and Kaposi sarcoma: using preference techniques to value the health gains from treatment.

The goal of this work was to investigate preference techniques to value potential health gains from treatments of Kaposi sarcoma (KS). The study was designed to take the form of face-to-face interviews with a sample of men with a history of HIV/AIDS ( n=15) or HIV/AIDS and KS ( n=17). The main outcome measure was quality of life (QoL) associated with various KS disease states expressed on a scale from 0 (death) to 1 (perfect health), obtained though time trade-off (TTO) and rating scale techniques.