Publications by authors named "Nathalie A Kulin"

Background/aim: The risk of injury among Pee Wee (ages 11-12 years) ice hockey players in leagues that allow body checking is threefold greater than in leagues that do not allow body checking. We estimated the cost-effectiveness of a no body checking policy versus a policy that allows body checking in Pee Wee ice hockey.

Methods: Cost-effectiveness analysis alongside a prospective cohort study during the 2007-2008 season, including players in Quebec (n=1046), where policy did not allow body checking, and in Alberta (n=1108), where body checking was allowed.

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Article Synopsis
  • * A Markov decision analytic model indicated that MoM HRA was generally more cost-effective than THA for younger and male patients, while THA remained a better option for older patients (aged 60+) and women.
  • * Ultimately, the results suggest that while MoM HRA is preferred for certain demographics, both procedures have merits, leading to discussions between patients and clinicians on the best choice based on individual circumstances.
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Purpose: Decision makers must make decisions without complete information. That uncertainty can be decreased when economic evaluations use local data and can be quantified by considering the variability of all model inputs concurrently per international evaluation guidelines. It is unclear how these recommendations have been implemented in evaluations of targeted cancer therapy.

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Article Synopsis
  • Decision makers in healthcare often lack complete information when evaluating treatments, and using local data can help reduce uncertainty, particularly in economic evaluations of therapies like adjuvant trastuzumab for breast cancer.
  • A systematic review was conducted of published economic evaluations related to adjuvant trastuzumab, examining adherence to Canadian, UK, and US guidelines regarding the use of local data and sensitivity analyses.
  • The findings revealed that while costs were consistently estimated using local data, efficacy data were not; additionally, most studies employed univariate sensitivity analysis rather than probabilistic methods, indicating that compliance with guideline recommendations was generally inadequate.
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Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies.

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Trastuzumab is a targeted therapy for human EGF receptor-2 (HER2)-positive breast cancer. The effectiveness and cost-effectiveness of trastuzumab hinges not only on its clinical efficacy in responding patients, but on the ability to accurately identify appropriate therapeutic candidates. We sought to systematically review the cost-effectiveness of trastuzumab with a focus on the impact of the test(s) used for HER2 diagnosis.

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Background: Patient preferences can affect colorectal cancer (CRC) screening test use. We compared utility-based preferences for alternative CRC screening tests from a stated-preference discrete-choice survey of the general population and physicians in Canada and the United States.

Methods: General population respondents (Canada, n = 501; US, n = 1087) participated in a survey with 12 choice scenarios and 9 CRC screening test attributes.

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Objective: Colorectal cancer (CRC) screening uptake remains poor. Until we understand patient motivation and preferences for undertaking screening, it is unlikely the uptake will be optimal. Our objective is to examine patient preferences for CRC screening modalities and uptake rates using utility-based methods.

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Background: Public insurance plans for pharmaceuticals in Canada differ substantially across provinces in the conditions under which pharmaceuticals are reimbursed. Coxibs provide a good example. Québec had no restrictions on reimbursement for these drugs.

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