Decision Analysis and the Implementation of Research Findings

Lilford, R J; Pauker, S G; Braunholtz, David; Chard, Jiri

doi:10.1002/9780470755891.ch12

Cited by 40 publications

(45 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Decision analysis 20 was used to compare downstream consequences of tPA treatment (tPA group) with absence of tPA treatment (control group) and is conceptualized in Figure 1. The clinical outcome of interest was attainment of mRS of 0 or 1 at 90 days, as per the Lansberg meta-analysis.…”

Section: Cost-effectiveness Analysismentioning

confidence: 99%

Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke

Tanny

Busija

Liew

et al. 2013

Stroke

View full text Add to dashboard Cite

Background and Purpose-Previous economic studies outside Australia have demonstrated that patients treated with tissuetype plasminogen activator (tPA) within 4.5 hours of stroke onset have lower healthcare costs than those not. We aim to perform cost-effectiveness analysis of intravenous tPA in an Australian setting. Methods-Data on clinical outcomes and costs were derived for 378 patients who received intravenous tPA within 4.5 hours of stroke onset at Royal Melbourne Hospital (Australia) between January 2003 and December 2011. To simulate clinical outcomes and costs for a hypothetical control group assumed not to have received tPA, we applied efficacy data from a meta-analysis of randomized trials to outcomes observed in the tPA group. During a 1-year time-horizon, net costs, years of life lived, and quality-adjusted life-years were compared and incremental cost-effectiveness ratios derived for tPA versus no tPA. Results-In the study population, mean (SD) age was 68.2 (13.5) years and 206 (54.5%) were men. Median National Institutes of Health Stroke Scale score (interquartile range) at presentation was 12.5 (8-18). Compared with no tPA, we estimated that tPA would result in 0.

show abstract

Section: Cost-effectiveness Analysismentioning

confidence: 99%

Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke

Tanny

Busija

Liew

et al. 2013

Stroke

View full text Add to dashboard Cite

show abstract

“…However, the problems of getting evidence into practice, or guidelines into action, have been widely documented, 4,5 so that a new discipline of 'implementation research' has emerged to deal with the problem. [6][7][8] In a bold experiment, the NHS in the UK cut many of the implementation corners when it introduced, as part of GPs' contract, the Quality and Outcomes Framework (QOF) in 2004. 9 GPs score QOF points for attaining targets related to the management of common chronic disorders, and their score is translated directly into a significant proportion of their income.…”

Section: Introductionmentioning

confidence: 99%

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

Jones¹,

Hunt²,

Stevens³

et al. 2009

Br J Gen Pract

271

View full text Add to dashboard Cite

“…We used a pharmacoeconomic model (17) to assess the cost-effectiveness of two approaches for the management of PFN. The data were extrapolated from two earlier studies: a prospective cohort study (14) in which PFN episodes were managed following a DDAT approach (12).…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis Comparing Two Approaches for Empirical Antifungal Therapy in Hematological Patients with Persistent Febrile Neutropenia

Martín-Peña¹,

Gil-Navarro²,

Aguilar‐Guisado³

et al. 2013

Antimicrob Agents Chemother

View full text Add to dashboard Cite

e New approaches of empirical antifungal therapy (EAT) in selected hematological patients with persistent febrile neutropenia (PFN) have been proposed in recent years, but their cost-effectiveness has not been studied. The aim of this study was to compare the cost-effectiveness of two different approaches of EAT in hematological patients with PFN: the diagnosis-driven antifungal therapy (DDAT) approach versus the standard approach of EAT. A decision tree to assess the cost-effectiveness of both approaches was developed. Outcome probabilities and treatment pathways were extrapolated from two studies: a prospective cohort study following the DDAT approach and a randomized clinical trial following the standard approach. Uncertainty was undertaken through sensitivity analyses and Monte Carlo simulation. The average effectiveness and economic advantages in the DDAT approach compared to the standard approach were 2.6% and €5,879 (33%) per PFN episode, respectively. The DDAT was the dominant approach in the 99.5% of the simulations performed with average cost-effectiveness per PFN episode of €32,671 versus €52,479 in the EAT approach. The results were robust over a wide range of variables. The DDAT approach is more costeffective than the EAT approach in the management of PFN in hematological patients. Invasive fungal infection (IFI) is a serious health problem in hematological patients and hematopoietic stem cell transplant (HSCT) recipients, resulting in a significant morbidity and mortality rate (1-3). Persistent febrile neutropenia (PFN) is a common clinical presentation of IFI in hematological patients. For this reason, during the last 3 decades, the standard approach recommended by the Infectious Diseases Society of America (IDSA) and other international societies for the management of persistent fever in neutropenic hematological patients has been indicating empirical antifungal therapy (EAT) in every patient, with the main objective of improving the outcome of IFI by prompt therapy (4, 5). However, the relatively low incidence of IFI in the whole hematological population, the risk of overtreatment with expensive drugs, and the potential appearance of adverse effects and antifungal resistance selection (6, 7) have made IFIs a safety and economic problem since the optimization of the health care budget is a major priority for all health care systems. Furthermore, the improvement of diagnostic procedures and the efficacy of new antifungal drugs have changed dramatically over the years (8, 9), allowing for new approaches for the management of this syndrome (8,(10)(11)(12)(13)(14), and even updated guidelines consider acceptable other more rational antifungal therapy approaches in a subset of high risk patients, although it is still considered as an experimental practice (4). The Andalusian Society of Infectious Diseases (SAEI) (12) proposed a diagnostic and therapeutic approach based on risk profile and driven by clinical criteria for selecting those patients with PFN who do not need antifungal therapy, avoiding ove...

show abstract

Decision Analysis and the Implementation of Research Findings

Cited by 40 publications

References 33 publications

Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke

Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke

Management of common gastrointestinal disorders: quality criteria based on patients' views and practice guidelines

Cost-Effectiveness Analysis Comparing Two Approaches for Empirical Antifungal Therapy in Hematological Patients with Persistent Febrile Neutropenia

Contact Info

Product

Resources

About