scholarly journals Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis

10.2196/26516 ◽  
2021 ◽  
Vol 23 (3) ◽  
pp. e26516
Author(s):  
Xinchan Jiang ◽  
Jiaqi Yao ◽  
Joyce Hoi-Sze You
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Hong Kong ◽  
Health Care Providers ◽  
Cost Effective ◽  
Base Case ◽  
Effective Strategy ◽  
Care Providers ◽  
Patients With Heart Failure

Background The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.

scholarly journals Potential cost-effectiveness of telemonitoring program for heart failure patients during the COVID-19 pandemic in Hong Kong (Preprint)

2020 ◽  
Author(s):  
Xinchan Jiang ◽  
Jiaqi Yao ◽  
Joyce You
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Hong Kong ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Healthcare Provider ◽  
Cost Effective ◽  
Base Case ◽  
Effective Strategy ◽  
Cost Effective Strategy

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring (TM) program in addition to usual care (UC) demonstrated improved effectiveness in managing heart failure (HF) patients. OBJECTIVE We aimed to examine the potential clinical and health economic outcomes of TM program for management of HF patients during COVID-19 pandemic from the perspective of healthcare provider in Hong Kong. METHODS A Markov model was designed to compare outcomes of (1) UC plus TM (TM group) and (2) UC alone (UC group) in a hypothetical cohort of elderly HF patients in Hong Kong. Model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to examine the model assumptions and robustness of base-case results. RESULTS In base-case analysis, TM group gained higher QALYs (1.9007) at higher costs (USD15,888), when compared to UC group (1.8345 QALYs at USD15,603).Adopting 48,937 USD/QALY (1× gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, the TM group was accepted as a highly cost-effective strategy, with ICER of 4,292 USD/QALY. No threshold value was identified in deterministic sensitivity analysis. In probabilistic sensitivity analysis, TM group was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS Adding TM program to usual care for HF patients appears to be a cost-effective strategy from the perspective of healthcare provider in Hong Kong.

scholarly journals Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Stefan Köberich ◽  
Jeantte Ziehm ◽  
Erik Farin ◽  
Gerhild Becker
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Palliative Care ◽  
Chronic Heart Failure ◽  
Health Care Providers ◽  
Symptom Burden ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
Heart Failure Patients ◽  
Patients With Heart Failure

<em>Background</em>. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. <br /><em>Design and Methods</em>. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. <br /><em>Expected Impact for Public Health.</em> The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

scholarly journals Preferences and Perceptions of Patients Attending Emergency Departments with Low Acuity Problems in Hong Kong

2009 ◽  
Vol 16 (3) ◽  
pp. 148-154 ◽  
Author(s):  
CA Graham ◽  
WO Kwok ◽  
YL Tsang ◽  
TH Rainer
Keyword(s):  
Health Care ◽  
Hong Kong ◽  
Health Care Providers ◽  
Waiting Time ◽  
Health Care Professionals ◽  
Waiting Times ◽  
Medical Advice ◽  
Care Providers ◽  
Convenience Sample ◽  
Waiting Area

Objective To explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED. Methods The study recruited 249 semi-urgent and non-urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire. Results From 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal-Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%). Conclusion Patients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.

SGLT2 inhibitors: A revolution in therapeutics of a major Non-Communicable Disease

2021 ◽  
pp. 1-3
Author(s):  
Muhammad Sami Khan
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Providers ◽  
Communicable Disease ◽  
Health Care Expenditure ◽  
Health Care Expenditures ◽  
Sglt2 Inhibitors ◽  
Care Providers ◽  
Cardiovascular Outcome Trials ◽  
Non Communicable Disease

Pakistan is facing an exorbitant burden of Non-communicable diseases among which Cardiovascular diseases are the most prominent which has not only caused mortality but also posed a big threat on weakened economy and health care system of the country. Amidst of this growing crisis, Sodium glucose co-transporter 2 (SGLT2) inhibitors emerge as a ray of hope by reducing simultaneously the complication and health care expenditure associated with the management of this major mortality-bringing Non-communicable disease. SGLT2 inhibitors, including Dapagliflozin and Empagliflozin, are evidence-based standardized novel anti-diabetic agents tested in cardiovascular outcome trials namely DAPA-HF and EMPEROR-Reduced, when added to standard care in heart failure patients with reduced ejection fraction, provides breakthrough heart failure outcomes and also addresses massive health care expenditures. This novel finding provides an impetus to promote its beneficial effects among health care providers and early implementation. Continuous....

scholarly journals Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?—A Registry Based Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (11) ◽  
pp. e0165021
Author(s):  
Ruth Pulikottil-Jacob ◽  
Martin Connock ◽  
Ngianga-Bakwin Kandala ◽  
Hema Mistry ◽  
Amy Grove ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Cost Effective ◽  
Effective Intervention ◽  
Care Providers ◽  
Metal On Metal

Knowledge Based Commissioning: Can a National Clinical Effectiveness Policy Be Compatible with Seeking Local Professional Advice?

1996 ◽  
Vol 1 (1) ◽  
pp. 28-34 ◽  
Author(s):  
Peter Littlejohns ◽  
Carol Dumelow ◽  
Sian Griffiths
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Care Providers ◽  
Professional Advice ◽  
Knowledge Based ◽  
Artery Disease ◽  
Health Care Purchasing ◽  
The Right

Objectives: To help develop a means, based on the views of purchasers and providers of health care, of incorporating national research on clinical effectiveness into local professional advisory mechanisms in order to inform health care purchasing and contracting. Methods: Three geographically based multidisciplinary workshops attended by National Health Service (NHS) staff drawn from the principal purchaser and provider groups in one English region were organized around the discussion of three health care purchasing case studies: Coronary artery disease, diabetes and management of clinical depression in general practice. The proceedings were transcribed and analyzed using content analysis methods. Results: 95 people took part. There were major differences between the purchasers' and health care providers' views on the right balance between local and national information and advisory sources for purchasing. In general, providers wanted the provision of advice to purchasers to be local, in which their opinion was sought, either individually or collectively, acted on and the results fed back to them. In contrast, health authority purchasers considered that local professionals were only one source of professional advice, albeit an important one, to be utilized in coming to decisions. General practitioner fundholders as purchasers, however, preferred to rely on their own experiences and contacts with local providers in making purchasing decisions. Conclusions: Professional specialist advisory groups are necessary to inform the purchasing of health care, but should extend beyond advising on the placement of individual contracts. Involving health care providers in all short-term contracting is unlikely to be cost-effective given the time commitment required. The emphasis at purchaser/provider meetings should be on education: Providing an opportunity for purchasers and providers to develop closer relationships to discuss political imperatives and financial constraints; increasing communication and understanding of providers' and purchasers' roles; and providing an environment for professionals and purchasers to share their views on purchasing. As currently presented, elements of the national policies in the NHS advocating the use of both national evidence on clinical effectiveness and local professional advice are contradictory and should be clarified.

scholarly journals Improving Access to Cancer Treatments: The Role of Biosimilars

2017 ◽  
Vol 3 (5) ◽  
pp. 596-610 ◽  
Author(s):  
Rakesh Chopra ◽  
Gilberto Lopes
Keyword(s):  
Health Care ◽  
Cancer Treatment ◽  
Health Care Providers ◽  
Cost Effective ◽  
Cancer Therapies ◽  
Care Providers ◽  
Cancer Treatments ◽  
Reference Drug ◽  
Effective Use ◽  
The Cost

Biologics play a key role in cancer treatment and are principal components of many therapeutic regimens. However, they require complex manufacturing processes, resulting in high cost and occasional shortages in supply. The cost of biologics limits accessibility of cancer treatment for many patients. Effective and affordable cancer therapies are needed globally, more so in developing countries, where health care resources can be limited. Biosimilars, which have biologic activity comparable to their corresponding reference drugs and are often more cost effective, have the potential to enhance treatment accessibility for patients and provide alternatives for decision makers (ie, prescribers, regulators, payers, policymakers, and drug developers). Impending patent expirations of several oncology biologics have opened up a vista for the development of corresponding biosimilars. Several countries have implemented abbreviated pathways for approval of biosimilars; however, challenges to their effective use persist. Some of these include designing appropriate clinical trials for assessing biosimilarity, extrapolation of indications, immunogenicity, interchangeability with the reference drug, lack of awareness and possibly acceptance among health care providers, and potential political barriers. In this review, we discuss the potential role and impact of biosimilars in oncology and the challenges related to their adoption and use. We also review the safety and efficacy of some of the widely used biosimilars in oncology and other therapeutic areas (eg, bevacizumab, darbepoetin, filgrastim, rituximab, and trastuzumab).

Cost-Effectiveness Of Arsenic Trioxide In The Treatment Of Relapsed/Refractory Acute Promyelocytic Leukemia In Canada

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5603-5603
Author(s):  
Jean Lachaine ◽  
Karine Mathurin ◽  
Stephane Barakat
Keyword(s):  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Societal Perspective ◽  
Cost Effective ◽  
Promyelocytic Leukemia ◽  
Effective Strategy ◽  
First Line ◽  
Health States ◽  
Cost Effective Strategy

Abstract Acute promyelocytic leukemia (APL) is a distinct and rare morphological, clinical and pathological variant of acute myeloid leukemia (AML). It represents approximately 10% to 15% of AML.  APL is characterized by a high incidence of coagulopathy caused by disseminated intravascular coagulation and/or excessive fibrinolysis and is associated with a high early mortality.  Current first-line treatments consist of all-trans retinoic acid (ATRA), anthracyclines and conventional chemotherapy (CT). Although considerable progress has been made in the first-line treatment of APL, about 20 to 30% of patients who achieved complete remission (CR) still relapse Trisenox® is a sterile injectable solution of arsenic trioxide (ATO) and has been approved in several countries, including Canada, for the induction of remission and consolidation in patients with APL who are refractory to, or have relapsed from, retinoid and anthracycline chemotherapy. At this time, ATO is recognized as the standard treatment for relapsed or refractory APL. However, it is not reimbursed yet by provincial public health care systems and was available through a special access program in Canada until product availability. The objective of this study was to assess, from a Canadian perspective, the economic impact of ATO in the treatment of patients with relapsed or refractory APL. A time-dependent Markov model was constructed to assess the cost-effectiveness of ATO compared to ATRA+CT in the treatment of relapsed/refractory APL. Because there was no head-to-head clinical trial available, data from the ATO treatment arm were taken from Soignet, 2001, while data for ATRA+CT were taken from Thomas, 2000. The comparative treatment was composed of ATRA + sequential CT including cytarabine, mitoxantrone or etoposide, followed by autologous hematopoietic stem cell transplantation (HSCT) in consolidation as described in Thomas, 2000. The Markov model comprises five health states: induction, second remission, treatment failure/relapse, post-failure, and death. The length of each Markov cycle was one month for the first 24-month study period then of one year. The model continued to run until all patients reached the absorbing state of death. All patients started in the induction state and could move to other health states thereafter. In case of treatment relapse/failure, patients were subsequently assigned to receive an allogeneic HSCT. The model also takes into account the incidence of treatment-induced grade 3-4 toxicity reported in both clinical trials (Soignet, 2001 and Thomas, 2000). Analyses were conducted from both a Canadian Ministry of Health (MoH) and a societal perspective over a lifetime horizon. In the treatment of relapsed/refractory APL, ATO is a cost-effective strategy over ATRA+CT, from both a health care system and a societal perspective. In fact, compared with ATRA+CT, ATO is associated with an incremental cost-effectiveness ratios (ICERs) of $20,443 per QALY and $22,219 per QALY, from a MoH and societal perspective respectively. Moreover, the results of the exhaustive sensitivity analysis confirm the robustness of the base-case results. In fact, according to the deterministic analysis results, ATO remained a cost-effective strategy compared with ATRA+CT from both perspectives. The ICERs vary between $9,785 and $40,732 / QALY from a MoH perspective and between $11,561 and $44,271 / QALY from a societal perspective. Results of the probabilistic sensitivity analysis indicated that, according to a willingness to pay of $50,000, ATO remains a cost-effective strategy in 99.37% and 98.98% of the simulations, from a MoH and a societal perspective respectively. In conclusion, this economic evaluation demonstrates that ATO+ATRA is a cost-effective strategy in the treatment of relapsed/refractory APL. Disclosures: Lachaine: Lundbeck Canada: Research Funding. Barakat:Lundbeck Canada: Employment.

scholarly journals Naive Expectations to Resignation

2018 ◽  
Vol 5 (3) ◽  
pp. 219-224
Author(s):  
Michael M Evans ◽  
Judith E Hupcey ◽  
Lisa Kitko ◽  
Windy Alonso
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Longitudinal Study ◽  
Health Care Providers ◽  
Secondary Analysis ◽  
Newly Diagnosed ◽  
Care Providers ◽  
Life Activity ◽  
Chronic Group ◽  
Stage D

Purpose: This study examined life descriptions of persons with stage D heart failure (HF) comparing those newly diagnosed to those with chronic HF. Methods: A secondary analysis of interviews from 75 participants followed in a longitudinal study of persons with stage D HF was thematically analyzed. There were 24 participants who were recently diagnosed with stage D HF (less than 2 years) and 51 participants with HF longer than 2 years. Results: Both groups shared life descriptions along a continuum, where recently diagnosed participants described naive expectations with hope for improvement, while the chronic group appeared resigned to their fate and the reality of the limitations of living with HF. Four themes illustrated differences between the groups: outlook on life, activity adjustments, understanding of HF, and mood. Conclusions: Although persons with stage D HF share the same life descriptions, they have differing perspectives of life with HF. Findings from this study can help health-care providers tailor interventions based on the length of time from diagnosis.

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