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Pockett R.D.,Cardiff Research Consortium | Adlard N.,Sanofi S.A. | Carroll S.,Sanofi S.A. | Rajoriya F.,Sanofi S.A.
Current Medical Research and Opinion | Year: 2011

Objectives: Infectious intestinal diseases cause substantial morbidity and economic loss in the UK. Rotavirus gastroenteritis (RVGE), a form of gastroenteritis, is the primary cause of severe diarrhoea in children. The primary objective of this study was to examine whether hospitalisation for gastroenteritis, and particularly RVGE, is linked to social deprivation. Methods: A retrospective study relating to hospital admissions in England with rotavirus, gastroenteritis, or type 1 diabetes mellitus (T1DM) was conducted in children aged under 5 years between 1st April 2009 and 31st March 2010 using the CHKS database. Admissions with selected diagnoses were extracted based on ICD-10 coding. Deprivation data were obtained from the Index of Multiple Deprivation (IMD) 2007 for England. Results: A total of 20,571 unique hospital admissions were made by children, in England, with RVGE (n = 1334; 6.5%) together with a diagnosis of infectious gastroenteritis of all causes (n = 19,237; 93.5%), giving an overall hospital admission rate, for those aged under 5 years, of 65.7 per 10,000 population. With 'rank of average score' and the 'rank of average rank' as measures of deprivation, the rate of hospital admissions with gastroenteritis of all causes decreased by 0.346 and 0.287 per 10,000 (p < 0.001) respectively for every unit increase in deprivation rank (decreasing deprivation), though this trend was not observed in patients admitted with RVGE specifically. Conclusions: Hospital admissions with gastroenteritis of all causes increased as deprivation increased. The implementation of a rotavirus vaccination programme would help to reduce the burden of RVGE and gastroenteritis of all causes, and in the context of gastroenteritis, some elements of health and social inequality may be vaccine preventable. Limitations: It is possible that the study is limited by the accuracy and completeness of deprivation indices, and coding within CHKS; the existence of the 'ecological fallacy' must also be considered. © 2011 Informa UK Ltd All rights reserved.

Miszczyk L.,Oncology and Radiotherapy Institute | Tukiendorf A.,Cardiff Research Consortium
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: An evaluation of dose-response relationship and an attempt to define predictive factors. Methods and Materials: A total of 137 cases of painful vertebral hemangioma irradiations (101 patients). Fraction dose (fd) varied from 2 to 15 Gy (123 fractionated and 14 radiosurgical treatments), and total dose (TD) from 8 to 30 Gy (111 cases irradiated with fd of 2 GY to TD of 24 Gy). We evaluated pain relief, changes in analgesic requirements, and reossification. Results: Means of pain relief 1, 6, 12, and 18 months after radiotherapy (defined as a decrease of primary pain level expressed in percent) were 60.5%, 65.4%, 68.3%, and 78.4%, respectively. Proportion of patients with no need for analgesics and patients using tramadol were 39%, 40%, 44%, 57%, and 20%, 17%, 22%, and 11% in these times. The proportion of patients experiencing complete/partial pain relief changed from 36/48% 1 month, to 64/22% 1.5 years after radiotherapy. No impact of radiotherapy on reossification was found. The positive impact of fd and TD increase for analgesics uptake reduction and pain relief was found. An increase of the fd by 1 Gy results in 27% chance of analgesics uptake reduction and 3.8% reduction of pain, whereas 14% analgesics uptake reduction and 2.2% of pain reduction in case of the TD. The predictive factors improving results were found: female gender, older age, better performance states (the chance of the lower analgesic treatment decreases over 2.5 times in comparison to the higher Zubrod degree), bigger Hb concentration, shorter symptoms duration and lower analgesics uptake before radiotherapy. Conclusions: The obtained data support the efficacy of radiotherapy in improving pain secondary to vertebral hemangioma, with the degree of pain amelioration being related to increasing fd and TD. The positive predictive factors were defined: female gender, older age, better performance status, increased Hb concentration, shorter symptoms duration, and lower analgesics uptake before radiotherapy. © 2012 Elsevier Inc.

Townsend R.,Cardiff Research Consortium | McEwan P.,Cardiff Research Consortium | Kim R.,Rochester College | Yuan Y.,Bristol Myers Squibb
Value in Health | Year: 2011

Published economic evaluations have reported available treatments for chronic hepatitis C to be cost-effective as part of the current approach to disease management, but as standards of care evolve, their approach to modeling should be reconsidered. This study aimed to review structural frameworks and key model parameters as reported in current economic evaluations for treatments for chronic hepatitis C, and model the impact of variability across parameters on results. A systematic review of studies published from 2000 to 2011 was performed. Studies were retrieved from five electronic databases using relevant search strategies. Model structures, disease progression rates, utilities, and costs were extracted from included studies, and were qualitatively reviewed and incorporated into a cost-utility model. Thirty-four studies were appropriate for data extraction. A common pathway of six disease states was identified. In some studies the early disease stages and/or the decompensated cirrhosis state were further subdivided. Large variability in values used for disease progression rates, utilities, and costs were identified. When incorporated into a model, incremental cost-effectiveness ratios (ICERs) varied: in the least favorable scenario, peginterferon plus ribavirin was dominated by interferon plus ribavirin; and in the most favorable scenario, peginterferon plus ribavirin dominated interferon plus ribavirin ($8,544 per quality-adjusted life year [QALY]; costs are given in 2008 US dollar amounts). Using mean values the ICER was $15,198 per QALY. Current models use a simplistic structure resulting from the lack of available data reflecting patient heterogeneity. Key model parameters are currently based on a small number of studies and the variability across these values can affect the interpretation of results. © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Gordon J.,University of Adelaide | Gordon J.,Flinders University | Lister S.,Johnson and Johnson Medical | Prettyjohns M.,Cardiff Research Consortium | And 3 more authors.
Journal of Medical Economics | Year: 2012

Objectives: A small but significant proportion of patients with peripheral neuropathic pain (NeP) are refractory to the typical treatments applied in clinical practice, including amitriptyline and gabapentin. Thus, they continue to suffer the debilitating effects of NeP. This study aimed to evaluate the cost-effectiveness of pregabalin in comparison to usual care, in patients with refractory NeP, from a third party payer's perspective (NHS). Methods: A stochastic simulation model was constructed, using clinical data from four non-randomized studies, to generate pain pathways of patients receiving usual care and pregabalin. Treatment effect (pain reduction) was converted to quality-of-life (QoL) data, using a regression analysis based on new utility data, collected from a survey of refractory NeP patients presenting to pain clinics in Cardiff, Wales. All relevant direct costs were estimated using resource use from the survey data (where available) and unit costs from the British National Formulary (BNF). The analysis was run over a 5-year time horizon, with costs and benefits discounted at 3.5%. Study limitations: The use of non-randomized (observational) data to characterize the effectiveness of treatments for NeP. Exclusion of productivity costs and consequences from the analysis. Results: In the base case analysis, an incremental cost-effectiveness ratio (ICER) of £10,803 per quality adjusted life year (QALY) was attained. This result was found to be reasonably insensitive to variations in the key input parameters, with ICERs ranging from £8505 to £22,845 per QALY gained. Conclusions: The analysis shows that pregabalin is a cost-effective alternative to usual care in patients with refractory NeP, with an ICER well below the threshold typically adopted by UK health technology assessment groups, such as NICE. © 2012 Informa UK Ltd.

McEwan P.,Cardiff Research Consortium | Evans M.,University of Wales | Bergenheim K.,Astrazeneca
Diabetes, Obesity and Metabolism | Year: 2010

Aim: The attainment of near-normal glycaemia is an important feature in reducing complications in people with type 2 diabetes. Current treatment pathways advocate a failure-driven therapy algorithm for blood-glucose lowering that leads to the sequential addition of therapies. The addition and combination of multiple blood-glucose lowering agents may be associated with significant side effects, such as weight gain and hypoglycaemia, resulting in a detrimental quality of life. The objective of this study is to quantify the overall costs and quality-adjusted life years (QALY) associated with therapy escalation via oral only treatment strategies with different adverse event profiles as a function of target HbA1c achievement. Methods: A previously published model was adapted to run as a non-terminating simulation model. The model is designed to evaluate the cost utility of treatment strategies in a population of type 2 diabetes mellitus patients. Model outputs include incidence of micro- and macrovascular complications, hypoglycaemia and diabetes-specific and all-cause mortality. Results: The total number of vascular events predicted by the model varied little across the four treatment strategies because of the glycaemic profile associated with each therapy strategy being similar. The strategy with sequential addition of thiazolidinediones (TZDs) and sulphonylureas (SUs) to metformin (MF) was associated with greatest predicted hypoglycaemia burden. The addition of SU and dipeptidyl peptidase (DPP-4) inhibitors to MF was associated with the highest estimated QALYs. Conclusions: A treatment strategy involving the sequential addition of SU and TZD to first-line MF therapy is associated with the lowest cost and lowest gain across a population, whereas addition of TZD and SU sequentially to first-line MF therapy resulted in the highest cost and incrementally less QALY gain when compared with treatment strategies involving the addition of a DPP-4 inhibitor and SU to first-line MF (irrespective of the treatment sequence) that were associated with both less cost and greatest QALY gain. © 2010 Blackwell Publishing Ltd.

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