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Thompson A.H.,Institute of Health Economics
The American journal of managed care | Year: 2015

BACKGROUND: Presenteeism (decreased productivity while at work) is reported to be a major occupational problem in many countries. Challenges exist for identifying the optimal approach to measure presenteeism. Evidence of the relative value of presenteeism instruments to support their use in primary studies is needed.OBJECTIVES: To assess and compare the measurement properties (ie, validity, reliability, responsiveness) and the quality of the evidence of presenteeism instruments.STUDY DESIGN: Systematic review.METHODS: Comprehensive searches of electronic databases were conducted up to October 2012. Twenty-three presenteeism instruments were examined. Methodological quality was appraised with the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. A best-evidence synthesis approach was used in the analysis.RESULTS: The titles and abstracts of 1767 articles were screened, with 289 full-text articles reviewed for eligibility. Of these, 40 studies assessing the measurement properties of presenteeism instruments were identified. The 3 presenteeism instruments with the strongest level of evidence on more than 1 measurement property were the Stanford Presenteeism Scale, 6-item version (content validity, internal consistency, construct validity, convergent validity, and responsiveness); the Endicott Work Productivity Scale (internal consistency, convergent validity, and responsiveness); and the Health and Work Questionnaire (HWQ; internal consistency and structural validity). Only the HWQ was assessed for criterion validity, with unknown quality of the evidence.CONCLUSIONS: Most presenteeism instruments have been examined for some form of validity; evidence for criterion validity is virtually absent. The selection of instruments for use in primary studies depends on weak forms of validity. Further research should focus on the goal of a comprehensive evaluation of the psychometric properties of existing tests of presenteeism, with emphasis on criterion validity.

Thompson A.H.,Institute of Health Economics | Dewa C.S.,Work and Well being Research and Evaluation Program | Phare S.,Alberta Health Services Addiction and Mental Health
Social Psychiatry and Psychiatric Epidemiology | Year: 2012

Purpose: The concept of the suicidal process implies a progression from behaviour of relatively low intent to completed suicide. Evidence from the literature has given rise to the speculation that the age of onset of an early form of the suicidal process may be associated with the ultimate seriousness of suicidal behaviour. This study was designed to test the hypothesis that early onset of the first stage of the suicidal process, a wish to die, is associated with increases in the ultimate position along the suicidal process dimension. Methods: Questions on the appearance and timing of suicidal process components (a death wish, ideation, plan, or attempt) were embedded in a telephone survey on mental health and addictions in the workforce. Records of those that had experienced suicidal behaviour were examined for the effects on the age of onset of the first death wish as a function of the level of severity of suicidal behaviour, gender, and depression. Results: The findings showed that increases in suicidal intent were associated with lowered age of the first death wish. This pattern held true for depressed and nondepressed persons alike. Conclusions: The results support the notion that the early onset of a supposed precursor of suicidal behaviour, a death wish in this case, adds to its ability to portend more serious problem levels in later stages of life. Furthermore, mood operates independently in its association with the timing of such suicidal behaviour, suggesting that the effect of a relatively youthful appearance of a wish to die cannot be explained by early onset depression. © Springer-Verlag 2011.

Husereau D.,Institute of Health Economics
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2015

Future perceptions of the value of curative therapies will likely reflect debates happening today about preferences for funding of preventive versus treatment programs, as well as funding orphan drugs. Little is known about how society will value curative therapies versus standard treatments, and the significant role of a host of psychological factors compared to overarching concerns about opportunity costs will likely lead to significant tension between payers and the public. More research to clarify societal preferences and healthcare goals in regards to curative therapies and in light of the potential for significant opportunity costs will be required. Given what we know about preferences for the funding of prevention and treatment measures, we should expect that cures will not be held to a different measure. © 2015 Informa UK Ltd.

Guo B.,Institute of Health Economics | Harstall C.,Institute of Health Economics | Louie T.,University of Calgary | Veldhuyzen Van Zanten S.,University of Alberta | Dieleman L.A.,University of Alberta
Alimentary Pharmacology and Therapeutics | Year: 2012

Background Management of recurrent Clostridium difficile-associated disease (CDAD), particularly in elderly patients, remains clinically challenging. Faecal transplantation (FT) may restore normal microbiota and break the cycle of recurrent CDAD. Aim To critically appraise the clinical research evidence on the safety and effectiveness of FT compared with standard care in the treatment of patients with CDAD. Methods A comprehensive literature search was conducted by a research librarian to identify relevant studies published between 2000 and 2011. The Cochrane Library, PubMed, EMBASE, CINAHL, Biological Abstracts, BIOSIS Previews and Web of Science were searched using the following Medical Subject Headings (MeSH) terms and keywords, alone or in combination: Clostridium infections/Clostridium difficile/pseudomembranous/colitis/faeces/rectal/colon flora/gastrointestinal/nasogastric tube/enema/donor/transplant/infusion/ bacteriotherapy/human probiotic infusion. Methodological quality of the included case series studies was assessed in terms of patient selection criteria, consecutive recruitment, prospective data collection, reporting of lost to follow-up, and follow-up rates. Results No controlled studies were found. Based on the weak evidence from seven full-text case series studies of 124 patients with recurrent/refractory CDAD, FT appears to be a safe and effective procedure. In most cases (83%) symptoms improved immediately after the first FT procedure, and some patients stayed diarrhoea free for several months or years. Conclusions Although these results appear to be promising, the treatment effects of faecal transplantation cannot be determined definitively in the absence of a control group. Results from randomised controlled trials that compare faecal transplantation to oral vancomycin without or with a taper regimen will help to better define the role of faecal transplantation in the management of recurrent CDAD. © 2012 Blackwell Publishing Ltd.

Jacobs P.,Institute of Health Economics
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2011

In the 1980s, drug prices began rising considerably worldwide, and in the 1990s, countries began incorporating health economics into the scientific review process. Rising prices in vaccines began around the year 2000 and national bodies began to use health economics to review vaccines in the next decade. Health economics is a discipline that evaluates alternative interventions, balancing costs and health outcomes. There are characteristics of infectious diseases that differ from other illnesses, most notably the herd effect. We reviewed the role of economics in conducting vaccine scientific reviews. We conclude that health economics can move some of the considerations in vaccine policy decision-making from the political to the scientific arena, but there are still many unresolved issues. Health economists will continue to address these issues in the coming years, but there will always be a need for a separate policy review. © 2011 Expert Reviews Ltd.

Pannu N.,University of Alberta | James M.,University of Calgary | Hemmelgarn B.,University of Calgary | Klarenbach S.,Institute of Health Economics
Clinical Journal of the American Society of Nephrology | Year: 2013

Background and objectives This study aimed to determine if recovery of kidney function after AKI modifies the association between AKI during hospitalization and adverse outcomes after discharge. Design, setting, participants, & measurements The effect of renal recovery after AKI was evaluated in a population-based cohort study (n=190,714) with participants identified from a provincial claims registry in Alberta, Canada, between November 1, 2002 and December 31, 2007. AKI was identified by a two-fold increase between prehospital and peak in-hospital serumcreatinine (SCr). Recoverywas assessed using SCr drawn closest to 90 days after the AKI event. All-cause mortality and a combined renal outcome of sustained doubling of SCr or progression to kidney failure were evaluated. Results Overall, 3.7% of the participants (n=7014) hadAKI, 62.7% of whom(n=4400) survived 90 days. In the 3231 patients in whom recovery could be assessed over a median follow-up of 34 months, 30.8% (n=1268) of AKI survivors died and 2.1% (n=85) progressed to kidney failure. Participants who did not recover kidney function had a higher risk for mortality and adverse renal outcomes when AKI participants who recovered to within 25% of baseline SCr were used as the reference group (adjusted mortality hazard ratio (HR), 1.26; 95% confidence interval, 1.10, 1.43) (adjusted renal outcomes HR, 4.13; 95% confidence interval, 3.38, 5.04). Mortality HR was notably higher when participants failed to recover within 55% of baseline. Conclusions Renal recovery after AKI is associated with a lower risk of death or adverse renal outcomes after hospital discharge. © 2013 by the American Society of Nephrology.

Chuck A.,Institute of Health Economics
Value in Health | Year: 2010

Objectives: The aim of this study is to assess the cost-effectiveness of 21 alternative cervical cancer screening (CCS) strategies. Methods: A cohort simulation model was developed to determine from a health systems perspective the cost-effectiveness of the 21 alternative CCS strategies that incorporated combinations of Papanicolaou's smear test (PAP), liquid-based cytology (LBC) or human papillomavirus deoxyribonucleic acid (HPV-DNA) testing. The model was calibrated to categorize total costs into four budgetary authorities: testing, physician, inpatient, and outpatient services. Within each category, alternative screening strategies were contrasted in terms of their cost impacts and the percent change calculated within each category. Epidemiologic data and costs were derived from administrative health databases. Estimates of test characteristics and quality-adjusted life years (QALYs) were derived from available literature. Results: Three-year screening with PAP and HPV-DNA triage testing for women older than 30 years of age (3-year PAP + HPV + PAP-age) is less costly and more effective saving $16,078 per additional QALY gained. Although there was an associated net cost decrease of 4.2% driven by a reduction in testing and physician costs of 22.1% and 18.6%, respectively, there is a cost increase of 0.8% and 27.7% in inpatient and outpatient services, respectively. Conclusion: There is economic evidence to support adopting 3-year PAP + HPV + PAP-age. Budgetary resources can potentially be shifted from testing and physician services to fund the additional resource requirements for inpatient and outpatient services. © 2009, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Houle S.K.D.,University of Alberta | McAlister F.A.,University of Alberta | Jackevicius C.A.,Western University of Health Sciences | Chuck A.W.,Institute of Health Economics | Tsuyuki R.T.,University of Alberta
Annals of Internal Medicine | Year: 2012

Background: Pay-for-performance (P4P) is increasingly touted as a means to improve health care quality. Purpose: To evaluate the effect of P4P remuneration targeting individual health care providers. Data Sources: MEDLINE, EMBASE, Cochrane Library, OpenSIGLE, Canadian Evaluation Society Unpublished Literature Bank, New York Academy of Medicine Library Grey Literature Collection, and reference lists were searched up until June 2012. Study Selection: Two reviewers independently identified original research papers (randomized, controlled trials; interrupted time series; uncontrolled and controlled before-after studies; and cohort comparisons). Data Extraction: Two reviewers independently extracted the data. Data Synthesis: The literature search identified 4 randomized, controlled trials; 5 interrupted time series; 3 controlled before-after studies; 1 nonrandomized, controlled study; 15 uncontrolled before-after studies; and 2 uncontrolled cohort studies. The variation in study quality, target conditions, and reported outcomes precluded meta-analysis. Uncontrolled studies (15 before-after studies, 2 cohort comparisons) suggested that P4P improves quality of care, but higher-quality studies with contemporaneous controls failed to confirm these findings. Two of the 4 randomized trials were negative, and the 2 statistically significant trials reported small incremental improvements in vaccination rates over usual care (absolute differences, 8.4 and 7.8 percentage points). Of the 5 interrupted time series, 2 did not detect any improvements in processes of care or clinical outcomes after P4P implementation, 1 reported initial statistically significant improvements in guideline adherence that dissipated over time, and 2 reported statistically significant improvements in blood pressure control in patients with diabetes balanced against statistically significant declines in hemoglobin A1c control. Limitation: Few methodologically robust studies compare P4P with other payment models for individual practitioners; most are small observational studies of variable quality. Conclusion: The effect of P4P targeting individual practitioners on quality of care and outcomes remains largely uncertain. Implementation of P4P models should be accompanied by robust evaluation plans. © 2012 American College of Physicians.

Husereau D.,Institute of Health Economics
BMJ (Clinical research ed.) | Year: 2013

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. A list of possible items based on a systematic review was created. A two round, modified Delphi panel consisting of representatives from academia, clinical practice, industry, government, and the editorial community was conducted. Out of 44 candidate items, 24 items and accompanying recommendations were developed. The recommendations are contained in a user friendly, 24 item checklist. A copy of the statement, accompanying checklist, and this report can be found on the ISPOR Health Economic Evaluations Publication Guidelines Task Force website (www.ispor.org/TaskForces/EconomicPubGuidelines.asp). We hope CHEERS will lead to better reporting, and ultimately, better health decisions. To facilitate dissemination and uptake, the CHEERS statement is being co-published across 10 health economics and medical journals. We encourage other journals and groups, to endorse CHEERS. The author team plans to review the checklist for an update in five years.

Thompson A.H.,Institute of Health Economics
Crisis | Year: 2010

Background: It has not been made clear whether self-esteem is associated with the severity of suicidal behavior. Aims: To test the association between responses to a self-esteem inventory and levels of suicidal behavior as conceptualized in the notion of the suicide process. Methods: Questions on the severity of suicidal behavior over the lifespan (death wishes, ideation, plans, and attempts), as well as a self-esteem inventory, were administered to 227 university undergraduates. Results: A negative relationship was found between the level of suicidality and self-esteem. As hypothesized, there were fewer cases in each succeeding level of seriousness of suicidal behavior. However, nearly all cases from any particular level were contained in the cohort of individuals who had displayed suicidal behavior at a less serious level. Conclusions: This suggests a possible progression through each of the stages of suicidal behavior, with very few cases showing a level of suicidal behavior that was not associated with a previous, less serious, form. It was hypothesized that early entry into the suicidal process may be indicated by low self-esteem, thus, allowing for a more timely preventive intervention. © 2010 Hogrefe Publishing.

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