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AIMS: The Endeavor zotarolimus-eluting coronary stent has been shown to reduce the restenosis rate compared to bare metal stents and has impacted other clinical measures such as mortality, acute myocardial infarctions (AMI) and target vessel revascularisation (TVR).
METHODS AND RESULTS: Using pooled efficacy data from the Endeavor clinical trial programme, a model was developed to compare the cost effectiveness of the Endeavor drug eluting stent (DES) with the Driver bare meal stent (BMS) over a four year time period. Endeavor was more costly but had an improved clinical outcome compared to Driver BMS over four years with a 4% reduction in deaths, 33% reduction in AMI and a 45% reduction in TVR. Late stent thrombosis was the only event showing an increased incidence for Endeavor of 0.2% compared to 0% for Driver. The incremental cost effectiveness ratio was £3,757/quality adjusted life years (QALY).
CONCLUSIONS: Although much controversy has surrounded the appropriate way to assess the cost effectiveness of DES technology, a comprehensive analysis is presented and this suggests that by using extended clinical trial data out to four years, the Endeavor DES in particular, but DES technologies in general, are cost-effective approaches to percutaneous coronary intervention.
Pressure ulcers are associated with a significant economic burden that, in many cases, is recognised as being avoidable. The effectiveness of pressure relieving surfaces is well documented and acknowledged in clinical guidelines on the prevention and management of pressure ulcers. Whilst pressure relieving surfaces are more expensive than traditional hospital mattresses, judicious use, targeted to patients most at risk, can help to reduce the incidence and costs of pressure ulcers in hospital settings. This review paper includes a summary of pivotal clinical evidence on pressure relieving surfaces as well as a suggested approach for modelling their financial impact on hospital budgets. Simple financial modelling suggests that pressure relieving surfaces could lead to financial savings for a hospital when used appropriately.
With the number of available health technologies increasing at a greater rate than ever before, there is a growing need to ensure that decision-makers have the necessary tools to select and implement only those technologies that offer the greatest benefits to society. This, combined with the limited budgets available to healthcare providers, means that rigorous assessment of the benefits and costs of new interventions is both useful and necessary.
OBJECTIVES: Health technology assessment (HTA) agencies assessing the cost-effectiveness of healthcare technologies seek evidence from economic evaluations. As well as searching economic evaluation databases, researchers often search MEDLINE and EMBASE, using search filters whose current performance is unclear. We assessed the performance of search filters in identifying economic evaluations from MEDLINE and EMBASE.
METHODS: A gold standard of economic evaluations was compiled from National Health Service Economic Evaluation Database (NHS EED) records for 2000, 2003, and 2006. Corresponding records were retrieved in MEDLINE and EMBASE. Search filters were identified from the InterTASC Information Specialists' SubGroup Web site and from Canadian Agency for Drugs and Technologies in Health (CADTH) Information Services. The sensitivity and precision of search filters in retrieving gold standard records from MEDLINE and EMBASE were tested.
RESULTS: A total of 2,070 full economic evaluations were identified from NHS EED. Of these, 1,955 records were available in Ovid MEDLINE and 1,873 were available in Ovid EMBASE. Thirteen MEDLINE and eight EMBASE filters were identified. NHS Quality Improvement Scotland (full and brief filters), the NHS EED and Royle and Waugh filters achieved over 0.99 sensitivity in MEDLINE. NHS Quality Improvement Scotland, CADTH, Royle and Waugh, and NHS EED filters achieved greater than 0.99 sensitivity in EMBASE. Filters demonstrated low precision.
CONCLUSIONS: This research provided new performance data on search filters to identify economic evaluations in MEDLINE and EMBASE. It demonstrated that highly sensitive economic evaluation filters are available, but that precision is low, yielding perhaps 5 relevant records per 100 records scanned.
OBJECTIVES: There is considerable interest in the potential for harmonizing health technology assessments (HTA) across jurisdictions. This study aims to consider four HTAs of drug eluting stents to determine the degree to which the methods adopted, evidence considered, and resulting recommendations diverge.
METHODS: Four HTAs of drug eluting stents were selected for inclusion and evaluated using a framework developed to systematically capture information on the process adopted, the evidence considered and the recommendations of each HTA.
RESULTS AND CONCLUSIONS: The findings suggest that, although there is a common core data set considered by most of the agencies, differences in the approach to HTA, heterogeneity of studies, and the limited relevance of research findings to local practice meant that the core data set had only limited influence on the resulting recommendations. Of the HTA agencies considered in the analysis, many sought to generate additional primary research from local settings to help inform the development of recommendations that were relevant to local practice. This raises questions about the extent to which HTA methods can be harmonized across jurisdictions.
No abstract available.
BACKGROUND: Those working in psychiatric units care for some of the most vulnerable and needy patients within health services, and suffer some of the highest levels of job dissatisfaction and burnout within healthcare workforce. Poor staff morale is bad for patient care and is economically wasteful. The same level of evidence of effectiveness and efficiency should be considered in workforce planning as is required in patient care. This has hitherto not occurred.
AIM: To examine the impact and cost effectiveness of strategies to improve staff morale and reduce "burnout" amongst staff working in psychiatric units.
METHODS: We conducted a systematic review of robust evaluations of strategies designed to improve psychological wellbeing or the working experience of staff working in psychiatric units. We searched the following databases: EMBASE; MEDLINE; PsycINFO; CINAHL; Sociological Abstracts; HMIC; Management and Marketing Abstracts; Management Contents and Inside Conferences (all to 2004), and sought the following outcomes: Psychological wellbeing; Job satisfaction; staff burnout and stress; staff sickness and turnover; Direct and indirect costs. The following designs were included: Randomised Controlled Trails (RCTs); Controlled Clinical Trials (CCTs); Controlled Before and after studies (CBAs); and interrupted time series (ITSs). We conducted a narrative overview of key design features, endpoints and results.
RESULTS: We identified eight evaluations of strategies to improve staff morale (3 RCTs; 3 CCTs and 2 CBAs). Educational interventions designed to enhance the skill and competency of staff were the most commonly evaluated, and showed positive impact on at least one outcome of interest. Psycho-social interventions that sought out members of staff who were experiencing emotional problems and offered work-based support and enhanced social support networks were positive in US healthcare settings, but had been incompletely implemented and evaluated in UK settings. Organisational interventions, such as a shift to continuous care and primary nursing also showed a potential to be effective in reducing sickness rates and improving job satisfaction.
CONCLUSIONS:There is substantial opportunity to design and implement interventions to improve the working experience of staff in psychiatric units. There is an onus to evaluate the longer term impact and cost effectiveness of these strategies. Unfortunately strategies are currently being implemented in the absence of any prospective evaluation.
