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No abstract available
OBJECTIVE: To estimate the yield from searching a range of bibliographic databases and additional sources to identify test accuracy studies for systematic reviews.
STUDY DEISGN AND SETTING: We examined eight systematic reviews and their database searches: MEDLINE, EMBASE, BIOSIS, Science Citation Index, LILACS, Pascal, and CENTRAL. We used studies included in each systematic review as the "gold standard," against which yield was estimated. For each database, we classified studies in each gold standard set as being (1) included in the database and identified by searches, (2) included and not identified, and (3) not included in the database.
RESULTS: No search identified all studies in any gold standard set. EMBASE, Science Citation Index, and BIOSIS contained studies that were not on MEDLINE. Over 20% of studies in the gold standard sets were not identified by searching MEDLINE. Six studies on LILACS were not on any other database. Eight gold standard studies were not included in any of the databases, and a further 22 were not identified by the electronic search strategies.
CONCLUSIONS: Systematic reviews of test accuracy studies should search a range of databases. Even searches designed to be very sensitive, that do not use study design filters, can fail to identify relevant studies.
OBJECTIVE: To determine the cost-effectiveness ofVacuum Assisted Closure (VAC) therapy (KCI Medical), based on a comparison with both traditional and advanced wound dressings, for the treatment of diabetic foot ulcers in the US.
METHOD: A Markov model was designed to estimate the cost per amputation avoided and the cost per quality-adjusted life year (QALY) of VAC therapy, compared with both traditional and advanced dressings. Over a one-year period the Markov model simulated 1000 patients using transition probabilities obtained from the literature. The health states used in the model were: uninfected ulcer; infected ulcer; infected ulcer post-amputation; healed; healed post-amputation; amputation; and death. Patients initially treated with VAC switched to the advanced dressing after three months of treatment if their wound remained unhealed. Patients treated with traditional or advanced dressings were assumed to continue with their treatment for the full 12 months if they remained unhealed.
RESULTS The model results demonstrate improved healing rates (61% versus 59%), more QALYs (0.54 versus 0.53) and an overall lower cost of care ($52,830 versus $61,757 per person) for patients treated with VAC therapy compared with advanced dressings. Vacuum Assisted Closure was also shown to be a dominant intervention when compared with traditional dressings.
CONCLUSION: The model results indicate that VAC therapy is less costly and more effective than both traditional and advanced dressings. The results are robust to changes in key parameters, including the transition probabilities, the cost ofVAC therapy and the utility weights applied to health states.
No abstract available
PURPOSE: To document published utilities for health states associated with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) and determine the most appropriate values for use in economic models to evaluate renal treatments in the UK.
METHODS: A structured literature review was conducted (MEDLINE, EMBASE, NHS EED and HTA) in order to identify relevant articles published between January 1990 and January 2006. In addition searches were conducted on websites of Health Technology Assessment (HTA) organizations and the Cost Effectiveness Analysis Registry. Articles were reviewed and those not containing utilities excluded. Results were assessed on the quality of the elicitation studies and their relevance to the UK HTA environment.
RESULTS Thirty-five studies satisfied the inclusion criteria. Most studies were conducted in Canada (13), the US (10) and the Netherlands (4). Utilities were identified for all/most of the necessary states, but scores for individual states differed widely between studies and very few studies met the quality criteria. The majority of studies used the time trade-off (23) and standard gamble (11) to elicit utilities, while only six used EQ-5D. Seven studies provided community preferences. Two studies were judged to be directly relevant to economic evaluations in the UK.
CONCLUSIONS: Many studies have estimated utilities in ESRD patients, but only a few have estimated utilities based upon public preferences. Further empirical research is needed to produce more reliable utilities for economic modelling in the UK, especially in chronic kidney disease patients who do not require dialysis.
OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care.
DESIGN: Randomized, controlled trial.
SETTING: Seven community hospitals and five general hospitals in the midlands and north of England.
PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness.
INTERVENTION: Multidisciplinary team care for older people in community hospitals.
MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services.
RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26-6.28; P=.03). The results for the secondary outcome measures were similar for the two groups.
CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.
No abstract available
