Showing papers by "Zanfina Ademi published in 2014"

Overview of methods for comparing the efficacies of drugs in the absence of head‐to‐head clinical trial data

Abstract: In most therapeutic areas, multiple drug options are increasingly becoming available, but there is often a lack of evidence from head-to-head clinical trials that allows for direct comparison of the efficacy and/or safety of one drug vs. another. This review provides an introduction to, and overview of, common methods used for comparing drugs in the absence of head-to-head clinical trial evidence. Naive direct comparisons are in most instances inappropriate and should only be used for exploratory purposes and when no other options are possible. Adjusted indirect comparisons are currently the most commonly accepted method and use links through one or more common comparators. Mixed treatment comparisons (MTCs) use Bayesian statistical models to incorporate all available data for a drug, even data that are not relevant to the comparator drug. MTCs reduce uncertainty but have not yet been widely accepted by researchers, nor drug regulatory and reimbursement authorities. All indirect analyses are based on the same underlying assumption as meta-analyses, namely that the study populations in the trials being compared are similar.

Quantifying the excess cost and resource utilisation for patients with complications associated with elective knee arthroscopy: A retrospective cohort study

Abstract: Background Recent studies have demonstrated morbidity associated with elective knee arthroscopy. The objective of the current study was to quantify resource utilisation and costs associated with postoperative complications following an elective knee arthroscopy. Methods We undertook a retrospective, longitudinal cohort study using routinely collected hospital data from Victorian public hospitals during the period from 1 July 2000 to 30 June 2009. A generalised linear model was used to examine relative cost and length of stay for venous thromboembolism, joint complications and infections. Log-transformed multiple linear regression and retransformation were used to determine the excess cost after adjustment. Results We identified 166,770 episodes involving an elective knee arthroscopy. There were a total of 976(0.6%) complications, including 573 patients who had a venous thromboembolism (VTE) (0.3%), 227 patients with a joint complication (0.1%) and 141 patients with infections (0.1%). After adjustment, the excess 30-day cost per patient for venous thromboembolism was $USD + 3227 (95% CI: $3211–3244), for joint complications it was $USD + 2247 (95% CI: $2216–2280) and for infections it was $USD + 4364 (95% CI: $4331–4397). Conclusion This is the first study to quantify resource utilisation for complications associated with elective knee arthroscopy. With growing attention focused on improving patient outcomes and containing costs, understanding the nature and impact of complications on resource utilisation is important.

Performance of the assessment of quality of life measure in people with hip and knee joint disease and implications for research and clinical use

Abstract: Objective To comprehensively evaluate the performance of the Assessment of Quality of Life (AQoL) instrument for measuring health-related quality of life (HRQOL) in people with hip and knee joint disease (arthritis or osteoarthritis) Methods Data from 237 individuals were available for analysis from a national cross-sectional, population-based study of hip and knee joint disease in Australia AQoL-4D data were evaluated using Rasch analysis A range of measurement properties was explored, including model and item fit, threshold ordering, differential item functioning, and targeting Results Good overall fit of the AQoL with the Rasch model was demonstrated across a range of tests, supporting internal validity Only 1 item (relating to hearing) showed evidence of misfit Most AQoL items showed logical sequencing of response option categories, with threshold disordering evident for only 2 of the 12 items (items 4 and 9) Minor issues with potential clinical and research implications include limited options for reporting pain and some evidence of measurement bias between demographic subgroups (including age and sex) Participants' HRQOL was generally better than that represented by the AQoL items (mean ± SD for person abilities −215 ± 139, mean ± SD for item difficulties 000 ± 067), indicating ceiling effects that could impact the instrument's ability to detect HRQOL improvement in population-based studies Conclusion The AQoL is a competent tool for assessing HRQOL in people with hip and knee joint disease, although researchers and clinicians should consider the caveats identified when selecting appropriate HRQOL measures for future outcome assessment involving this patient group

PW241 The Cost-Effectiveness of Guideline-Driven Use of Drug-Eluting Stents in Victorian Public Hospitals

Abstract: O ST E R A B ST R A C T S care in the delivery of medical interventions. Cardiovascular interventions including Percutaneous Coronary Intervention (PCI) are high cost activities that have become widely adopted across the region. Registries in individual institutions and countries are valuable, however, the establishment of a collaboration across the Asia Pacific Region to inform on variations in patient and procedural characteristics and associated clinical outcomes would enable regional benchmarking of quality performance. Objectives: An inaugural Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration meeting was held in Singapore in July 2012 with 27 hospital representatives attending. The proposed aims of the collaboration included a) to identify the characteristics of patients undergoing PCI across the Asia Pacific region, b) to report on outcomes of patients undergoing PCI across the Asia Pacific Region, c) to develop an appropriate ethnic specific risk adjustment model for patients undergoing PCI across the Asia Pacific Region and d) to establish a registry framework for research, education and training in the area of cardiovascular interventions across the Asia Pacific Region. Methods: Following agreement, common fields were identified from data sets of existing local registries and an initial report on patient characteristics across the region was proposed. Descriptive characteristics of patients undergoing PCI over a 12 month period were collated and reported. Results: In every country, males predominated PCI activity. Subjects were older and had higher rates of family history of cardiovascular disease in Australia, while Asian subjects had higher rates of diabetes, dyslipidaemia and renal failure. STEMI presentation was higher in Australia than in Asia and Drug eluting stent use was higher in Asia. Procedural success rates were similar across the region (>95%). Conclusion: Resolution of cross border individual patient data transfer and collation of pooled data in a central registry is ongoing. Patient characteristics differ across countries in Asia in terms of pre-procedural risk factors and clinical presentation, however procedural success was similar. Impact on patient outcomes at 30 days and longer term outcomes are being assessed. Disclosure of Interest: None Declared

Cardiovascular risk prediction in a population with the metabolic syndrome: Framingham vs. UKPDS algorithms.

Abstract: Background:Cardiovascular disease (CVD) risk-prediction algorithms are key in determining one’s eligibility for prevention strategies, but are often population-specific. Metabolic syndrome (MetS), a clustering of risk factors that increase the risk of CVD, does not currently have a risk-prediction algorithm available for prediction of CVD. The aim of this study was to compare the predictive capacities of an algorithm intended for ‘healthy’ individuals and one intended for ‘diabetic’ individuals.Methods:Individual-specific data from 2700 subjects defined as MetS but free of diagnosed CVD from the Australian Diabetes, Obesity and Lifestyle study was used to estimate 5-year risk of CVD using the two algorithms, and compared using Wilcoxon-signed rank test. CVD end point data was used to assess the performance using discrimination and calibration techniques of the two algorithms.Results:Five-year risk-prediction comparisons demonstrated that the UKPDS algorithm overpredicted risk in the younger age groups (25...

Using WOMAC Index scores and personal characteristics to estimate Assessment of Quality of Life utility scores in people with hip and knee joint disease

Abstract: To determine whether Assessment of Quality of Life (AQoL) utility scores can be reliably estimated from Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in people with hip and knee joint disease (arthritis or osteoarthritis). WOMAC and AQoL data were analysed from 219 people recruited for a national population-based study. Generalised linear models were used to estimate AQoL utility scores based on WOMAC total and subscale scores and personal characteristics. Goodness of fit was assessed for each model, and plots of prediction errors versus actual AQoL utility scores were used to gauge bias. Each model closely predicted the average AQoL utility score for the overall sample (actual mean AQoL 0.64, range of predicted means 0.63–0.64; actual median AQoL 0.71, range of predicted medians 0.68–0.69). No clear preferred model was identified, and overall, the models predicted 40–46 % of the variance in AQoL utility scores. The WOMAC function subscale model performed similarly to the total score model. The models functioned best at the mid-range of AQoL scores, with greater bias observed for extreme scores. Inaccuracies in individual-level estimates and low/high health-related quality of life (HRQoL) subgroup estimates were evident. Reliable overall group-level estimates were produced, supporting the application of these techniques at a population level. Using WOMAC scores to predict individual AQoL utility scores is not recommended, and the models may produce inaccurate estimates in studies targeting patients with low/high HRQoL. Where pain and stiffness data are unavailable, the WOMAC function subscale can be used to generate a reasonable utility estimate.

Cost Effectiveness of Eplerenone in Patients with Chronic Heart Failure

Abstract: Background Chronic heart failure (CHF) remains an important cause of morbidity and mortality worldwide. Currently, there are no cost-effectiveness studies of eplerenone use in patients with New York Heart Association (NYHA) class II CHF.