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Cost-effectiveness of Crohn's disease post-operative care

World Journal of Gastroenterology 2016年第14期22卷 3860-3868页

作者： Emily K Wright Michael A Kamm Peter Dr Cruz Amy L Hamilton Kathryn J Ritchie Sally J Bell Steven J Brown William R Connell Paul V Desmond danny liew Department of Gastroenterology St Vincent's Hospital University of Melbourne Fitzroy VIC 3065 Melbourne Australia Imperial College London SW7 2AZ United Kingdom Melbourne EpiCentre University of Melbourne and Melbourne Health Parkville VIC 3010 Melbourne Australia

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal ***: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 ***: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence ***: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.

关键词： Crohn’ s disease Post-operative Health economics Health care cost Biologics

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Risk stratification for coronary artery disease in multi-ethnic populations:Are there broader considerations for cost efficiency?

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World Journal of Methodology 2019年第1期9卷 1-19页

作者： Pupalan Iyngkaran William Chan danny liew Jalal Zamani John D Horowitz Michael Jelinek David L Hare James A Shaw Department of Cardiology Flinders UniversityNT Medical School Department of Cardiology Alfred and Western Health University of Melbourne Clinical Outcomes Research School of Public Health and Preventive MedicineMonash University Department of Interventional Cardiology Feris Shiraz UniversityShiraz University of Medical Sciences Department of Cardiology and Clinical Pharmacology the Queen Elizabeth HospitalUniversity of Adelaide Department of Cardiology Vincent’s Hospital Cardiovascular Research University of Melbourne Department of Cardiology The Alfred HospitalBaker IDI Heart and Diabetes Institute

Coronary artery disease(CAD) screening and diagnosis are core cardiac specialty *** symptoms,autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as *** angina remains a clinical diagnosis,most cases require correlation with a diagnostic *** the onset of the evidence building process much research,now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being *** we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is *** it would seem veryunlikely that for the majority,scientific arguments against guidelines would differ,however from a translational perspective,there will be populations who differ and importantly there are cost-efficacy questions,e.g.,the most suitable first-line tests or what parameters equate to an adequate *** article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.

关键词： Cost efficacy Coronary artery disease Coronary heart disease Ethnicity Outcomes Risk stratification

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Difficulties in Recruitment for a Randomised Controlled Trial of Lifestyle Intervention for Type 2 Diabetes: Implications for Diabetes Management

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Open Journal of Endocrine and Metabolic Diseases 2012年第4期2卷 53-57页

作者： George A. Jelinek Emily Hadgkiss Craig Hassed Bernard Crimmins Peter Schattner danny liew Rick Kausman Warrick J. Inder Siegfried Gutbrod Tracey J. Weiland Department of General Practice Faculty of Medicine Nursing and Health Sciences Monash University Clayton Australia Department of Medicine Faculty of Medicine and Health Sciences The University of Melbourne Royal Melbourne Hospital Melbourne Australia East Bentleigh General Practice Melbourne Australia Emergency Practice Innovation Centre St Vincent’s Hospital Melbourne Australia Formerly Department of Endocrinology St Vincent’s Hospital Melbourne Australia Manningham General Practice Melbourne Australia The Butterfly Foundation Malvern Australia The Gawler Foundation Yarra Junction Australia

Objective: To report our experience of attempting a randomised controlled trial of an intensive lifestyle intervention for early type 2 diabetes delivered in a residential setting. Methods: We established a trial requiring 84 participants (46 standard care and 38 intervention) to detect a 1% difference in HbA1c between intervention and control groups at 12 months, allowing for attrition. Ethics approval was obtained from Monash University. Results: The study was abandoned after five months of consistent promotion due to recruitment failure (four subjects recruited). Conclusion: It appears to be difficult for patients with diabetes to commit to a live-in period of education regarding lifestyle modification as a means of treating the illness. We recommend better education of patients and their doctors about the potential health benefits of lifestyle change to manage type 2 diabetes, and further research into novel methods of delivering lifestyle advice which are both effective and sustainable.

关键词： Type 2 Diabetes Mellitus Randomised Controlled Trial Management Lifestyle Risk Factors

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