PubMed Health⌕ Search

Biomedical subjects

Emma McIntosh

Publications and source records attributed to Emma McIntosh.

10 recordsLinked to original sources
PubMed2006

Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation.

OBJECTIVES: To evaluate the effectiveness and cost effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families. DESIGN: Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n = 67) or standard services (n = 64). Incremental cost analysis. SETTING: 40 general practitioner practices across 2 counties in the UK. PARTICIPANTS: 131 vulnerable pregnant women. INTERVENTION: Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6 months antenatally to 12 months postnatally. MAIN OUTCOME MEASURES: Mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse. RESULTS: At 12 months, differences favouring the home-visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. A non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group were found. The mean incremental cost per infant of the home visiting intervention was 3246 pounds sterling (bootstrapped 95% CI for the difference 1645-4803 pounds sterling). CONCLUSION: This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed, along with long-term follow-up to assess possible sleeper effects.

Adolescent↗
PubMed2006

Using discrete choice experiments within a cost-benefit analysis framework: some considerations.

A great advantage of the stated preference discrete choice experiment (SPDCE) approach to economic evaluation methodology is its immense flexibility within applied cost-benefit analyses (CBAs). However, while the use of SPDCEs in healthcare has increased markedly in recent years there has been a distinct lack of equivalent CBAs in healthcare using such SPDCE-derived valuations. This article outlines specific issues and some practical suggestions for consideration relevant to the development of CBAs using SPDCE-derived benefits. The article shows that SPDCE-derived CBA can adopt recent developments in cost-effectiveness methodology including the cost-effectiveness plane, appropriate consideration of uncertainty, the net-benefit framework and probabilistic sensitivity analysis methods, while maintaining the theoretical advantage of the SPDCE approach. The concept of a cost-benefit plane is no different in principle to the cost-effectiveness plane and can be a useful tool for reporting and presenting the results of CBAs.However, there are many challenging issues to address for the advancement of CBA methodology using SPCDEs within healthcare. Particular areas for development include the importance of accounting for uncertainty in SPDCE-derived willingness-to-pay values, the methodology of SPDCEs in clinical trial settings and economic models, measurement issues pertinent to using SPDCEs specifically in healthcare, and the importance of issues such as consideration of the dynamic nature of healthcare and the resulting impact this has on the validity of attribute definitions and context.

Advisory Committees↗
PubMed2005

An economic analysis of implementing the SIGN third molar guideline: implications for the design and analysis of implementation studies.

OBJECTIVES: To compare the cost-effectiveness of four third molar guideline implementation strategies. METHODS: Fifty-one dental practices in Scotland were randomized to one of four implementation strategies. The effectiveness of the strategies was measured by general dental practitioners' compliance with the guideline. RESULTS: The effectiveness of the guideline depended crucially upon the type of patient treated. In particular, for a minority of patients (14%) with no clinical signals of their 'type', the implementation strategies generate potentially large gains in evidence-based practice. However, the cost per patient of achieving these gains is large given that the costs are incurred for all patients, but benefits accrue only to a minority. DISCUSSION: The results show that the type of patient presenting for treatment can influence the effectiveness, cost-effectiveness and therefore policy conclusions. Consequently, the design and analysis of studies need to be sufficiently sensitive to detect subtle interaction effects. This may explain the dearth of guideline implementation trials with significant findings. The results also suggest that a more cost-effective implementation method in primary care dentistry may be to subsidize treatment conditional upon patient type.

Cost-Benefit Analysis↗
PubMed2005

The importance of drug adverse effects compared with seizure control for people with epilepsy: a discrete choice experiment.

INTRODUCTION: Antiepileptic drugs (AEDs) have been shown to reduce the severity and frequency of seizures for most patients. However, many patients experience adverse effects in order to maintain seizure control. STUDY DESIGN: A stated preference discrete choice experiment (DCE) was used to explore the preferences of people with epilepsy regarding the adverse effects and seizure control of AEDs. METHODS: The main adverse effects of AEDs were identified through a literature search and expert consultation. In addition, a national epilepsy patient advocacy group helped to identify important attributes and commented on the attributes we had already identified. The DCE included five attributes related to adverse effects (alopecia, nausea, skin rash, concentration effects and weight change) plus seizure control and cost (to estimate willingness to pay [WTP]). A cost attribute was included in the DCE in order to estimate people's WTP for changes in attribute levels. Five hundred members of a national patient advocacy group with a diagnosis of epilepsy were presented with pairs of hypothetical drug profiles with varied levels of adverse effects, seizure control and cost; they were then asked to indicate which drug they preferred. Questions were also included to collect sociodemographic data (including income) and information regarding experience of adverse effects and medication. The survey was administered via the post and the Internet. Data were analysed using a random effects probit model. RESULTS: A total of 148 surveys were returned. All attributes were significant and had the expected polarity, i.e. participants showed a preference for less severe adverse effects, greater seizure control and less cost. To achieve 100% seizure control and no adverse effects, participants were willing to pay 709 pounds sterlings (1105 US dollars) per month, 95% CI 451 pounds sterlings, 1278 pounds sterlings (1 pound sterling = 1.56 US dollars, 2002 exchange rate). Participants' WTP was significantly influenced by different adverse effects; for example, people with epilepsy were willing to pay only 174 pounds sterlings (271 US dollars) per month for a drug that provided seizure freedom but also caused hair loss. Segmented models showed that seizure frequency has a significant negative impact on respondents' income levels. Also, women were willing to pay twice as much as men to avoid weight gain. Participants were also willing to trade changes in seizure control for improvements in adverse effects. CONCLUSION: Participants placed a high value on gaining total seizure control with no adverse effects. This study underlines the importance that people with epilepsy place on reducing adverse effects. The study also revealed how preferences for AEDs vary in different subgroups. Management of epilepsy is usually aimed at minimising seizures within a tolerable level of adverse effects. The present study suggests that people with epilepsy have strong preferences for reducing adverse effects as well as improving seizure control. These data may be considered useful when making medical management decisions in epilepsy.

Adult↗
PubMed2003

Estimating the costs of surgical innovations: the case for subthalamic nucleus stimulation in the treatment of advanced Parkinson's disease.

We estimated the current cost of deep brain stimulation surgery targeted on the subthalamic nucleus. The method used was a cost analysis using typical resource use patterns and unit costs from a leading surgical centre, detailed equipment costs from the manufacturer, and sensitivity analysis. Resource use was based on patients with advanced Parkinson's disease. The main outcome measure was the likely total health service costs per patient, including preoperative assessment, surgery, and postoperative management over a 5-year period. The preoperative assessment, surgery, and discounted follow-up costs associated with subthalamic nucleus surgery were estimated at approximately UK Pounds 32,526 per patient over 5 years. Almost 70% of these costs are attributable to the initial costs of the equipment and the likely follow-up and replacement costs of the equipment. These costs will be affected mainly by future equipment costs and their replacement period and are relatively insensitive to preoperative assessment staff costs, length of hospital stay after surgery, and imaging costs. This cost estimate should be of use to researchers, health care managers, policy makers, and surgeons working in this area. Providing an estimate of the cost of this new procedure will provide a baseline for tracking future changes in costs and will assist the production of cost-effectiveness estimates.

Data Collection↗
PubMed2002

Willingness to pay for complete symptom relief of gastroesophageal reflux disease.

BACKGROUND: Over $6 billion per year is spent on prescription medication for gastroesophageal reflux disease (GERD). This study is an economic analysis of patients' willingness to pay for a prescription medication that offers complete relief of GERD symptoms. METHODS: The study was a cross-sectional, nonrandomized design recruiting patients from 5 clinical sites. A computer-administered discrete-choice questionnaire was used to explore patients' willingness to pay for various attributes (time to relief, amount of relief, side effects, and out-of-pocket cost) associated with GERD treatment. Patients chose between 2 different combinations of attributes by indicating which scenario they preferred. Data were gathered on health status, health-related quality of life, and sociodemographic characteristics. RESULTS: Two hundred five patients completed the discrete-choice questionnaire with a consistency rate of 99.5%. All attributes were relevant to patient decision making. Respondents were willing to pay up to $182 to obtain complete relief in a short period of time without side effects. Patients with less severe GERD symptoms were willing to pay more to avoid side effects ($58.25 vs $38.43). Older patients were less willing to pay for better relief than younger patients. CONCLUSIONS: Results demonstrate that patients are willing to pay more per month for a medication that provides more complete and faster relief from GERD symptoms. This information can guide clinicians and formulary committees in evaluating optimal treatment for GERD.

Adult↗
PubMed1998

Using conjoint analysis to elicit the views of health service users: an application to the patient health card.

OBJECTIVE: To demonstrate the application of conjoint analysis (CA) for eliciting the views of health service users. METHODS: A CA study was conducted alongside a randomized controlled trial evaluating the introduction of a patient health card (PHC). The PHC was evaluated with respect to three other aspects of general practice: number of days between making a non-urgent appointment and seeing a doctor; waiting time in reception between the time of the appointment and seeing a doctor; and whether the patient is usually seen by the doctor of their choice. A postal questionnaire was sent to 100 individuals from a general practice in Inverurie, Scotland. RESULTS: Seventy-five individuals returned the questionnaire, of whom 51 answered the CA section. The PHC was the least important of the attributes considered. The number of days between making a non-urgent appointment and seeing a doctor was considered to be the most important. A 1-day reduction in the number of days to appointment was four and a half times more important than having a PHC; a 1-minute reduction in waiting time in the reception area was three and a half times more important than having a PHC; and seeing a doctor of choice was over three times more important than having a PHC. Satisfaction or utility scores for different ways of providing a general practice service also indicated that priority should be given to reducing waiting time to see a doctor or reducing waiting time in reception. CONCLUSIONS: While the PHC is a significant and positive predictor of satisfaction in general practice, it is less important than the other three attributes considered. More generally, CA appears to be a potentially useful instrument for eliciting the views of health service users.

Journal Article↗