PubMed Health⌕ Search

Biomedical subjects

K H Tolley

Publications and source records attributed to K H Tolley.

15 recordsLinked to original sources
PubMed2001

Assessing the relationship between productivity levels and severity of haemophilia.

In this study, we assessed whether severity of haemophilia was associated with levels of productivity. Productivity levels were assessed by sending a 'time-use' questionnaire to 228 individuals with mild, moderate and severe haemophilia. The results showed that, after adjusting for differences in age and HIV serostatus, there were no differences between individuals with severe and mild/moderate haemophilia in terms of completed levels of education, employment status, absenteeism from work over the previous 2 weeks, the number of hours each week spent performing unpaid tasks and how efficiently individuals performed these tasks. The data did suggest, however, that a significantly larger proportion of individuals with severe haemophilia (32%) required help from family or friends to perform routine household tasks each week than individuals with mild/moderate haemophilia (13%). In conclusion, it is possible that individuals with severe haemophilia have similar levels of productivity compared to individuals with mild/moderate haemophilia or that treatment with secondary prophylaxis has helped to reduce differences between the two patient groups.

Activities of Daily Living↗
PubMed2000

Primary prophylaxis for individuals with severe haemophilia: how many hospital visits could treatment prevent?

OBJECTIVES: To assess how many hospital visits primary prophylaxis with clotting factor could prevent. DESIGN: The potential for reducing hospital visits was assessed by comparing rates of in-patient, Out-patient and day-case visits per patient-year for individuals with severe (< 1 IU dL-1) haemophilia who had never received primary prophylaxis with attendance rates for individuals with mild/moderate (1-50 IU dL-1) haemophilia. Hospital attendance data were collected retrospectively for the period 1988-97 inclusive for individuals who were aged 18 years or over. SETTING: Data were obtained on patients who were registered at the Katharine Dormandy Haemophilia Centre (KDHC), London, UK. OUTCOME MEASURES: In-patient stays, Out-patient and day-case visits. RESULTS: Individuals with mild/moderate haemophilia were 45% (31-56), 36% (30-41) and 70% (68-73) less likely to have required in-patient, Out-patient and day-case visits than were individuals with severe haemophilia. HIV serostatus and age were also shown to be significant and independent predictors of the rate of Out-patient and day-case visits, but not the rate of in-patient stays. CONCLUSION: These results suggest that primary prophylaxis for individuals with severe haemophilia could significantly reduce the demand for in-patient stays, and Out-patient and day-case visits.

Adolescent↗
PubMed1999

Assessing health-related quality-of-life in individuals with haemophilia.

The objectives of this study were to analyse current levels of health-related quality-of-life (HR-QoL) in individuals with severe haemophilia and to assess the scope for these levels to improve. To do this, 249 individuals with severe, moderate and mild haemophilia were asked to complete Medical Outcomes Study (MOS) Short-Form 36 (SF-36) and EuroQol (EQ-5D) questionnaires. Access was also gained to two appropriate normative data sets. The results from these questionnaires showed that HIV status, history of orthopaedic surgery and bleeding frequency in the previous calendar year were not strong predictors of HR-QoL for individuals with severe haemophilia. However, for the majority of scales, age was found to be a strong predictor of HR-QoL for this patient group. The results from the analysis also showed that compared to individuals with moderate/mild haemophilia and the UK male normative population, individuals with severe haemophilia generally recorded poorer levels of HR-QoL. These results suggest, therefore, that individuals with severe haemophilia have reduced levels of HR-QoL compared to individuals with moderate/mild haemophilia and the general population, irrespective of differences in age. The results also suggest that the scope for primary prophylaxis to increase HR-QoL in individuals with severe haemophilia is significant.

Adult↗
PubMed1998

The ethics of resource allocation: the views of general practitioners in Lincolnshire, U.K.

Concerns about the intrusion of economic and financial considerations into patient management have increased in the United Kingdom, largely as a result of the passage of the 1990 National Health Services Act. Based on an agenda set by the British Medical Association, a questionnaire was designed to reveal general practitioners' attitudes to potential ethical problems posed by rationing and resource allocation. The questionnaire was issued to each of the 105 practices in Lincolnshire and 70 replies were returned for analysis. The survey revealed that, in certain areas, there existed a wide divergence of opinion amongst physicians. Examples included the extent to which the government was to be held responsible for full health care funding, the legitimacy or otherwise of general practice budgets and the extent to which service provision should be dependent on upon personal remuneration. On the other hand, relatively high degrees of consensus appeared to exist with respect to issues such as rationing by deterrence and service dilution. Additional, qualitative, evidence suggests that practitioners perceive themselves to be under increasing pressure from patient demand and that morale in the profession is falling. The results of the present study appear consistent with those obtained in other countries. In view of recent policy initiatives with respect to public sector health care, it is likely that the debate over the ethical dimensions of resource allocation in the U.K. will become more vigorous.

Attitude of Health Personnel↗
PubMed1998

The changing patterns of factor VIII (FVIII) and factor IX (FIX) clotting factor usage in a comprehensive care centre between 1980 and 1994.

The annual amount of clotting factor used by patients at the Royal Free Haemophilia Centre increased significantly from 4 million iu in 1980 to over 15 million iu by 1994 (P < 0.0001). In order to assess the reasons for this increase, data on concentrate usage over this period were retrospectively collected for patients who had haemophilia or von Willebrand's disease. Only patients who were registered exclusively at the Centre were included in the study. In total, 498 patients met the inclusion criterion. The median age of the cohort on 1 January 1980 was 21 (range < 1-69) years. During the period there were 88 births and 45 deaths. The majority of patients had haemophilia A (55%). The median follow-up period per patient was 2.1 (range 0-14.8) years. Despite adjusting for increases in the number of patients and changes in body weight, statistically significant increases in clotting factor usage were detected for some subgroups of patients, in particularly for those with severe haemophilia A and B and from the late 1980s onwards, for patients with von Willebrand's disease. Two reasons for this increase in clotting factor usage were identified as being the introduction of improved products and prophylaxis. However, the increased cost of clotting factor provision that has resulted from these changes in treatment policy should not be analysed in isolation but should be balanced off against cost decreases in other areas and against increases in the effectiveness of treatment.

Comprehensive Health Care↗
PubMed1998

Assessing the effectiveness and cost-effectiveness of prophylaxis against bleeding in patients with severe haemophilia and severe von Willebrand's disease.

OBJECTIVES: To assess the effectiveness and cost-effectiveness of prophylaxis with clotting factor against bleeding in patients with severe haemophilia and von Willebrand's disease (vWD). DESIGN: Treatment details that related to 179 patients with severe (< 1 u dL-1) haemophilia A, B and vWD were retrospectively examined for the period 1980-95. A subgroup of these patients, 25 adults and 22 children, who had previously received treatment on demand and who had switched to treating with prophylaxis, were studied in order to examine the effects of the change. The cost-effectiveness of prophylaxis was also analysed using another subgroup of 38 patients and by adjusting their treatment details by age and method of treatment. SETTING: Data were obtained on patients who were solely registered at the Royal Free Hospital Haemophilia Centre (RFHHC), London, UK. OUTCOME MEASURE: Bleeds. RESULTS: The median annual number of bleeds decreased from 23.5 (range 1-107) in 1980, to 14 (range 0-45) in 1995 (P < 0.0001). Switching from treating on demand to prophylaxis reduced bleeding frequency in 41 out of 47 patients within the period of 1 year. At the base scenario, switching to prophylaxis cost an additional pound547 per averted bleed; however, this figure was highly sensitive to certain variables. CONCLUSION: Prophylaxis can reduce bleeding frequency but requires more clotting factor than treatment on demand. More detailed proof of cost-effectiveness is likely to require the use of modelling techniques.

Adolescent↗
PubMed1997

GP fundholding and the costs of prescribing: further results.

BACKGROUND: An earlier paper published in this journal suggested that fundholding practices in Lincolnshire had managed to constrain the growth in their prescribing costs more successfully than had non-fundholders, largely on the basis of restricting the number of items prescribed per patient. At that time, insufficient data were available to explore the impact of a change in status from non-fundholding to fundholding on prescribing behaviour. METHOD: Time-series prescribing data for the fourth-wave of Lincolnshire fundholders are analysed, and comparisons are made between this group, non-fundholders and the fundholders of the earlier waves. RESULTS: In their first year of fundholding, fourth-wave practices adopted the prescribing strategies employed previously by existing fundholders, namely, reductions in the number of items prescribed per patient and substantial increases in generic prescribing. The hypothesis that prospective fundholders inflate their prescribing budget before attaining fundholding status is not generally supported by the Lincolnshire data. Evidence is presented which suggests that the prescribing cost economies accruing to fundholding status may be short term. CONCLUSIONS: With the acquisition of fundholding status, the structure of incentives facing practices changes. Our results suggest that, with respect to prescribing, practices adjust rapidly to the new incentive structure.

Drug Costs↗
PubMed1997

Interferon-beta in multiple sclerosis. Can we control its costs?

The recent licensing of interferon-beta for use in patients with multiple sclerosis has caused concern, in view of the equivocal evidence of efficacy, pressure of public expectation towards its use and the high expected cost if widespread use were to be sanctioned. Whether such alarm is justified remains a moot point. Owing to the limited range of circumstances of proven efficacy and the lack of cost-effectiveness data, it remains unclear whether sanctioned usage will proliferate to the anticipated extent. Unit costs may well fall in the future owing to competition in the pharmaceutical market. Interferon-beta is simply one example of a growing trend in actively promoted high-cost preparations over which rationing decisions will have to be reached.

Cost-Benefit Analysis↗
PubMed1997

General practitioner fundholding and prescribing expenditure control. Evidence from a rural English health authority.

In April 1991, the fundholding and indicative prescribing schemes introduced budgets for expenditure on prescribed drugs into UK general practice. Although both schemes were designed to be equally effective at containing prescribing-cost inflation, several studies suggest that expenditure growth has been lower in fundholding practices, compared with nonfundholding practices. This study attempts to ascertain how fundholding practices control their expenditure by examining data from a rural English health authority for the financial year 1993 to 1994. The fundholding practices sampled were found to control their expenditure through: (i) reduced overprescribing; (ii) using fewer drugs that have limited clinical value; (iii) substituting similar, but less expensive, drugs; (iv) more generic prescribing; and (v) appropriate use of expensive preparations. However, whether the cost differential between fundholding and nonfundholding practices is sustained in future years will depend upon: (i) the ability of fundholding practices to generate further savings; (ii) the characteristics of the practices that enter the fundholding scheme in subsequent waves; (iii) the way in which the scheme is organised; and (iv) the level at which budgets are set.

Cost Control↗
PubMed1997

GP fundholding and prescribing in UK general practice: evidence from two rural, English Family Health Services Authorities.

BACKGROUND: Two separate prescribing budget regimes (part of GP fundholding and the indicative prescribing scheme) were introduced into UK general practice in April 1991 in an attempt to contain the growth in NHS expenditure on prescribed drugs. OBJECTIVES: The aims of this study are (i) to examine whether the fundholding scheme has been more effective at containing prescribing cost growth than the indicative prescribing scheme and (ii) to ascertain whether its implementation, at a practice level, has been affected by local circumstances and conditions. METHODS: Prescribing cost data were collected from two rural, English Family Health Services Authorities for the financial years 1990/1991 to 1993/1994. Exploratory analysis was performed using regression analysis and nonparametric statistical techniques. RESULTS AND CONCLUSIONS: Initially, the fundholding scheme has been the more effective at containing expenditure on prescribed drugs. However, the implementation of the schemes in rural areas has probably been affected by the existence of practices with permission to dispense drugs to their own patients, due to a lack of pharmacies in such areas.

Aged↗
PubMed1996

The costs of prescribing in dispensing practices.

The existence of significant disparities between the prescribing costs of dispensing and non-dispensing general practices has long been suspected, and received confirmation in a study of Lincolnshire, based on data for 1990-91. This study subsequently attracted much criticism. In this paper, we extend the analysis by considering annual cost and other prescribing data for Lincolnshire for the years between and including 1990-91 and 1993-94, in the light of the prescribing criteria developed by the Audit Commission. Our results show that dispensing practices had higher prescribing costs per patient for all the years analysed. In 1993-94, dispensing practices prescribed more items per patient (fewer of them generically) and were less capable of remaining within their prescribing budgets. The essential difference in prescribing costs lies in the area defined by the Audit Commission as 'core prescribing'. Using the Audit Commission's criteria for 'rational' prescribing, dispensing practices could make a significantly higher level of savings than non-dispensing practices. The findings lend support to the hypothesis advanced in the earlier analysis, namely, that the higher costs of prescribing in dispensing practices are accounted for primarily by management practice and the structure of incentives.

Drug Costs↗
PubMed1995

Hospital costs of treating haemophilic patients infected with HIV.

OBJECTIVE: To calculate the costs of treating HIV-infected haemophilic patients. DESIGN: Two-year retrospective study of hospital-based resource use and costs, from April 1991 to March 1993. SETTING: Haemophilia Centre and Haemostasis Unit, Royal Free Hospital and School of Medicine, London, UK. PATIENTS: Sixty patients infected with HIV between October 1979 and July 1985. RESULTS: During the 2-year period a total of 1668 hospital visits were made by patients. The mean number of episodes per patient-year (PY) was 0.6 inpatient admissions, 11.5 outpatient visits and 1.8 day cases. The mean cost per PY was 32,528 pounds, with the majority of this spent on clotting factor concentrate products and haemophilia inpatient admissions (81%). A mean cost for HIV-related treatment of 6050 pounds was estimated. The additional cost incurred in switching this group of haemophilic patients from intermediate-purity factor concentrate to high-purity products was 8614 pounds per PY. When clotting factor concentrate and expenditure on haemophilia-related inpatient admissions were excluded, the mean cost of treating HIV infection per PY was 6065 pounds, varying with CD4+ count (< or = 50 x 10(6)/l, 13,093 pounds; 51-200 x 10(6)/l, 6521 pounds; 201-500 x 10(6)/l, 2848 pounds; > 501 x 10(6)/l, 1497 pounds). CONCLUSIONS: CD4+ count may be used as a marker of costs of HIV infection. The HIV-related cost estimates can be used for the planning of current and future hospital-based care in the National Health Service in the United Kingdom. The switch from intermediate-purity factor concentrate to high-purity products has increased the mean HIV-related cost per PY of treating haemophilic patients infected with HIV.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Financing the rising cost of haemophilia care at a large comprehensive care centre.

Haemophilia affects 1 in every 6,000 males. Patients with haemophilia A receive treatment with factor VIII (FVIII) and those with haemophilia B receive factor IX (FIX). In the UK, patients receive their treatment from comprehensive care centres (CCCs) or haemophilia centres. Over the last two decades the amount of clotting factor used per patient has increased; the quality of the clotting factors available and the methods of administration have also improved. As a consequence, the cost of providing care has increased substantially. In theory, the nature and level of haemophilia treatment is specified in contracts between purchasers and providers, ensuring that the costs of treating patients are fully recovered. However, at our large CCC, which has 1,700 registered patients with inherited bleeding disorders, the costs of care regularly exceed contract revenue. This paper describes the cost pressures and difficulties faced by a North London Trust in an attempt to maintain, and in some instances improve, the services provided within its CCC.

Factor IX↗