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Martin J Buxton

Publications and source records attributed to Martin J Buxton.

16 recordsLinked to original sources
PubMed2007

The information sources and journals consulted or read by UK paediatricians to inform their clinical practice and those which they consider important: a questionnaire survey.

BACKGROUND: Implementation of health research findings is important for medicine to be evidence-based. Previous studies have found variation in the information sources thought to be of greatest importance to clinicians but publication in peer-reviewed journals is the traditional route for dissemination of research findings. There is debate about whether the impact made on clinicians should be considered as part of the evaluation of research outputs. We aimed to determine first which information sources are generally most consulted by paediatricians to inform their clinical practice, and which sources they considered most important, and second, how many and which peer-reviewed journals they read. METHODS: We inquired, by questionnaire survey, about the information sources and academic journals that UK medical paediatric specialists generally consulted, attended or read and considered important to their clinical practice. RESULTS: The same three information sources--professional meetings & conferences, peer-reviewed journals and medical colleagues--were, overall, the most consulted or attended and ranked the most important. No one information source was found to be of greatest importance to all groups of paediatricians. Journals were widely read by all groups, but the proportion ranking them first in importance as an information source ranged from 10% to 46%. The number of journals read varied between the groups, but Archives of Disease in Childhood and BMJ were the most read journals in all groups. Six out of the seven journals previously identified as containing best paediatric evidence are the most widely read overall by UK paediatricians, however, only the two most prominent are widely read by those based in the community. CONCLUSION: No one information source is dominant, therefore a variety of approaches to Continuing Professional Development and the dissemination of research findings to paediatricians should be used. Journals are an important information source. A small number of key ones can be identified and such analysis could provide valuable additional input into the evaluation of clinical research outputs.

Adult↗
PubMed2006

An economic evaluation of pediatric small bowel transplantation in the United Kingdom.

BACKGROUND: Small bowel transplantation (SBTx) offers an alternative to parenteral nutrition (PN) for the treatment of chronic intestinal failure in children: this study estimated its cost-effectiveness in the early phase of a U.K. program. METHODS: Children assessed for SBTx were categorized as: 1) requiring SBTx following PN-related complications (n=23), 2) stable at home not requiring SBTx (n=24), and 3) terminally ill and unsuitable for SBTx (n=6). Costs were estimated from detailed resource-use data. Two comparisons were used for effectiveness: actual survival following transplantation (n=14) compared to: 1) estimated survival without transplantation using a prognostic model, and 2) the waiting list experiences of all patients listed for SBTx (n=23). RESULTS: Mean costs up to 30 months were pounds sterling 207,000 for those transplanted or on the waiting list, pounds sterling 159,000 for those stable on home PN, and pounds sterling 56,000 for those terminally ill. The prognostic model estimated a mean survival gain from transplantation of 0.12 years over 30 months, and suggested that transplantation was cost-saving. The second approach suggested that transplantation reduced survival by 0.24 years at an additional cost of pounds sterling 131,000. CONCLUSIONS: Firm conclusions on cost-effectiveness of SBTx are not possible given the two different estimates. The prognostic model approach (suggesting that pediatric SBTx may provide a small survival benefit at a small reduction in costs) should be less subject to bias, but the model requires external validation. Meanwhile, children at risk of fatal PN-complications should be given the opportunity to receive a SBTx only within a continuing formal assessment of the technology.

Child↗
PubMed2006

The journals of importance to UK clinicians: a questionnaire survey of surgeons.

BACKGROUND: Peer-reviewed journals are seen as a major vehicle in the transmission of research findings to clinicians. Perspectives on the importance of individual journals vary and the use of impact factors to assess research is criticised. Other surveys of clinicians suggest a few key journals within a specialty, and sub-specialties, are widely read. Journals with high impact factors are not always widely read or perceived as important. In order to determine whether UK surgeons consider peer-reviewed journals to be important information sources and which journals they read and consider important to inform their clinical practice, we conducted a postal questionnaire survey and then compared the findings with those from a survey of US surgeons. METHODS: A questionnaire survey sent to 2,660 UK surgeons asked which information sources they considered to be important and which peer-reviewed journals they read, and perceived as important, to inform their clinical practice. Comparisons were made with numbers of UK NHS-funded surgery publications, journal impact factors and other similar surveys. RESULTS: Peer-reviewed journals were considered to be the second most important information source for UK surgeons. A mode of four journals read was found with academics reading more than non-academics. Two journals, the BMJ and the Annals of the Royal College of Surgeons of England, are prominent across all sub-specialties and others within sub-specialties. The British Journal of Surgery plays a key role within three sub-specialties. UK journals are generally preferred and readership patterns are influenced by membership journals. Some of the journals viewed by surgeons as being most important, for example the Annals of the Royal College of Surgeons of England, do not have high impact factors. CONCLUSION: Combining the findings from this study with comparable studies highlights the importance of national journals and of membership journals. Our study also illustrates the complexity of the link between the impact factors of journals and the importance of the journals to clinicians. This analysis potentially provides an additional basis on which to assess the role of different journals, and the published output from research.

Attitude of Health Personnel↗
PubMed2006

Economic evaluation and decision making in the UK.

This article reviews the development of economic evaluation of health technologies in the UK and its impact on decision making. After a long period of limited impact from studies mainly carried out as academic exercises, the advent of the National Institute for Health and Clinical Excellence (NICE) in 1999 provided a transparent decision-making context where economic evaluation plays a central role. This article reviews some of the key characteristics about the way NICE works, for example, the way NICE has defined the form of analysis that it requires, reflecting its objective of maximising health gain (QALYs) from the predetermined and limited UK NHS budget. Two broad areas of widespread concern are noted. The first relates to the cost-effectiveness thresholds that NICE uses and the basis for them. The second is the patchy implementation of NICE guidance and the possible reasons for this. But even within the UK, NICE is the exception in making extensive and explicit use of economic evaluation and this article goes on to suggest that if there is to be a more widespread and consistent use of economic evaluation at both central and local levels, then health economists and others need to address three issues. The first is to be clear about what is the correct conceptual basis for determining the cost-effectiveness threshold and then to ensure that NICE has the empirical evidence to set it appropriately. The second is to recognise that even using the limited view of costs adopted by NICE, economic evaluations imply temporal and cross-service budgetary flexibility that the NHS locally does not in practice enjoy. The third issue is that with academic pressures for ever-increasing sophistication of 'state of the art' economic evaluation analysis, the NHS has more and more precise understanding of the cost effectiveness of just a few new technologies and little or no analysis of most. This limits the value of the former by reducing further the scope for appropriately disinvesting from cost-ineffective technologies to meet the additional costs of investing in cost-effective new ones. Whilst NICE stands out as an example of a context where high-quality economic evaluation plays a major role in decision making, the process is far from perfect and certainly is not representative of the use made of economic evaluation by the NHS as a whole. Health economists need to engage with the public and the health service to better understand their perspectives, rather than focusing on academic concerns relating to details of theory and analytical method.

Cost-Benefit Analysis↗
PubMed2005

Global IDEA.

Explore the source record for details and available documents.

Communicable Diseases↗
PubMed2005

Estimating utility data from clinical indicators for patients with stable angina.

This study estimated a model from which data routinely collected in clinical trials of angina patients can be mapped to a utility scale and used to estimate quality-adjusted life years (QALYs). Patients with stable angina attending four cardiac out-patient clinics in the UK were included in the study. Data collected included information on patients' health-related quality of life (HRQL) using the EQ-5D, and severity of angina symptoms using two cardiac-specific measures [Breathlessness Grade and Canadian Cardiovascular Society (CCS) classification of angina]. Regression analysis was used to predict EQ-5D index values from the data. Data were obtained from 510 patients. For CCS grades, mean EQ-5D scores ranged from 0.36 (95% confidence interval 0.25-0.48) for grade 4 to 0.81 (0.77-0.85) for grade 0, and for breathlessness grades, EQ-5D scores ranged from 0.31 (0.06-0.55) for grade 0 to 0.84 (0.79-0.88) for grade 5. The final model used data on CCS grades, breathlessness grades, and patients' current medications to predict EQ-5D scores. The model had an R2 value of 0.37, and predictions for less severe angina were considered more reliable than the estimates for severe angina. In the absence of utility data collected as part of a clinical trial it is possible to map HRQL utility data from samples of patients with similar characteristics to those in the original trial. The uncertainty surrounding the estimates should be considered when using the results to estimate QALYs for purposes of economic evaluation.

Adult↗
PubMed2005

Trial-based cost-utility comparison of percutaneous myocardial laser revascularisation and continued medical therapy for treatment of refractory angina pectoris.

This study examined from a health service perspective whether percutaneous myocardial laser revascularisation (PMR) plus standard medical management is cost-effective when compared with standard medical management alone in the treatment of refractory angina. This involved a cost-utility analysis using patient-specific data from a single-centre, randomised, controlled trial carried out in the United Kingdom. Of 73 patients diagnosed as having refractory angina and not suitable for conventional forms of revascularisation, 36 were randomised to PMR plus medical management and 37 to medical management alone. We collected costs to the health service of PMR and all secondary sector health care contacts and cardiac-related medication in the 12 months following randomisation. Patient utility, measured using the EuroQol EQ-5D questionnaire, was combined with 12-month survival data to generate quality-adjusted life years (QALYs). The mean 12-month cost per patient for PMR was 8,307 pounds, and that for medical management was 1,888 pounds, giving a cost difference of 6,410 pounds. The mean QALY difference favoured PMR at 0.126, giving an incremental cost per QALY of 50,873 pounds. The cost-effectiveness acceptability curve indicates that the probability of PMR being cost-effective over the first 12 months is quite low. Whilst a longer period of follow-up might indicate continued benefit from PMR, which would make the intervention economically more attractive, PMR could not be considered cost-effective based on 1-year follow-up data.

Angina Pectoris↗
PubMed2004

Proposed methods for reviewing the outcomes of health research: the impact of funding by the UK's 'Arthritis Research Campaign'

BACKGROUND: External and internal factors are increasingly encouraging research funding bodies to demonstrate the outcomes of their research. Traditional methods of assessing research are still important, but can be merged into broader multi-dimensional categorisations of research benefits. The onus has hitherto been on public sector funding bodies, but in the UK the role of medical charities in funding research is particularly important and the Arthritis Research Campaign, the leading medical charity in its field in the UK, commissioned a study to identify the outcomes from research that it funds. This article describes the methods to be used. METHODS: A case study approach will enable narratives to be told, illuminating how research funded in the early 1990s was (or was not) translated into practice. Each study will be organised using a common structure, which, with careful selection of cases, should enable cross-case analysis to illustrate the strengths of different modes and categories of research. Three main interdependent methods will be used: documentary and literature review; semi-structured interviews; and bibliometric analysis. The evaluative framework for organising the studies was previously used for assessing the benefits from health services research. Here, it has been specifically amended for a medical charity that funds a wide range of research and is concerned to develop the careers of researchers. It was further refined in three pilot studies. The framework has two main elements. First, a multi-dimensional categorisation of benefits going from the knowledge produced in peer reviewed journal articles through to the health and potential economic gain. The second element is a logic model, which, with various stages, should provide a way of organising the studies. The stock of knowledge is important: much research, especially basic, will feed into it and influence further research rather than directly lead to health gains. The cross-case analysis will look for factors associated with outcomes. CONCLUSIONS: The pilots confirmed the applicability of the methods for a full study which should assist the Arthritis Research Campaign to demonstrate the outcomes from its funding, and provide it with evidence to inform its own policies.

Journal Article↗
PubMed2004

Women and health care professionals' preferences for Down's Syndrome screening tests: a conjoint analysis study.

OBJECTIVE: To describe and compare women and health care professionals' preferences for Down's Syndrome screening tests with different test characteristics. DESIGN: Cross sectional questionnaire based conjoint analysis study. SETTING: London teaching hospital. SAMPLE: 291/383 women in their first or second trimester of pregnancy and 98/122 health care professionals (41 obstetricians, senior house officers and above and 57 qualified midwives) providing care at the same hospital. METHODS: Women completed a questionnaire while attending a clinic visit for a dating scan or a routine 20-week anomaly scan. Health care professionals completed a postal questionnaire. MAIN OUTCOME MEASURES: The relative values participants attach to Down's Syndrome screening test attributes: time of test, detection rate and risk of miscarriage of a baby unaffected by Down's Syndrome as a result of subsequent diagnostic tests. RESULTS: Pregnant women and health care professionals shared broadly similar relative values regarding the importance of safe tests, conducted early and with high detection rates. When asked to choose between different Down's Syndrome screening tests, health care professionals valued earlier tests more highly than did women. CONCLUSIONS: While pregnant women and health care professionals share similar relative values regarding optimal prenatal tests, health care professionals place a higher value on earlier tests. This may result in screening policies that overweight timing in the selection of a test to the relative neglect of tests associated with lower miscarriage rates and higher detection rates but conducted later in pregnancy.

Adult↗
PubMed2003

Survival gain after liver transplantation for patients with alcoholic liver disease: a comparison across models and centers.

BACKGROUND: Prognostic models, which estimate survival probabilities, enable the survival benefit from a procedure to be assessed and allow the comparison of outcomes between centers. We therefore compared three models that estimate survival in the absence of transplantation for patients with alcoholic liver disease (ALD) to assess survival benefit after transplantation and to compare the outcomes in the six liver-transplant centers in England. METHODS: The Béclére and Birmingham models and the Model for End-Stage Liver Disease (MELD) were used to estimate survival in the absence of transplantation in a cohort of 82 patients with end-stage ALD. Posttransplant survival in the same cohort of patients was calculated using conventional survival techniques. Each individual's short-term survival gain after liver transplantation was also calculated and compared across UK liver transplant centers. RESULTS: The expected gain in survival differed substantially depending on the model used. Over the 4-year study period, the survival gain for all ALD patients was 1.70 years (95% confidence interval [CI] 1.37-2.03) using the Béclére model, 0.95 years (CI 0.60-1.30) using MELD, and 0.08 years (CI -0.31-0.47) using the Birmingham model. Two centers consistently had greater estimated survival gains up to 4 years postliver transplant regardless of the model used to estimate nontransplant survival. CONCLUSIONS: These findings suggest that although liver transplantation is associated with an improvement in survival, the gain over 4 years is modest. The three models are poorly correlated and should be applied with caution. Survival gain does, however, appear to vary between centers.

Bilirubin↗
PubMed2003

The utilisation of health research in policy-making: concepts, examples and methods of assessment.

The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions.The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation.Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation.Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis.Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies.

Journal Article↗
PubMed2003

Stratified cost-effectiveness analysis: a framework for establishing efficient limited use criteria.

The cost-effectiveness of new health care technologies is conditional upon who receives what therapy and under what circumstances. Understanding this heterogeneity in cost-effectiveness, health care payers often limit reimbursement of therapies to a more restrictive sub-group of patients than that indicated in a product's licensing. Such limits may be based upon clinical or demographic criteria that are prognostic of costs, outcomes or both. However, there is little guidance on how to estimate and interpret stratified cost-effectiveness analysis. In this paper we present a framework for estimating the benefits from stratification that permits consideration of both the opportunity cost resulting from a lack of adherence with criteria and the efficiency loss associated with incorporating equity concerns.

Cost-Benefit Analysis↗
PubMed2003

Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups.

Liver transplantation has never been the subject of a randomized controlled trial, and there remains uncertainty about the magnitude of benefit and cost-effectiveness for specific patient groups. This article reports the results of an economic evaluation of adult liver transplantation in England and Wales. Patients placed on the waiting list for a liver transplant were observed over 27 months. The costs and health benefits of a comparison group, representing experience in the absence of liver transplantation, were estimated using a combination of observed data from patients waiting for a transplant and published prognostic models. The analysis focuses on three disease groups, for each of which prognostic models were available: primary biliary cirrhosis (PBC), alcoholic liver disease (ALD), and primary sclerosing cholangitis (PSC). A higher proportion of patients with ALD were assessed for a transplant but not placed on the waiting list. The estimated gain in quality-adjusted life-years from transplantation was positive for each of the disease groups. The mean incremental cost per quality-adjusted life-year (95% bootstrap confidence intervals) from time of listing to 27 months for patients with PBC, ALD, and PSC are pound 29,000 (pounds 1,000 to pounds 59,000), pounds 48,000 (pounds 12,000 to pounds 83,000) and pounds 21,000 (-pounds 23,000 to pounds 60,000), respectively. In conclusion, liver transplantation increases the survival and health-related quality of life of patients with each of three end-stage liver diseases. However, the extent of this increase differs between different disease groups. Cost-effectiveness estimates were poorer for patients with ALD over the 27-month period than for patients with PBC or PSC. This in part reflects the costs of the higher number of ALD patients assessed for each transplant.

Adolescent↗
PubMed2003

Measures of importance for economic analysis based on decision modeling.

In probabilistic economic analysis, the uncertainty concerning input parameters is quantified, and determines the level of uncertainty over the optimal decision. Researchers from a wide range of disciplines employ mathematical models to simulate complex processes. Common through many such disciplines is the conduct of importance analysis to determine those input parameters that contribute most to the uncertainty over the optimal decision based on the results of the analysis. In this study, we compare a range of potential importance measures to see how they compare with methods used in economic analysis. Techniques were classified as variance/correlation, information, probability, entropy, or elasticity-based measures. A selection of the most commonly used measures were applied to an economic model of treatment for patients with Parkinson's disease. Techniques were evaluated in terms of their ranking of variables, complexity, and interpretation.

Cost-Benefit Analysis↗