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Biomedical subjects

Maurice McGregor

Publications and source records attributed to Maurice McGregor.

12 recordsLinked to original sources
PubMed2006

QALYs: are they helpful to decision makers?

The QALY is the product of life expectancy (estimated in years) and its quality over that time (estimated in utilities or QOL units). It theoretically enables direct comparison of the costs of obtaining different health outcomes through cost utility analysis (CUA). In this review, we argue that, at present, the problems related to the use of utilities preclude the use of cost per QALY as a major determinant of policy decisions on the acquisition and use of health technologies. Those who use CUA can be divided into (i) those who inform the process of decision making through CUA and (ii) those who make the decisions. The former have no direct budgetary responsibility for the decisions that are taken, while the decision makers must pay for those decisions from their budgets. Use of CUA rests on the assumption that all QALYs are of equivalent value in the eyes of society. However, the value accorded to them varies with circumstances. The utilities or QOL indices required to compute QALYs can be measured in different ways, which give different answers, and have been shown to be unreliable. Thus, the QALY is not sufficiently accurate or reliable to be used by decision makers as a basis for comparison of the costs of different technologies. Until the theoretical and practical problems of determining health preferences are resolved and the methods of their measurement are standardised, it is necessary to estimate the cost effectiveness of health interventions by relating their cost to their primary health outcomes.

Cost-Benefit Analysis↗
PubMed2005

Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review.

BACKGROUND: The recent increase in the number and severity of cases of nosocomial Clostridium difficile-associated diarrhea (CDAD) has prompted interest in the use of probiotics for the prevention and treatment of this disease. We performed a systematic review of randomized controlled trials to assess the effectiveness of probiotic therapy. METHODS: We searched the PubMed, EMBASE, INAHTA, HEN and Cochrane Collaboration databases to identify trials in which the prevention or treatment of CDAD with probiotic therapy was the primary or secondary outcome. We extracted data on the number of patients randomly assigned to receive probiotic or placebo, the number of patients with CDAD, the type of probiotic, criteria for diagnosing CDAD, persistence of infection after treatment, compliance and adverse effects. RESULTS: We identified 4 eligible studies in which prevention (n = 1) or treatment (n = 3) of CDAD was the primary outcome. The benefit of probiotic therapy seen in 2 of the studies was restricted to subgroups characterized by severe CDAD and increased use of vancomycin. The remaining 2 studies were too methodologically flawed for us to draw meaningful conclusions. We also identified 4 trials in which prevention of antibiotic-associated diarrhea with probiotics was the primary outcome and prevention of CDAD a secondary outcome. These studies were limited primarily by too few CDAD cases and provided no evidence of effective prophylaxis. Overall, heterogeneity in choice and dose of probiotic and in criteria for diagnosing CDAD makes it difficult to synthesize information from the 8 studies. INTERPRETATION: Studies conducted to date provide insufficient evidence for the routine clinical use of probiotics to prevent or treat CDAD. Better designed and larger studies are needed.

Clostridioides difficile↗
PubMed2005

End-user involvement in health technology assessment (HTA) development: a way to increase impact.

OBJECTIVES: A mechanism to increase the influence of Health Technology Assessments (HTAs) on hospital policy decisions was developed. METHODS: We describe the process and results of an experiment in which a local in-hospital HTA unit was created to provide sound evidence on technology acquisition issues, and to formulate locally appropriate policy recommendations. The Unit consists of a small technical staff that accesses and synthesizes the evidence incorporating local health and economic data, and a Policy Committee that develops policy recommendations based on this evidence. It represents administration, health-care professionals, patients, and representatives of the clinical disciplines affected by each issue. The level of success of the Unit was independently evaluated. RESULTS: To date, 16 reports have been completed, each within 2-4 months. Five recommended unrestricted use, seven recommended rejection, and four recommended very limited use of the technology in question. All have been incorporated into hospital policy. Budget impact is estimated at approximately 3 million dollars of savings per year. CONCLUSIONS: This local in-house HTA agency has had a major impact on the adoption of new technology. Probable reasons for success are (i) relevance (selection of topics by administration with on-site production of HTAs allowing them to incorporate local data and reflect local needs), (ii) timeliness, and (iii) formulation of policy reflecting community values by a local representative committee. Because over one third of all health-care costs are incurred in the hospital, diffusion of this model could have a significant effect on the quantity and quality of health-care spending.

Budgets↗
PubMed2004

Should the implantable cardiac defibrillator be used for primary prevention of sudden death? A review of the issues relevant to hospital decision making.

BACKGROUND: New evidence suggests that the implantable cardiac defibrillator (ICD) may be effective for primary prevention of sudden death. High instrumental cost and the potentially large number of candidates will significantly impact hospital budgets. OBJECTIVE: To review the information relevant to hospital policy decisions on the use of ICDs for primary prevention. METHODS: Modelling based on an evaluation of reported studies and Canadian costs, detailed in a comprehensive review available at . RESULTS: Health outcomes: Two high-quality primary prevention trials suggest a reduction in annual mortality of 2.9% with bounds of probability (PB) of 2.0% to 3.8%, in early years. To undertake 100 implants per year may result in an increasing annual saving of life-years of acceptable quality, stabilizing by 15 years at 110 (PB 72 to 154) each year. Economic impact: The annual costs would stabilize at 15 years at approximately 4.3 million dollars. Cost-effectiveness: The incremental cost-effectiveness from the point of view of the health care system would be approximately 47,000 dollars (PB 35,000 dollars to 70,000 dollars), discounted at 3%. Ethical and legal issues: The decision should not be individual but institutional, using a process that is transparent, consistent and fair. CONCLUSIONS: The ICD can prolong life, with acceptable quality. Restriction of its use would be solely on grounds of expense.

Budgets↗
PubMed2002

The academic prince.

The author presents advice to deans and chairs of academia by imagining what Machiavelli might recommend were he to write a modern version of The Prince for academics. "Machiavelli" cautions that since modern academic "princes" have little power (except, perhaps, over teaching and laboratory space), the success of their rule depends upon respect. Regarding the choice of an academic prince, find someone who can be a good role model, set standards, and reward academic excellence, and who will, above all, be respected. Avoid choosing a prince who is a nice, nonthreatening candidate with "good human relations" and "good executive skills." Choose candidates who are already successful and fulfilled and who will see the new post not as a promotion or a balm for their insecurity, but as an intrusion into their academic lives. Fill empty positions as quickly as possible-better a weak prince than no prince at all. Seek short terms for princes, both because respected academics will want to return to their normal lives as soon as possible, and because with short mandates, greater chances can be taken with young, unproved, but promising candidates. At the same time, the appointment of aging administrators who have lost their academic skills is to be avoided. Above all, respect the throne-i.e., the position of chair or dean-even if the person holding the position may not deserve the respect, since when the prince retires with honor, the position becomes more attractive to future good candidates.

Career Choice↗