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Nick Bosanquet

Publications and source records attributed to Nick Bosanquet.

12 recordsLinked to original sources
PubMed2004

The economics of cancer care in the UK.

Cancer care accounts for an increasing proportion of global spending on healthcare, driven by an increased incidence caused by ageing populations, greater frequency from better treatments, and changes in care that have made cancer a chronic, controllable illness. The cost of cancer care has three components: direct and easily determined clinical costs (ie, medical costs); extra financial requirement of living with disease for the patient and their family (ie, morbidity costs); and loss of income from the premature death (ie, mortality costs). Effective planning of cancer services needs detailed consideration of the economics of care delivery-an area of research that has so far been lacking outside the USA. Here, we review the literature and attempt to answer key questions on the economics of cancer care, including probable changes in disease burden over the next 20 years, changes in the way costs will be distributed between carers and delivery services, changing patterns of service delivery, and the direct contribution patients will make to treatment costs in terms of co-payments and escalating costs of comorbidity in elderly populations.

Adult↗
PubMed2004

Cost-effectiveness: seeking value for money in lower extremity wound management.

This article discusses the different methods of evaluating cost in relation to the outcomes of treatment, and reviews the evidence of cost-effectiveness (CE) in the management of chronic leg ulceration. In essence, the CE argument revolves around the need to demonstrate outcomes of treatment in relation to particular levels of financial input by the health providers. High CE allows for either the same number of patients to be treated more efficiently (at a lower cost) or more patients to be treated for the same financial input. A review of medical and nursing databases (Medline, Embase, and Cinahl) identified studies of CE of dressing materials (n = 8), use of compression therapy (n = 4), and other treatments (n = 2). In addition, 5 research groups have undertaken studies to evaluate the relative CE of different systems of care. Overall conclusions are that modern wound dressings provide a more cost-effective alternative to saline gauze, whereas the evidence relating to the use of tissue-engineered skin is less clear. The use of compression bandaging is substantially more cost-effective when compared with a system of care where compression is not systematically offered. The systems that offer compression are not only cost-effective but also lead to reductions in absolute cost. The evaluation of CE is likely to become an ever-increasing part of wound care evaluation as we strive to achieve greater efficiency in the use of scarce health resources.

Journal Article↗
PubMed2004

Impact on society.

Explore the source record for details and available documents.

Cost of Illness↗
PubMed2003

NICE reports. NICE to see you....

NICE has published 62 technology appraisal reports in three years. Many reports refer to complex, specialist topics and affect only small numbers of patients. Some opportunities to give clear guidelines have been missed. There is scope for reports designed to maximise existing NHS resources and to assess the role of prevention, care integration and other ways to cut long-term costs.

Academies and Institutes↗
PubMed2003

Treatment of anaemia in cancer patients: implications for supportive care in the National Health Service Cancer Plan.

The National Health Service (NHS) Cancer Plan published in 2000 has a short-term focus on the most pressing problems of improving survival rates and replacing equipment. It also mentioned as a target 'improved quality of life for those affected by cancer'. Continuity of care for longer-term care programmes was seen predominantly in terms of palliative care. Recent National Institute for Clinical Excellence (NICE) reports may have reinforced this approach by focussing on the clinical and cost effectiveness of chemotherapy for late-stage cancer. The impact on local decision-makers has been that drug funds have been prioritised for use on survival-enhancing interventions, with few resources left for short and longer-term supportive care targeted primarily on improving quality of life. Within supportive care, resources are particularly limited for funding treatments such as erythropoietin for the management of cancer-related anaemia, a common and very debilitating side-effect of intensive therapy. The need for a re-focusing on supportive care is associated with cancer becoming, in many instances, a longer-term illness. The prevalence of cancer is rising markedly due to increased survival rates. However, this creates a new challenge of reducing disability and improving quality of life. In surveys, patients have rated fatigue associated with anaemia as one of the most debilitating effects of their cancer and its treatment with chemotherapy. This paper reviews the evidence demonstrating the quality of life benefits of erythropoietin, and then considers the policy constraints that have limited the adoption of this treatment within the NHS. Through co-ordinated planning there are opportunities for cancer networks and primary care trusts (PCTs) working with cancer centres to develop more support in ways which are feasible and fundable. The case is argued that PCTs and cancer networks, in implementing the Cancer Plan locally, need to integrate short- and longer-term supportive care into their cancer service development plans, and recognise the importance of anaemia management as an integral part of this. Lessons can be learnt from UK renal services where anaemia management with erythropoietin is standard practice.

Anemia↗
PubMed2003

Modern dressings: healing surgical wounds by secondary intention.

There is a lack of robust research evidence on many aspects of wound care. The inaugural Professional Select Committee on Wound Care, held at the Royal College of Surgeons, explored the relative value of modern and traditional dressings in treating wounds healing by secondary intention. This article outlines its main findings.

Bandages↗
PubMed2003

Costs and cost effectiveness of low molecular weight heparins and platelet glycoprotein IIb/IIIa inhibitors: in the management of acute coronary syndromes.

The most well established antithrombotic treatment for acute coronary syndromes (ACS) is unfractionated heparin (UFH) plus aspirin, but such treatment may not prevent arterial thrombotic events. Low molecular weight heparins (LMWHs) and platelet glycoprotein (GP) IIb/IIIa inhibitors offer alternative or adjunctive treatments. However, before these alternatives with higher acquisition costs are accepted in today's healthcare systems, their cost effectiveness must be proven. This paper reviews international pharmacoeconomic studies on the use of LMWHs and GP IIb/IIIa inhibitors in patients with ACS in an attempt to determine whether these therapies are cost effective. Most of the studies on LMWHs have been cost-minimisation analyses and have focused on enoxaparin sodium, because this is the only LMWH proven to be superior to UFH. Several analyses show that, compared with UFH plus aspirin, enoxaparin sodium provides cost savings both during hospitalisation (30 days) and 1-year follow-up. These cost savings are mainly attributable to fewer cardiac interventions, shorter hospital stays and lower administrative costs. Indeed, the clinical and economic advantages of enoxaparin sodium have led to its recommendation in recent guidelines as the antithrombotic agent of choice for coronary artery disease. Most of the economic analyses of GP IIb/IIIa inhibitors have been cost-effectiveness analyses. Such analyses indicate that the high acquisition costs of these drugs may be at least partially offset by reductions in other costs if a noninvasive approach to risk stratification is used. Furthermore, use of GP IIb/IIIa inhibitors appears to give favourable cost-effectiveness ratios compared with other accepted therapies, such as fibrin-specific thrombolytic therapy, in the cardiovascular field, particularly in high-risk patients and those undergoing percutaneous coronary intervention. However, more comprehensive economic data on the GP IIb/IIIa inhibitors are needed.

Acute Disease↗
PubMedDate not supplied

Increasing capacity for innovation in bureaucratic primary care organizations: a whole system participatory action research project.

PURPOSE: We wanted to identify what organizational features support innovation in Primary Care Groups (PCGs). METHODS: Our study used a whole system participatory action research model. Four research teams provided complementary insights. Four case study PCGs were analyzed. Two had an intervention to help local facilitators reflect on their work. Data included 70 key informant interviews, observations of clinical governance interventions and committee meetings, analysis of written materials, surveys and telephone interviews of London Primary Care Organizations, interviews with 20 nurses, and interviews with 6 finance directors. A broad range of stakeholders reviewed data at annual conferences and formed conclusions about trustworthy principles. Sequential research phases were refocused in the light of these conclusions and in response to the changing political context. RESULTS: Five features were associated with increased organizational capacity for innovation: (1) clear structures and a vision for corporate and clinical governance; (2) multiple opportunities for people to reflect and learn at all levels of the organization, and connections between these "learning spaces"; (3) both clinicians and managers in leadership roles that encourage participation; (4) the right timing for an initiative and its adaptation to the local context; and (5) external facilitation that provides opportunities for people to make sense of their experiences. Low morale was commonly attributed to 3 features: (1) overwhelming pace of reform, (2) inadequate staff experience and supportive infrastructure, and (3) financial deficits. CONCLUSIONS: These features together may support innovation in other primary care bureaucracies. The research methodology enabled people from different backgrounds to make sense of diverse research insights.

Group Practice↗