Publications (6)19.65 Total impact
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Article: A comparison of the resources used in advanced cancer care between two different strong opioids: an analysis of naturalistic practice in the UK.
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ABSTRACT: To assess the resource implications of using strong opioids in patients with advanced cancer in the UK, based on naturalistic practice, in order to develop the evidence base supporting better management. A modelling study performed from the perspective of the UK's National Health Service (NHS). Study participants and interventions: A data set was created from the DIN-link database comprising 986 patients with advanced cancer who were prescribed either 12-hourly sustained release morphine (SR morphine; MST Continuous) ( n = 784) or transdermal fentanyl (Durogesic) (n = 202) as their first strong opioid between 1st January 1998 and 30th September 2000 and died during that period. Palliative care-related resource use data were obtained from the DIN-link database. Unit costs at 2000/2001 prices were applied to the resource use values to determine the mean NHS cost of palliative care from the start of treatment until death. Patients initially treated with transdermal fentanyl started their strong opioid regime 8.5 years after diagnosis compared to 6.4 years after diagnosis in those who started SR morphine. This equates to an overall survival period from diagnosis of 8.8 years and 7.4 years respectively. Nevertheless, the total NHS cost of palliative care was similar between treatment groups, ranging from a mean 3087-3462 pounds per patient. Hospitalisation accounted for up to 71% of the total cost and opioids accounted for up to a further 17%. Less than one-third of patients received 4-hourly morphine as part of their initial opioid treatment despite UK guidelines recommending that moderate-to-severe pain should always be managed initially with an immediate-release preparation. Additionally, patients who received transdermal fentanyl as part of their initial treatment received significantly more laxative prescriptions than patients who started with SR morphine. SR morphine and transdermal fentanyl seem to be used in different situations. The results also confirm previous findings that pain management in cancer patients is often sub-optimal. The low contribution of opioids to the overall costs indicates that this should not be an obstacle to starting this aspect of palliative care earlier in disease progression. This characterisation of the resource implications of using SR morphine and transdermal fentanyl should enable purchasers and providers to optimise the availability of strong opioids for cancer patients on medical, economic and humanitarian grounds.Current Medical Research and Opinion 03/2005; 21(2):271-80. · 2.38 Impact Factor -
Article: Factors Affecting UK Primary-Care Costs of Managing Patients with Asthma over 5 Years
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ABSTRACT: Objective: To determine the effect of age, disease severity and compliance on the annual primary-care cost of managing patients with asthma initially on British Thoracic Society British Guidelines on Asthma Management (BGAM) treatment steps 2/3 over 5 years. Design and setting: A modelling study performed from the perspective of the UK's National Health Service (NHS). Study participants and interventions: A data set was created comprising 4519 patients with asthma in the DIN-link database who were prescribed twice-daily inhaled corticosteroids and who were on steps 2/3 between 1 January and 31 December 1993. These patients were followed over 5 years. Methods: Asthma-related primary-care resource utilisation data obtained from the DIN-link database were stratified by patients' age, compliance and BGAM treatment step. Unit costs at 1999-2000 prices were applied to the resource use estimates to determine the mean annual cost per patient. Main outcome measures and results: High compliance with inhaled corticosteroids was not associated with a reduction in use of other primary-care resources, although the ratio of the number of prescriptions for inhaled corticosteroids to that for short-acting beta2-agonists increased, suggesting that patients' asthma was better controlled. Overall, the primary-care cost of managing a patient starting on steps 2/3 was found to be most strongly influenced by whether that patient moved onto steps 4/5 or continued to be managed on the same treatment step. If a patient continued to be managed at steps 2/3, costs were influenced in descending order of impact by compliance, previous BGAM step and the patient's age. Conclusions: Better compliance with inhaled corticosteroids is likely to lead to better asthma control and fewer asthma attacks. Notwithstanding this, increasing compliance is likely to increase primary-care costs. Consequently increasing healthcare expenditure may be the inevitable consequence of improving asthma control.PharmacoEconomics 01/2003; 21(5):357-369. · 2.66 Impact Factor -
Article: Annual cost of bipolar disorder to UK society.
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ABSTRACT: The socio-economic impact of bipolar disorder in the UK is unknown. To estimate the annual socio-economic burden imposed by bipolar disorder on UK society. The annual cost of resource use attributable to managing bipolar disorder was calculated. Indirect societal costs were also calculated. The annual National Health Service (NHS) cost of managing bipolar disorder was estimated to be 199 million pounds sterling , of which hospital admissions accounted for 35%. The annual direct non-health-care cost was estimated to be 86 million pounds sterling annually and the indirect societal cost was estimated to be 1770 million pounds sterling annually. The annual cost to UK society attributable to bipolar disorder was estimated to be 2 billion pounds sterling at 1999/2000 prices (estimated 297 000 people with the disorder). Ten per cent of this cost is attributable to NHS resource use, 4% to non-health-care resource use and 86% to indirect costs.The British Journal of Psychiatry 04/2002; 180:227-33. · 6.62 Impact Factor -
Article: A model to estimate the cost benefit of an occupational vaccination programme for influenza with Influvac in the UK.
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ABSTRACT: To model the economic impact of introducing an occupational vaccination programme for influenza with an inactivated influenza subunit vaccine (Influvac) in the UK. Using published sources, a decision tree was constructed which modelled the costs and benefits of introducing an influenza vaccine in a business in the UK from the perspective of an employer. STUDY PARTICIPANTS AND INTERVENTIONS: The model considered the implementation of an occupational vaccination programme with Influvac in a business employing 1000 normal healthy adults earning the national average wage in the UK. The model assumed that 95% of employees would be absent from work after contracting influenza for a mean of 5 days and that the level of productivity would be reduced by 60% for one day by 85% of sick employees returning to work. The expected probability of an employee being absent from work following an influenza vaccination would be reduced from 5.7 to 1.8% when the incidence of influenza in the community is 6%. Accordingly, if all 1000 employees were vaccinated, a business would be expected to reduce absenteeism from work attributable to an influenza outbreak by 220 days. Moreover, the expected return on every pound invested by an employer would be UK pounds 1.03, UK pounds 3.09 and UK pounds 5.15 (2000 values) when the annual incidence of influenza in the community is 2, 6 and 10%, respectively. Implementation of an occupational vaccination programme with Influvac would be expected to reduce the incidence of influenza among a workforce leading to less absenteeism from work and averted lost productivity. Even if the incidence of influenza was as low as 2% it may be a worthwhile investment for UK employers to vaccinate their employees with Influvac.PharmacoEconomics 02/2002; 20(7):475-84. · 2.66 Impact Factor -
Article: Health-related quality of life in a UK-based population of men with erectile dysfunction.
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ABSTRACT: To measure health-related quality of life (HR-QOL) among a sample of men with erectile dysfunction (ED) in the UK. A structured questionnaire was mailed to a sample of 5000 men in the UK with ED. The questionnaire included the International Index of Erectile Function (IIEF-5) scale to determine ED severity and the EuroQoL (EQ-5D) questionnaire, a generic HR-QOL instrument. Descriptive information relating to personal relationships and sociodemographics as well as details of comorbidities were also requested. 23% of the sample (n = 1141) returned a completed questionnaire. Of the respondents, 82.2% (n = 939) met the criteria for ED based on the IIEF-5 scale. The mean age of the respondents was 60.4 +/- 24.9 years. There was a gradual convergence of respondents' HR-QOL scores to that of the normal male population as their age increased. The HR-QOL of respondents was significantly poorer than that of the normal population for those under 65 years of age, whereas it was significantly better for those between the ages of 65 and 74 years. Comorbid illness had a significant impact on the HR-QOL of respondents over 44 years of age. Furthermore, the HR-QOL of respondents with multiple risk factors for ED was significantly lower than that of respondents without any risk factors (p < 0.001). The respondents' HR-QOL was significantly poorer compared with the normal male population when stratified by marital status. It was also significantly poorer when stratified by whether the respondents were manual or non-manual workers. HR-QOL among men with ED is poorer in those with comorbid illnesses and improves with age.PharmacoEconomics 01/2002; 20(2):109-17. · 2.66 Impact Factor -
Article: A Model to Estimate the Cost Benefit of an Occupational Vaccination Programme for Influenza with Influvac(R) in the UK Use of the tradename is for product identification purposes only and does not imply endorsement.
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ABSTRACT: Objectives: To model the economic impact of introducing an occupational vaccination programme for influenza with an inactivated influenza subunit vaccine (Influvac(R)) in the UK. Design and setting: Using published sources, a decision tree was constructed which modelled the costs and benefits of introducing an influenza vaccine in a business in the UK from the perspective of an employer. Study participants and interventions: The model considered the implementation of an occupational vaccination programme with Influvac(R) in a business employing 1000 normal healthy adults earning the national average wage in the UK. The model assumed that 95% of employees would be absent from work after contracting influenza for a mean of 5 days and that the level of productivity would be reduced by 60% for one day by 85% of sick employees returning to work. Main outcome measures and results: The expected probability of an employee being absent from work following an influenza vaccination would be reduced from 5.7 to 1.8% when the incidence of influenza in the community is 6%. Accordingly, if all 1000 employees were vaccinated, a business would be expected to reduce absenteeism from work attributable to an influenza outbreak by 220 days. Moreover, the expected return on every pound invested by an employer would be Lstg 1.03, Lstg 3.09 and Lstg 5.15 (2000 values) when the annual incidence of influenza in the community is 2, 6 and 10%, respectively. Conclusions: Implementation of an occupational vaccination programme with Influvac(R) would be expected to reduce the incidence of influenza among a workforce leading to less absenteeism from work and averted lost productivity. Even if the incidence of influenza was as low as 2% it may be a worthwhile investment for UK employers to vaccinate their employees with Influvac(R).@SUMMARY ORA = Influenza is a common respiratory illness that has been estimated to affect up to 20% of the population annually.[1] In a non-epidemic year in the UK, influenza results in approximately 9000 hospitalisations in people aged over 65 years[2] and between 3000 and 4000 deaths.[3] In a serious epidemic year, such as 1989/1990, mortality can be as high as 30 000 deaths.[4] Additionally, influenza has a substantial impact on direct and indirect costs.[5-9] In 1982/1983, there were an estimated 6.4 million working days lost in the UK associated with certified influenza illness.[10] These data clearly demonstrate that influenza is a serious public health problem, which requires all possible prevention and control measures to minimise its impact. The efficacy and effectiveness of currently available inactivated influenza vaccines have been proven beyond doubt. Influenza vaccines have been shown to be effective in reducing the incidence of infection and associated morbidity and mortality,[11-13] and most European countries have a governmentally-sponsored programme for vaccinating high-risk groups.[14] A recent review on 15 years of experience with an inactivated influenza subunit vaccine (Influvac(R)) showed safety and efficacy data derived from marketing experience and clinical studies.[15] During the period 1982 to 1996, 87.5 million doses of the subunit vaccine were distributed and only 273 adverse events were reported and filed in the post-marketing surveillance database. Of these 273 adverse events, 121 were rated as serious, but in most cases no cause-effect relationship with the vaccine was established. The data from clinical studies showed that 56% of vaccinees reported no reactions at all after vaccination. From 3000 subjects, 95% reported no or only slight inconvenience and 4% reported moderate inconvenience after vaccination. Serological protection rates of 65 to 78% were reported in a meta-analysis of clinical data in the above-mentioned review. Influenza vaccination among people over 60 years of age is both clinically effective and cost effective in reducing the incidence of infection and associated illness, hospitalisation and mortality when the infectious and vaccine strains are closely related.[11-13,16-19] Present UK guidance on influenza immunisation recommends that it should be provided for those of any age with chronic respiratory disease, heart disease, renal disease, diabetes mellitus and immunosuppression due to disease or treatment. It is also recommended for those over 74 years of age and all those living in long-stay residential accommodation.[20] However, little emphasis is given to working age adults receiving the vaccine. Moreover, while it may be clinically beneficial to vaccinate healthy adults under 65 years of age, it has been reported that there are few economic benefits to the healthcare system and society.[21] Against this background, this study aimed to model the economic impact of introducing an occupational vaccination programme in terms of the net costs to an employer in the UK.PharmacoEconomics 01/2002; 20(7):475-484. · 2.66 Impact Factor
