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Publications (73)
Background
Migraine is a prevalent neurologic disorder that affects women more than men. Examining health-related quality of life (HRQoL) by gender can aid decision makers in prioritizing future treatment and prevention programs. We aimed to quantify HRQoL by different levels of migraine disability and by gender.
Methods
As part of a Canada-wide c...
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Background
We previously showed biosimilar-promoting policies like tendering (i.e., inviting bids from potential suppliers) and prescribing quotas (i.e., mandating switching to or new prescriptions of biosimilar products) are key drivers for biosimilar market penetration.[1] Whether these policies reduce expenditures on anti-TNF products is unknown...
Background:
The Patented Medicine Prices Review Board (PMPRB), the agency that regulates the prices of patented medicines in Canada, published proposed amendments to the regulatory framework in December 2017. Because of a series of changes and delays, the revised policy has not yet been finalized. We sought to evaluate the potential early impact o...
This study aimed to examine the impact of employment transitions (ETs) on anthropometric changes among middle-aged and older workers (ages 45y+). Using two waves of data from the Canadian Longitudinal Study on Aging, we analyzed the impact of ETs (stayed working, entered retirement, and stopped working) on change in body weight and waist circumfere...
Background
The current prostate cancer (PCa) screening standard of care (SOC) leads to unnecessary biopsies and overtreatment because decisions are guided by prostate‐specific antigen (PSA) levels, which have low specificity in the gray zone (3–10 ng/mL). New risk assessment tools (RATs) aim to improve biopsy decision‐making. We constructed a model...
Background
Health systems across countries have used different policy measures (e.g. price discounts, tendering, mandating switches) to encourage the introduction of biosimilars but their differential impact on market penetration is unknown.
Objectives
To evaluate the impact of policy measures on market penetration of anti-TNF biosimilars.
Method...
Objectives:
From the perspectives of patients and caregivers, the objectives were: identifying which result presentations, describing work productivity loss (WPL) outcomes, are most understandable; measuring which presentations are important to report; and investigating which WPL outcomes are viewed as important alongside clinical trials results....
We aimed to estimate the total health care costs attributable to prostate cancer (PCa) during care phases by age, cancer stage, tumor grade, and primary treatment in the first year in British Columbia (BC), Canada. Using linked administrative health data, we followed a cohort of men aged ≥ 50 years at diagnosis with PCa between 2010 and 2017 (Cohor...
Objective:
Drug plans take different approaches to determining reimbursement prices for generic drugs. One common approach is to set the maximum reimbursement price as a percentage of the price of the interchangeable branded drug. In many countries this percentage depends on the number of generic entrants, a model we call "tiered pricing." This pa...
Objectives:
To assess the association between caregiving length/intensity and labor force participation among middle-aged Canadians.
Methods:
We used baseline data from the Canadian Longitudinal Study on Aging. Labor force participation status included working full-time, part-time, part retirement, complete retirement and non-participation. We d...
Objective:
Measure the association of working from home (WFH) with work productivity loss due to caregiving responsibilities or health problems during the COVID-19 pandemic.
Methods:
We conducted an online survey of family/friend caregivers (N = 150 WFH/75 Non-WFH) and patients (N = 95/91) who worked during the past 7 days in May and July 2020,...
Objectives
This study aimed to conduct a scoping review of randomized controlled trials (RCTs) and investigate which work productivity loss outcomes were measured in these RCTs, how each outcome was measured and analyzed, and how the results for each outcome were presented.
Methods
A systematic search was conducted from January 2010 to April 2020...
Objective
This study aimed to: (a) adapt the previously validated Valuation of Lost Productivity (VOLP) questionnaire for people with health problems, to a caregiver version to measure productivity losses associated with caregiving responsibilities, and (b) evaluate measurement feasibility and validity of an online version of the caregiver VOLP que...
In Canada and around the world, policy makers are struggling with funding between informal care and formal home care. Understanding the relationship between the two types of care is helpful to inform funding allocations. In this study, we examined the relationship between informal care and formal home care and assessed whether this relationship var...
Background
An increasing number of randomized controlled trials (RCTs) have measured the impact of interventions on work productivity loss. Productivity loss outcome is inflated at zero and max loss values. Our study was to compare the performance of five commonly used methods in analysis of productivity loss outcomes in RCTs.
Methods
We conducted...
Background:
Generic drug prices have been capped at specified percentages of the interchangeable branded drug's price by the Canadian provincial public drug plans since 1993. The Pan-Canadian Pharmaceutical Alliance, formed as a coalition by the provinces/territories in Canada, implemented an alternative approach, a tiered-pricing framework (TPF)...
Background
Middle-aged and older adults are more likely to suffer from chronic conditions, which can increase their need for both formal and informal care. This study seeks to assess and compare the extent to which the use of formal and informal care is attributed to different chronic conditions among middle-aged and older women and men in Canada....
Background:
To monitor the magnitude of the drug shortage problem in Canada, since 2017, Health Canada has required manufacturers to report drug shortages. This study aimed to identify the factors associated with drug shortages in Canada.
Methods:
We conducted a retrospective cohort study of all prescription drugs available on the market between...
Objectives
Down syndrome (DS) is the most frequently occurring fetal chromosomal abnormality and different prenatal screening strategies are used for determining risk of DS worldwide. New non-invasive prenatal testing (NIPT), which uses cell-free fetal DNA in maternal blood can provide benefits due to its higher sensitivity and specificity in compa...
Background
Previous studies assessing preferences for prenatal screening have focused on preferences of the affected population and have largely assumed homogeneous preferences. We aimed to estimate public preferences and willingness to pay for prenatal screening and diagnosis from a Canadian general population sample, and to model preferences at t...
Objectives
To analyse the effects of health status on work exit and absenteeism among the older working population in China.
Design
Secondary analysis of a cohort sample.
Setting and participants
Community samples who engaged in either agricultural or non-agriculture work or both in the 2011 wave of the China Health and Retirement Longitudinal St...
Introduction
Musculoskeletal disorders (MSDs) are the most prevalent chronic condition in Canada, and account for the highest disability costs. Gradual-return-to-work (GRTW) can improve health and labour market outcomes in an aging workforce at risk of MSDs. Linked longitudinal data enables us to generate evidence of GRTW to inform policy needs.
O...
Background:
While discrete choice experiments (DCEs) are well established methods to ascertain patient preferences, there is limited literature describing use of qualitative methods in DCE design.
Aim:
This article provides a case study of the qualitative research process for developing the conceptual attributes for a DCE for prenatal screening...
Background:
People with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbidity and mortality. In order to assess comparative efficacy of influenza vaccine strategies among HIV-positive people, we performed a systematic review and Bayesian network meta-analysis (NMA).
Methods:
In this systematic review, we search...
Background
Inflammatory bowel diseases (IBD) are chronic conditions with a relapsing and remitting course. The presenting symptoms are heterogeneous and may overlap with other gastrointestinal conditions such as irritable bowel syndrome (IBS), which can lead to delays in diagnosis. Fecal calprotectin (FCP) is a protein excreted from granulocytes an...
Purpose of review:
One justification for using expensive biologic therapy in rheumatoid arthritis (RA) has been that it can reduce future healthcare utilization such as joint surgeries and physician visits. However, the evidence to support this assertion is unclear. We conducted a review of the literature for studies which have analyzed the trends...
In health economic evaluation studies, to value productivity loss due to absenteeism, existing methods use wages as a proxy value for marginal productivity. This study is the first to test the equality between wage and marginal productivity losses due to absenteeism separately for team workers and non-team workers. Our estimates are based on linked...
Background:
In 1998, the province of Ontario, Canada implemented price-cap '70/90' regulations: the first generic must be priced at ≤70% of the associated brand-name price and subsequent generics must be priced at ≤90% of the first generics' price. The price-cap was further lowered to 50% in 2006 and 25% in 2010 for all generic drugs regardless of...
Objectives:
This study aimed to measure and compare the relationship between chronic diseases and the number of absent workdays due to health problems and the associated costs among working Canadians.
Methods:
The study sample included respondents to the 2010 Canadian Community Health Survey between aged 15-75 years who reported employment in th...
Objective
To assess changes in work productivity in patients who have achieved response using etanercept (ETN) 50 mg+methotrexate (MTX) (phase I) are randomised to ETN 25 mg+MTX versus MTX versus placebo (phase II) and then withdrawn from treatment (phase III).
Methods
Patients included in the analysis were in employment entering phase II of the P...
Background:
In 1998, the Province of Ontario in Canada adopted price-cap "70/90" regulations whereby the first generic entrant was required to be priced at ≤70% of the associated brand-name product and subsequent generics were priced at ≤90% of the first generic price. The price-caps were further lowered to 50% in 2006 and 25% in 2010. This study...
One source of productivity loss due to illness is the reduced "quantity" or "quality" of labor input while working, often referred to as presenteeism. Illness-related presenteeism has been found to be potentially more costly than absenteeism. To value presenteeism, existing methods use wages as a proxy for marginal productivity at the firm level. H...
Background Previous results have demonstrated that etanercept 50mg (ETN50) plus methotrexate (MTX) can reduce work loss in patients with early rheumatoid arthritis (RA).
Objectives To assess the impact on work productivity of reducing and withdrawing etanercept in patients who had reached remission.
Methods Phase I of the PRIZE trial recruited pati...
Objective:
To measure and value the impact of combined etanercept (ETN) and methotrexate (MTX) therapy on work productivity in patients with early rheumatoid arthritis (RA) over 52 weeks.
Methods:
MTX- and biological-naïve patients with RA (symptom onset ≤12 months; Disease Activity Score based on a 28-joint count (DAS28) >3.2) received open-lab...
Psoriasis is a chronic inflammatory disease of the skin that has a major effect on an individual's physical and mental function. The disease is associated with increased healthcare resource use and costs, therefore cost-effectiveness analysis (CEA) can be used to assist decision makers with determining which treatments are optimal within a constrai...
Background Recent studies have demonstrated that biologic agents can improve work productivity in patients with rheumatoid arthritis (RA). However, the long term consequences on work productivity, particularly in step down treatment strategies has yet to be explored.
Objectives To assess changes in work productivity in patients who have achieved re...
In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. We examine the impacts of these programs (Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS))...
Many health systems are interested in the impact of disease and interventions on non-health outcomes. Over the last 10 years, work productivity has become one of the most important topics. This study was conducted to review guidelines for economic evaluations worldwide to identify how views on the types of productivity costs to be included differ a...
Existing productivity questionnaires do not capture sufficient information to enable the proper valuation of an individual's productivity loss to a society. The purpose of this article is to develop a questionnaire that captures the time lost from work due to a health problem and job and workplace characteristics so that the value of productivity l...
To explore rates of and reasons for work disability in an early RA cohort with median 10 years follow-up.
One thousand four hundred and sixty patients with early RA (<2 years symptom duration) and no prior DMARD therapy were recruited from nine rheumatology outpatient departments across the UK between 1986 and 1998. Standard clinical, laboratory an...
To understand the impact of the early years of RA on all aspects of work productivity, and determine how this is related to clinical markers. Previous research on work productivity has examined predominantly early retirement and absenteeism. The impact of reduced work performance (presenteeism) and activity impairment is less well understood in ear...
Leading up to the Outcome Measures in Rheumatology (OMERACT) 10 meeting, the goal of the Worker Productivity Special Interest Group (WP-SIG) was to make progress on 3 key issues that relate to the application and interpretation of worker productivity outcomes in arthritis: (1) to review existing conceptual frameworks to help consolidate our intende...
To evaluate the impact of clinical response on work stoppage or work absence among employed people with early RA.
First-year data from the combination of MTX and etanercept trial was used. The analyses were restricted to the 205 patients working full or part time at baseline who answered questions on whether they stopped working or missed days from...
To examine the validity and test-retest reliability of the Valuation of Lost Productivity (VOLP) questionnaire among patients with rheumatoid arthritis (RA).
Absenteeism, presenteeism, and unpaid work loss due to health were measured. Patients with RA who had paid work at their recent follow-up were recruited from the Early RA Network cohort. The V...
Rheumatoid arthritis (RA) not only causes significant morbidity, but also leads to substantial losses in terms of productivity that have a negative impact on the individual and the society. In countries, such as Canada, the US, and the UK, it is known that the costs to the economy in terms of sick leave and work-related disability run into billions...
The objective of this study is to review current measurement issues and valuation methods such as "human capital" and "friction cost" for estimating productivity loss due to illness. Since observed wages diverge from marginal productivity when allowances are made for sick days and workers are risk averse, or when a job type involves team production...
Among people with arthritis, the need for work transitions may signal a risk for more adverse work outcomes in the future, such as permanent work loss. Our aim was to evaluate the ability of the Work Instability Scale for Rheumatoid Arthritis (RA-WIS) to predict arthritis-related work transitions within a 12-month period.
Workers with osteoarthriti...
The Work Productivity and Activity Impairment (WPAI) questionnaire is a well validated instrument to measure impairments in work and activities. However, its validation among patients with rheumatoid arthritis (RA) has not been well established. The present study's purpose is to evaluate the construct validity of the WPAI-general health version amo...
To estimate and compare lost work hours attributable to presenteeism, defined as reduced productivity while working, in individuals with osteoarthritis (OA) or rheumatoid arthritis (RA), according to 4 instruments.
In our prospective study, 250 workers with OA (n = 130) or RA (n = 120) were recruited from community and clinical sites. Lost hours du...
To compare work productivity among employed people with arthritis to healthy controls.
The data source was the 2005 Canadian Community Health Survey. The outcomes were work absence (absenteeism) in the last week and reducing activities at work (presenteeism). The key explanatory variable was chronic condition status: 1) no chronic conditions; 2) ar...
To validate the 23-item Work Instability Scale for Rheumatoid Arthritis (RA-WIS) for use in osteoarthritis (OA) using both classical test theory and item response theory approaches.
Baseline and 12-month follow-up data were collected from workers with OA recruited from community and clinical settings (n = 130). Fit of RA-WIS data to the Rasch model...
To evaluate the cost-effectiveness of Anticipatory and Preventive Team Care (APTCare).
Analysis of data drawn from a randomized controlled trial.
A family health network in a rural area near Ottawa, Ont.
Patients 50 years of age or older at risk of experiencing adverse health outcomes. Analysis of cost-effectiveness was performed for a subsample of...
T o examine whether quality of care (QOC) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk of experiencing adverse health outcomes.
Randomized controlled trial.
A family health network with 8 family phys...
Worker productivity is a combination of time off work (absenteeism) due to an illness and time at work but with reduced levels of productivity while at work (also known as presenteeism). Both can be gathered with a focus on application as a cost indicator and/or as an outcome state for intervention studies. We review the OMERACT worker productivity...
To compare the impact of the combination of etanercept (ETN) and MTX with MTX alone on work productivity among MTX-naïve patients with active early RA over a 12-month period.
The COMET (COmbination of Methotrexate and ETanercept) trial was a 2-year double-blind randomized clinical trial. Absenteeism during the first year was measured and it include...
This study is to update the estimates of the economic burden of illness because of overweight and obesity in Canada by incorporating the increase in prevalence of overweight and obesity, findings of new related comorbidities and rise in the national healthcare expenditure. The burden was estimated from a societal perspective using the prevalence-ba...
Overweight and obese persons are at risk of a number of medical conditions which can lead to further morbidity and mortality. The primary objective of this study is to provide an estimate of the incidence of each co-morbidity related to obesity and overweight using a meta-analysis.
A literature search for the twenty co-morbidities identified in a p...
To evaluate the shortterm effect of adalimumab on work productivity in patients with moderate to severe active rheumatoid arthritis (RA).
In a substudy of the Canadian Adalimumab Clinical Trial (CanAct), clinical, health status, and productivity outcomes were measured at baseline and 12 weeks. Patients were classified as responders and nonresponder...
Mathematical summary – amortization of training costs.
Influenza poses concerns about epidemic respiratory infection. Interventions designed to prevent the spread of respiratory infection within family physician (FP) offices could potentially have a significant positive influence on the health of Canadians. The main purpose of this paper is to estimate the explicit costs of such an intervention.
A cost...
Hospital in the home programs have been implemented in several countries and have been shown to be safe substitutions (alternatives) to in-patient hospitalization. These programs may offer a solution to the increasing demands made on tertiary care facilities and to surge capacity. We investigated the acceptance of this type of care provision with n...
