Podcasts about Economic evaluation

In this episode of Infection Control Matters, we explore the potential of AI tools to support education and professional dialogue in infection prevention and control. We used NotebookLM, an experimental tool from Google designed to help users interact with their documents in new ways—summarising, clarifying, and even generating structured discussions based on uploaded content. Using research and guidance documents, we demonstrate how NotebookLM can be used to create a voice-generated conversation on key themes in IPC. The paper that we uploaded was the recently published cost-effectiveness research that relates to the CLEEN study that we have previously highlihghted. A link to the open access paper can be found below. The main part of this podcast was a dialogue created by NotebookLM following the upload of the paper. None of the voices are human (apart from Martin at the beginning and Brett at the end). This episode offers a glimpse into how AI might be used to support reflection, training, and knowledge sharing across the healthcare community... but with caveats!   The paper we discuss can be found here: Brain D, Sivapragasam N, Browne K, White NM, Russo PL, Cheng AC, et al. Economic Evaluation of Enhanced Cleaning and Disinfection of Shared Medical Equipment. JAMA Netw Open 2025;8(4):e258565. https://doi.org/10.1001/jamanetworkopen.2025.8565 NotebookLM: https://notebooklm.google/  

In this episode of Infection Control Matters, we explore the potential of AI tools to support education and professional dialogue in infection prevention and control. We used NotebookLM, an experimental tool from Google designed to help users interact with their documents in new ways—summarising, clarifying, and even generating structured discussions based on uploaded content. Using research and guidance documents, we demonstrate how NotebookLM can be used to create a voice-generated conversation on key themes in IPC. The paper that we uploaded was the recently published cost-effectiveness research that relates to the CLEEN study that we have previously highlihghted. A link to the open access paper can be found below. The main part of this podcast was a dialogue created by NotebookLM following the upload of the paper. None of the voices are human (apart from Martin at the beginning and Brett at the end). This episode offers a glimpse into how AI might be used to support reflection, training, and knowledge sharing across the healthcare community... but with caveats!   The paper we discuss can be found here: Brain D, Sivapragasam N, Browne K, White NM, Russo PL, Cheng AC, et al. Economic Evaluation of Enhanced Cleaning and Disinfection of Shared Medical Equipment. JAMA Netw Open 2025;8(4):e258565. https://doi.org/10.1001/jamanetworkopen.2025.8565 NotebookLM: https://notebooklm.google/  

In this episode of Uncommon Sense with Ginny Robinson, I'm giving my take (to the best of my ability—because I'm not a tariff expert and neither are most of the people chiming in right now) on Trump's gutsy new tariff move. It's the one that's got half the country cheering and the other half clutching their pearls. While the media yells “economic suicide,” I'm here to suggest that this strategy might actually work—but not overnight. We'll talk about the possibility of long-term gain, the reality of short-term discomfort, and the cultural obsession with instant results when what's often required is patience. I will also go over our collective short attention spans and why longer attention spans are needed for understanding complex issues like this. Every answer won't fit in a 15 second soundbite. At the end of the day, we'll have to pray, wait, and see. Some of the smartest plays take time to unfold.—https://noblegoldinvestments.com/learn/gold-and-silver-guide/?utm_campaign=21243613394&utm_source=g&utm_medium=cpc&utm_content=&utm_term=noble%20gold&seg_aprod=&ad_id=698073353663&oid=2&affid=1&utm_source=google&affiliate_source=googleads_brand_bmbc&utm_term=noble%20gold&gad_source=1&gbraid=0AAAAADQ2DzJSJ_mi5cJo8dO2FNUs7uNy-&gclid=CjwKCAjwktO_BhBrEiwAV70jXtjSCyioSM2Hz1McTAlR3f8t3KCDDN3-XBWLaIzwJmiEGe0ztxIk5RoCnM0QAvD_BwE

Hosts Roz and Josh are joined by Abraham Matar, MD to discuss the key articles of the December issue of American Journal of Transplantation. Dr. Abraham ‘Abe' Matar is a Transplant Surgery Fellow at the University of Minnesota   [02:15] Economic Evaluation of Weight Loss and Transplantation Strategies for Kidney Transplant Candidates with Obesity Editorial: Selecting Weight Loss Strategies for Kidney Transplant Candidacy: Weighty decisions [11:44] Electrostimulation suppresses allograft rejection via promoting lymphatic regulatory T cell migration mediated by lymphotoxin (LT)-LTb receptor signaling [18:57] Ischemia Reperfusion Responses in Human Lung Transplants at the Single Cell Resolution [28:36] The suggestion of mitigating disparity in the liver transplantation field among ABO blood type    

Episode 442: Neal and Toby discuss the final snapshot of major economic indicators before the general election that could potentially swing the last remnants of undecided voters. Then, major earnings reports from Alphabet, Reddit, McDonald's, and Chipotle. Next, new nutritional guidelines around red meat has the meat industry shaking in their boots. Plus, Starbucks tells its employees to return-to-office, or else…they're fired, as major companies are calling back staffers back to fill up empty office space. Lastly, the biggest headlines you should know. Subscribe to Morning Brew Daily for more of the news you need to start your day. Share the show with a friend, and leave us a review on your favorite podcast app. Find your fit at bonobos.com and use code BREW20 for 20% off.  Get your Morning Brew Daily T-Shirt HERE: https://shop.morningbrew.com/products/morning-brew-radio-t-shirt?_pos=1&_sid=6b0bc409d&_ss=r&variant=45353879044316  Listen to Morning Brew Daily Here: https://link.chtbl.com/MBD Watch Morning Brew Daily Here: https://www.youtube.com/@MorningBrewDailyShow 00:00 - Welcome 02:15 - Economic Evaluation  07:20 - Earnings Season  15:20 - Red Meat Beef  19:30 - Starbucks RTO Policy 22:30 - Headlines Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Shannon Westin, Dr. Stephanie Wheeler, and Dr. Caitlin Biddell discuss the paper "Economic Evaluation of a Non-Medical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer," a simultaneous publication, podcast, and presentation at the ASCO Quality Care Symposium. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we get in-depth on manuscripts published in the Journal of Clinical Oncology. I'm your host, Shannon Westin, Social Media Editor of the JCO and GYN Oncologist. And I am so excited that today we have a simultaneous publication in JCO and presentation at the 2023 ASCO Quality Care Symposium here on 10/28/2023. And this is going to be the manuscript “Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer.” Very exciting work. And I'm thrilled to tell you I have two of the authors here with me today. First is Dr. Caitlin Biddell. She's a Health Services Researcher at Mathematica Policy Research.  Welcome, Caitlin.  Dr. Caitlin Biddell: Thank you. Happy to be here. Dr. Shannon Westin: And we also have Dr. Stephanie Wheeler. She is the Michael S. O'Malley Distinguished Professor in the Department of Health Policy and Management at the University of North Carolina, Chapel Hill, as well as being the Associate Director of Community Outreach and Engagement at UNC Lineberger Comprehensive Cancer Center.  Welcome. Dr. Stephanie Wheeler: Thank you. Happy to be here as well. Dr. Shannon Westin: Please note that our authors and participants have no conflicts of interest.  Let's get started. So first I would love to level set. Can you speak a little bit about what financial toxicity is and how common it is among patients with cancer?  Dr. Stephanie Wheeler: Sure, Shannon. I'm happy to take that one. This is Stephanie. So we know that financial hardship is often reported by patients and survivors who've experienced cancer. And as many as 50% of people with cancer have trouble with financial toxicity. There has been prior work that has conceptualized financial toxicity in three domains. So there's the material hardship, kind of the out-of-pocket material costs associated with cancer, which include both medical and nonmedical expenses. There is the stress and the psychosocial effects of that material hardship. And then there's coping behaviors that patients and their caregivers may employ to help deal with the high cost of cancer care. And as we've seen, cancer care increases in cost over time, and these expenditures really have very burdensome effects on patients and their families. We've been interested in looking at ways that we can try to mitigate that harm and really thinking about interventions in addition to the health policy changes that are needed to really ensure that this doesn't become a barrier to patients seeking and receiving the best quality care that they can. Dr. Shannon Westin: I think that kind of leads pretty nicely into my next question, which is really: How does this toxicity potentially impact equitable cancer care delivery?  Dr. Stephanie Wheeler: Yeah, I'm happy to talk about that a little bit as well. So we know from prior research, including some of our own, that patients of color, those from rural areas, and those who are uninsured or underinsured face the largest financial burdens associated with their cancer care. So to the extent that those financial hardships influence people's ability to seek and continue with and complete their cancer care that's been recommended, this actually is directly in the pathway and a mechanism through which patients are not able to get recommended treatment and therefore can contribute to differences in cancer outcomes. So there's direct health impacts in terms of their ability to receive and respond to cancer treatment.   In addition to that, we know that this financial hardship contributes to household-level harms both economic and psychosocial in nature. And in some other work, this financial hardship has translated to worse quality of life, worse economic outcomes, things like being able to stay employed and seeking changes in employment or remaining within a particular position because you don't want to lose your insurance—this is referred to as “job lock”—or can also contribute to higher mortality. So there's been some really important work showing that financial toxicity is directly linked with cancer mortality.  And so, as we think about ways that we need to address this, it's really key to ensuring cancer health equity that we are thoughtful about multiple solutions implemented at multiple levels that can deal with not only the contributors to high cancer costs but that can also start to affect both the nonmedical and the medical components of this cost burden. And by nonmedical, I mean things like the cost associated with transportation and seeking care, accommodations for people who need to receive radiation therapy multiple days in a row at a different healthcare facility than where they live, childcare costs. These things really start to add up in addition to the medical costs associated with cancer treatment. Dr. Shannon Westin: I really was intrigued by the intervention here that you all are studying around this Cancer Patient Assistance Fund. Can you tell me a little bit more about exactly what that was or is? Dr. Caitlin Biddell: Yeah, absolutely. So this is a program at the North Carolina Basnight Cancer Hospital, located within the Lineberger Comprehensive Cancer Center, and it started back in 2013, actually, and has really grown in size. But the main goal of this program is to ensure that patients do not face the nonmedical financial barriers to care that Dr. Wheeler was just talking about. So thinking about giving patients gas cards so that they are able to drive to and from treatment. Lineberger has a catchment area of the entire state, so many people are coming a long distance to come for cancer treatment. They also provide things like lodging and accommodations, as Stephanie mentioned, and then even paying patients' utility bills, things to keep them housed with electricity, the lights on, while they're undergoing cancer treatment. So just last year, in 2022, they distributed almost $350,000 to over 700 patients, and most of this is funded by philanthropic grants to ensure that patients can access the care they need. And it is a program that's really targeted to patients with low incomes. So they target patients with household incomes less than 250% of the federal poverty level. Dr. Shannon Westin: And how does a patient get connected to the fund? How do they find it and get hooked up?  Dr. Caitlin Biddell: Yeah, there's a couple different ways. So one path is through the outpatient social work team. So they often perform distress screening for new cancer patients. So they use the Distress Thermometer, which was developed by the National Comprehensive Cancer Network. And it measures a variety of different factors that may be contributing to distress, but that does include financial stress, job stress, and the expense of daily living stress. And so, when a patient scores a certain amount on that thermometer, a social worker will meet with them for a full assessment. And then part of the referral pathway from that assessment includes the Cancer Patient Assistance Fund. Patients who are in inpatient will often be screened with the Social Determinants of Health Module, which is housed in the electronic health record. And so that can also generate referrals for assistance. And then beyond the kind of standard pathways, there's also many other ways that a patient may express concerns to a nurse, a care coordinator, an oncologist, and then that provider can reach out directly to the Cancer Patient Assistance Fund. Dr. Shannon Westin: Your objective was to basically try to formally assess the impact of this fund on missed radiation or chemotherapy appointments. And so what was kind of your rationale for choosing this endpoint? And kind of take us through the design. Dr. Caitlin Biddell: Yeah, absolutely. So the idea for this study actually came about from the program coordinator of the Cancer Patient Assistance Fund several years back. We were just having a conversation about the program. I was commenting how important I thought it was, how interesting it was. And she was saying, “You know, I know anecdotally that this program makes a difference, but we've never really known how to quantify that.” And that's becoming increasingly important as they apply for philanthropic grants and really need to show that their program is having an impact. So that's what originally started our plan for evaluating the program.  And then, in thinking about endpoints, of course we imagined this program could have an impact on a range of different endpoints. So missed appointments is quite practicable. We also imagine it could influence patient health-related quality of life, patient symptoms associated with their cancer treatment, even potentially other long-term outcomes like mortality. But for the purposes of this evaluation, we needed to identify an endpoint that we believed could be measured, the association could be measured, in the data we had. And so we had electronic health record data. Missed appointments is something that is routinely captured in the electronic health record data because it's an endpoint that matters financially to health systems. So they are regularly tracking missed or no-show appointments. And it's also an outcome that matters financially to the health system, so they want to reduce this.  So we thought if we measure the impact of this program on missed appointments, there's potentially an opportunity to kind of align financial incentives so that if we show that the program has an impact on missed appointments, then that could be something that could get decision makers at the health system level to say, well, that's also an endpoint that we want to reduce, and so let's think about ways that we can align resources to reduce missed appointments through potentially the Cancer Patient Assistance Fund and other mechanisms. Dr. Shannon Westin: It's interesting because it definitely caught my eye because we give radiation, obviously, for gynecologic malignancies, and there's some pretty decent data that longer treatment duration for radiation has worse outcomes, with the implication that patients have missed appointments and so then, to finish their work, it takes longer, or to finish their treatment plan, it takes longer. So I definitely would be really intrigued to see the cancer-related outcomes. But I completely agree, like something practical, straightforward, and something easily obtained was the right way to start. I was just curious. So that's really interesting. So why don't you just walk us through the design of how you laid this out? Dr. Caitlin Biddell: Yeah, absolutely. So we conducted a retrospective evaluation between 2015 and 2019, and we chose that time point to end before the COVID-19 pandemic since we know that had many impacts on missed appointments. And we compared the proportion of missed appointments in the six months following treatment initiation between patients who were receiving Cancer Patient Assistance Fund assistance and then propensity-weighted comparators. And this is really just a method to make the pool of potential comparison patients look as similar to those receiving Cancer Patient Assistance Fund assistance as possible so that we can really tease apart that direct effect of the Cancer Patient Assistance Fund and separate it out from other characteristics that may be influencing missed appointments.  So we had stratified our analysis by treatment type. We looked at radiation therapy, and then we also looked at oncology infusion, so specifically immunotherapy and chemotherapy. And to evaluate these endpoints, we used a couple of different data sources that we linked together. So the first and the primary data source was the electronic health record. So at UNC, we have EHR data for research purposes stored in a data warehouse that we were able to pull from. And then we also linked in UNC Health's portion of the North Carolina Cancer Registry to get that really important information on cancer stage, cancer type, and treatment start date. And then, of course, we pulled in program records from the Cancer Patient Assistance Fund to identify which patients were receiving assistance, how much, and at what time points. And so, essentially, using that data and thinking about missed appointment outcomes in those six months following treatment initiation, we created a couple different models. So we looked at the high versus low no-show proportion using a logistic regression. And then we also looked at just the continuous no-show proportion in the sample to see if there was an effect on that as well. Dr. Shannon Westin: And what did you find? What was the impact of the fund's support on your outcomes? Dr. Caitlin Biddell: For radiation therapy, which I'll start with, the radiation therapy had a higher number of encounters, as we might expect, than immunotherapy/chemotherapy. There were a mean of 37 total radiation therapy encounters in the six-month follow-up period, and about 53% of the sample had one or more no shows. And so, then, when we looked at the impact the Cancer Patient Assistance Fund on radiation therapy missed appointments, we found that receipt of any assistance was associated with an eight-percentage-point decrease in the probability of having a no-show proportion in the highest quintile.  And then, when looking at continuous no-show proportion, we found it was associated with a 2.1-percentage-point decrease in the overall proportion of no shows, which corresponds to a 51% decrease in the overall mean no-show proportion. So a really substantial effect on radiation therapy missed appointments. And unsurprisingly, when we stratified the analysis by the amount of assistance received, we did see a greater impact of the program among patients receiving higher amounts of assistance.  Moving on to the oncology infusion cohort, this sample had a lower number of encounters in the follow-up period and less no shows, so only about 14% had one or more no shows. And so it potentially wasn't as surprising that we did not see an impact of the Cancer Patient Assistance Fund on infusion oncology missed appointments, though, of course, with the additional power and alternative analyses, it's not to say that there wasn't an effect, but in our population, we were not able to detect that. Dr. Shannon Westin: Yeah, and that makes a lot of sense. I mean, radiation is so much more time intensive and having to come back and forth. And when you were describing the fund and saying, like, housing assistance, I was like, “Oh, well, there you go.” Because that, I feel like, is one of the major issues. At MD Anderson, we also kind of take care of a very large catchment area, and it can be a huge burden for patients to have to come for that 15-minute appointment every day. So, yeah, when I saw your results, I thought that was likely what you were hypothesizing was the reason. And certainly, the impact on radiation is so impressive. It's just a hugely successful study and a hugely successful fund. So congratulations.  So, I guess, any other variables? You spoke a little bit about the amount of financial assistance received. Was there anything else that impacted the number of missed appointments in your study? Dr. Caitlin Biddell: Yeah, because of our propensity-weighting design, we really didn't focus as much on other patient-level contributors to missed appointments. So we attempted to control for all of those things through the waiting and then kind of didn't add those into the final model. So that was really the main focus, was looking at the impact of the Cancer Patient Assistance Fund and then, of course, looking by amount of assistance. That was a really important finding and also, of course, needs to be taken in the context that every patient has different needs and so the amount of assistance may differ for every patient. And so there's always a need to kind of really assess what a patient's needs are and base the amount of assistance on that. Dr. Stephanie Wheeler: It's probably worth saying again that the level at which we dichotomized these results was $180, which was sort of the median level of assistance provided. As you can imagine, there's a long tail, with some people receiving considerably more financial assistance. But I think it's really noteworthy that in the grand scheme of things, $180 per patient is a very small amount of money to provide to assist with things like housing support, transportation support, gas cards, and so forth. And the program does not have strict rules about how those funds are used. So, in our setting, where we've got a lot of rural patients potentially traveling hours across state in their own vehicles, gas cards are really important for them. But in other settings—more urban settings, for example—having flexibility in how those funds are used could be really helpful for people who need bus assistance or other public transportation beyond kind of having to drive a private vehicle to appointments.  Dr. Shannon Westin: It is a great point, and it is incredible how much you can do with a fairly little amount of money. And when we were talking about healthcare spending, obviously, that's a lot of money to an individual or a family. But in the grand scheme of what we spend on healthcare, that is a very, very small amount. So really, again, congratulations.  So I think the last question I'll ask is just kind of what are the next steps? And really should we be making sure that we have these programs everywhere? Do I need to go back and make sure that this kind of situation is set up in my institution? Dr. Stephanie Wheeler: Well, we also should share a little bit more about the economic evaluation results. Caitlin, why don't you describe that? Dr. Caitlin Biddell: Yeah, absolutely. And this speaks exactly to what you were talking about in terms of the amount of assistance that can go a really long way for a patient and is a drop in the bucket for a health system. So we did want to look at what the cost-effectiveness, or the cost consequence, of this program was from the health system perspective. And so we conducted a decision tree analysis, which is a method used in economic evaluation research, using kind of a hypothetical cohort of 350 patients, that mean number of radiation therapy encounters, 37 encounters over a six-month time horizon. And we did find that under the current funding of the model, which essentially is that philanthropy covers all of the financial assistance and then UNC Lineberger covers the cost of the staffing and the indirect cost of housing the program, we found that this program was estimated to save the health system $153 per missed appointment averted.  And then, in kind of an additional threshold analysis we conducted to see how much could the health system chip into this program in some way, whether it's through indirect cost or direct financial assistance, while still kind of breaking even from the perspective of no shows averted, and it was around $100 per patient. So, of course, that would be split across patients in different ways. Not everyone might receive that same amount. But there is opportunity here for health systems to make investments in reducing patient nonmedical barriers to care in a way that will come back in the form of saved revenue from averting missed appointments. Dr. Stephanie Wheeler: And the only thing I would add to that is this obviously was focused on those no-show appointments, but we anticipate that there's other financial benefits to the health system, like retention in care, patient satisfaction. There's a whole host of quality-of-life and clinical outcomes that are probably also benefited through use of this kind of nonmedical financial assistance program that we weren't able to measure. But I think part of our goal with this analysis is to start to make the case to hospitals and health systems that providing direct nonmedical financial assistance helps their bottom line as well. Dr. Shannon Westin: We, as clinicians and researchers, always want the benefit to the patients. But I agree, when you're dealing with administrators, we also need to show that. So I think that is super clever and a really nice part of the design.  So what's next steps for your research? Dr. Caitlin Biddell: Yeah, so I think we're currently kind of disseminating these findings within our own institution, so disseminating them back to the Cancer Patient Assistance Fund program so that they can use them in additional grant applications, but also really trying to get these findings in front of the health system administrators who might be able to make funding decisions surrounding this program. And then I think we are also thinking about ways to measure other endpoints beyond missed appointments. So we've kind of created this data set that involved some complicated linkages upfront, and now I do think there's opportunities to pull in other endpoints and even potentially some patient-reported endpoints as our electronic health records get better at collecting patient-reported data and even social determinant of health data, opportunities to really think about other impacts of this program.  And then I'll also add that there is talk among other groups at our institution about using this kind of approach to measure other similar programs. For example, we have a pretty large AYA program that does a lot of similar types of assistance and also psychosocial assistance. And so they're thinking about ways to use a similar methodology to evaluate some of their own work. So I think it's just kind of starting to open the door to thinking about how we can use the data we have within our institutions to really underscore the impacts that the programs that already exist are having on patients. Dr. Stephanie Wheeler: I would only add to Caitlin's fabulous answer that dissemination of this is really critical because we know that NCI-Designated Conference of Cancer Centers, the vast majority of them provide some kind of direct medical and nonmedical financial assistance, but many of them have restrictions on who can access those funds and eligibility criteria that preclude patients with certain cancers from accessing those funds or patients with still what we would consider to be relatively high financial vulnerability to not be able to access those funds. In addition to that, we know that community oncology practices less often have access to these kinds of financial support resources. And so what often happens—and this is an extremely fragmented space for patients and their caregivers to be navigating—is that when nonmedical financial needs present, people are left to their own devices to have to search out, seek out, and identify programs for which they're eligible in the community. And these are often funded by philanthropic organizations, really wonderful healthcare support organizations. But oftentimes these types of financial supports are not directly provided through the hospital, or if they are, they're in the form of “charity care provisions,” which are often opaque to patients and their caregivers to even find. And then the eligibility requirements for those programs, again, are often preventing access for a number of patients in need.   So what I would like to see, as a person who does a lot of research in this space around financial hardship, is for that burden to be shifting away from patients and caregivers and more towards the systems that are treating these patients and that are supporting the caregivers so that people can focus on what's important during their cancer care, which is getting treatment that's recommended, staying in treatment, and attaining the best possible health that they can. When patients and their families spend hours and hours and days and weeks trying to understand existing financial support programs in the community and then those disappear or evaporate, as they do when funding and contributions subside, that really has a very detrimental impact on the patient's entire care experience. And I think it's on us, as people who are part of the healthcare system, to ensure that that doesn't happen. And the financial case to hospitals is clear, I think, from this analysis, but the moral case to all of us, as providers, should be clear and should be compelling in itself.   Dr. Shannon Westin: On that note, I think that's a perfect way to end. Thank you so much. This was such an intriguing discussion, and I really hope people are listening that are making the decisions for their hospitals and will see how they can implement something like this in their institution.  Again, this was a discussion of “Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults with Cancer,” simultaneous publication in the JCO and presentation at the 2023 ASCO Quality Care Symposium on October 28th. It was great to have you all here. This was amazing, and I hope our listeners had a good time. And please do check out our other podcast offerings wherever you get your podcasts.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the Podcast do not express the opinions of ASCO. The mention of any product, service, organization, patient activity or therapy should not be construed as an ASCO endorsement.      

NCCID's new Mod4PH Research Highlights podcast showcases new and relevant mathematical modelling concepts and research for public health. Today, we will be speaking to Man Wah Yeung and Dr Beate Sander about the recently published Guidelines for the Economic Evaluation of Vaccination Programs in Canada, produced by the National Advisory Committee on Immunizations, or NACI. Man Wah is a Senior Health Economist at the Public Health Agency of Canada and Beate is a Canadian Research Chair in Economics of Infectious Diseases, Senior Scientist at the Toronto General Hospital Research Institute, and a Professor of at the University of Toronto. Man Wah and Beate are two of many experts who have worked together to create these guidelines on how to conduct economic evaluations of public health intervention strategies. This episode will provide an overview of the NACI Health Economics Guidelines, and how they can be used to inform best practices and promote standardized and high-quality evidence for public health decision making.

In this episode recorded at the 2023 SHEA Spring Meeting in Seattle, Martin talks to Associate Professor Alex Sundermann about his work on sequencing all isolates from local healthcare settings and the discoveries that this enables. Healthcare infections due to previous admissions, endoscopes, even pseudo-outbreaks are all laid bare by this approach. Some recent papers from the group are listed below: 1. Sundermann AJ, et al. Two artificial tears outbreak-associated cases of XDR Pseudomonas aeruginosa detected through whole genome sequencing-based surveillance. medRxiv. 2023. https://doi:10.1101/2023.04.11.23288417 2. Sundermann AJ, et al. Sensitivity of National Healthcare Safety Network definitions to capture healthcare-associated transmission identified by whole-genome sequencing surveillance. Infect Control Hosp Epidemiol. 2023:1-3. https://doi:10.1017/ice.2023.52 3. Branch-Elliman W, et al. The future of automated infection detection: Innovation to transform practice (Part III/III). Antimicrob Steward Healthc Epidemiol. 2023;3(1):e26. https://doi:10.1017/ash.2022.333 4. Sundermann AJ, et al. Whole-genome sequencing surveillance and machine learning for healthcare outbreak detection and investigation: A systematic review and summary. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e91. https://doi:10.1017/ash.2021.241 5. Sundermann AJ, et al. Whole-Genome Sequencing Surveillance and Machine Learning of the Electronic Health Record for Enhanced Healthcare Outbreak Detection. Clin Infect Dis. 2022;75(3):476-482. https://doi:10.1093/cid/ciab946 6. Sundermann AJ, et al. Outbreak of Pseudomonas aeruginosa Infections from a Contaminated Gastroscope Detected by Whole Genome Sequencing Surveillance. Clin Infect Dis. 2021;73(3):e638-e642. https://doi:10.1093/cid/ciaa1887 7. Kumar P, et al. Method for Economic Evaluation of Bacterial Whole Genome Sequencing Surveillance Compared to Standard of Care in Detecting Hospital Outbreaks. Clin Infect Dis. 2021;73(1):e9-e18. https://doi:10.1093/cid/ciaa512 8. Sundermann AJ, et al. Automated data mining of the electronic health record for investigation of healthcare-associated outbreaks. Infect Control Hosp Epidemiol. 2019:1-6. https://doi:10.1017/ice.2018.343

In this episode recorded at the 2023 SHEA Spring Meeting in Seattle, Martin talks to Associate Professor Alex Sundermann about his work on sequencing all isolates from local healthcare settings and the discoveries that this enables. Healthcare infections due to previous admissions, endoscopes, even pseudo-outbreaks are all laid bare by this approach. Some recent papers from the group are listed below: 1. Sundermann AJ, et al. Two artificial tears outbreak-associated cases of XDR Pseudomonas aeruginosa detected through whole genome sequencing-based surveillance. medRxiv. 2023. https://doi:10.1101/2023.04.11.23288417 2. Sundermann AJ, et al. Sensitivity of National Healthcare Safety Network definitions to capture healthcare-associated transmission identified by whole-genome sequencing surveillance. Infect Control Hosp Epidemiol. 2023:1-3. https://doi:10.1017/ice.2023.52 3. Branch-Elliman W, et al. The future of automated infection detection: Innovation to transform practice (Part III/III). Antimicrob Steward Healthc Epidemiol. 2023;3(1):e26. https://doi:10.1017/ash.2022.333 4. Sundermann AJ, et al. Whole-genome sequencing surveillance and machine learning for healthcare outbreak detection and investigation: A systematic review and summary. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e91. https://doi:10.1017/ash.2021.241 5. Sundermann AJ, et al. Whole-Genome Sequencing Surveillance and Machine Learning of the Electronic Health Record for Enhanced Healthcare Outbreak Detection. Clin Infect Dis. 2022;75(3):476-482. https://doi:10.1093/cid/ciab946 6. Sundermann AJ, et al. Outbreak of Pseudomonas aeruginosa Infections from a Contaminated Gastroscope Detected by Whole Genome Sequencing Surveillance. Clin Infect Dis. 2021;73(3):e638-e642. https://doi:10.1093/cid/ciaa1887 7. Kumar P, et al. Method for Economic Evaluation of Bacterial Whole Genome Sequencing Surveillance Compared to Standard of Care in Detecting Hospital Outbreaks. Clin Infect Dis. 2021;73(1):e9-e18. https://doi:10.1093/cid/ciaa512 8. Sundermann AJ, et al. Automated data mining of the electronic health record for investigation of healthcare-associated outbreaks. Infect Control Hosp Epidemiol. 2019:1-6. https://doi:10.1017/ice.2018.343

Dr. Martin Underwood discusses his article, "Supportive Self-Management Program for People With Chronic Headaches and Migraine: A Randomized Controlled Trial and Economic Evaluation". Show references: https://n.neurology.org/content/100/13/e1339

Dr. Ankur Pandya is an associate professor of health decision science at the Harvard T.H. Chan School of Public Health. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. G. Persad and A. Pandya. A Comprehensive Covid-19 Response — The Need for Economic Evaluation. N Engl J Med 2022;386:2449-2451.

Happy New Year!Brendan Newton is a husband, father, ex-professional bodyboarder, mental health awareness advocate, and recruitment manager for the Australian Indigenous Mentoring Experience (AIME). AIME builds “Unlikely Connections for a Fairer World.” Brendan's intense approach to the ocean translates into all aspects of his life–a life devoted to his family, inspiring others, and serving the disadvantaged.  He is also the host of The Grey Space podcast which is about "healing loudly by addressing mental health & trauma, gently, yet openly... A space to be honest."Learn More About AIMECase Study: Harvard Business Case on AIME Report: KPMG  Economic Evaluation of AIME MentoringPodcast: AIME's founder Jack Manning Bancroft on Tyson Yunkaporta's PodcastVideo: The Imagination FactoryVideo: AIME's ValuesVideo: AIME's Value of FailureA Quote From This Episode"Our current systems value the capacity to meet results immediately. That's a really difficult thing for someone who has been put on the margins for the first 10 years of their life–through no fault of their own."Resources Mentioned In This EpisodeBook: CHERUB by Robert Muchamore Movie: Dear Rider: The Jake Burton StoryJohn Wooden Quote: "If you're not making mistakes then you're not doing anything. I'm positive that a doer makes mistakes."About The International Leadership Association (ILA)The ILA was created in 1999 to bring together professionals with a keen interest in the study, practice, and teaching of leadership. Connect with Scott AllenWebsite

As we have seen over the last week President Biden has made climate change a major focus of his campaign. The framework for much of his proposed legislation rests on the Green New Deal. The Green New Deal is unique because of its radical nature, causing conflicting opinions, even among democrats.

On Episode 3 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two featured articles from the April 2021 issue of Stroke. This episode also features a conversation with Dr. Simon Nagel, from Heidelberg University in Germany, to discuss his article “Predictors for Failure of Early Neurological Improvement After Successful Thrombectomy in the Anterior Circulation.” Dr. Negar Asdaghi:                       1) Is Andexanet a cost-effective treatment for the reversal of coagulopathy in factor Xa-associated intracranial hemorrhage? 2)  Are statins safe and efficacious in secondary prevention of stroke in the elderly population? 3)  What are the predictors of futile recanalization amongst successfully treated patients with endovascular therapy? We have the answers to the above and much more in today's podcast. You're listening to Stroke Alert Podcast. Stay with us. Dr. Negar Asdaghi:                       From the Editorial Board of Stroke, welcome to the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. For the April 2021 issue of Stroke, we have an exciting program today where I have the privilege of interviewing Dr. Simon Nagel from Heidelberg University in Germany on predictors of failure of early neurological improvement or futile recanalization after successful thrombectomy. But first I want to review these two interesting articles. Dr. Negar Asdaghi:                       Factor Xa inhibitors, such as apixaban, edoxaban and rivaroxaban, are commonly used for prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation. Bleeding is a serious adverse consequence of treatment with anticoagulants, including factor Xa inhibitors, with intracranial hemorrhage representing the most devastating form of such adverse events. Dr. Negar Asdaghi:                       Anticoagulant-associated intracranial hemorrhage typically results in larger hematoma volumes, higher risk of expansion, and worst clinical outcomes as compared to their spontaneous counterparts and requires immediate reversal of coagulopathy. Andexanet alfa is a recombinant modified factor Xa protein which is an effective antidote to reverse this coagulopathy, though it comes with an increased risk of thromboembolic events, either from Andexanet itself or delayed or lack of resumption of anticoagulation in the setting of intracranial hemorrhage. Dr. Negar Asdaghi:                       It is important to note that the estimated cost of Andexanet is between $25-50,000 US dollars, depending on the standard versus high dose used, and this medication is currently not available in many countries, including in Canada, and even in the United States, it's still not accessible in many centers mainly due to its high cost. Now, when Andexanet is not available, the non-specific antidote of prothrombin complex concentrate, or PCC, is used, carrying an approximate cost of $4-8,000 US dollars, depending on the dosage used. Dr. Negar Asdaghi:                       PCC, which is a combination of various clotting factors, together with protein C and protein S, have a limited efficacy and reversal of Xa inhibitors coagulopathy. In the absence of randomized control trials to directly compare Andexanet to PCC, there remains a significant gap in knowledge with regards to comparative efficacy, adverse events, and cost-effectiveness of these therapies for life-threatening bleeding, specifically intracranial hemorrhage, in the setting of Xa inhibitor use. Dr. Negar Asdaghi:                       In the current issue of the journal, Dr. Andrew Micieli and colleagues from the Division of Neurology, Department of Medicine, Universities of Toronto and Calgary, in Canada, did a comparative analysis between Andexanet and PCC in a study titled “Economic Evaluation of Andexanet Versus Prothrombin Complex Concentrate for Factor Xa-Associated Intracranial Hemorrhage.” Using a patient population on chronic factor Xa inhibitor treatment, when presenting with an intracranial hemorrhage, the authors applied a probabilistic Markov model over a lifetime horizon for each patient to evaluate the cost and benefits if either Andexanet or PCC was administered to reverse the coagulopathy. Dr. Negar Asdaghi:                       Estimates of outcomes, dosing, and administration protocols for Andexanet were derived from the ANNEXA-4 study and from the UPRATE study for the PCC. These are two previously published large cohorts of treatment for these agents, respectively. Dr. Negar Asdaghi:                       So, what they found was an overall reduction in the occurrence of fatal intracranial hemorrhage with Andexanet therapy, estimated around 18%, as compared to PCC, estimated at 34%, specifically if the antidote was administered in the first cycle, which is the first 30 days following intracranial hemorrhage. This, of course, came at a cost of a higher thromboembolic event rate measured as composite outcome of myocardial infarction, TIA stroke, deep vein thrombosis or pulmonary embolism of approximately 10% in the Andexanet-treated group as compared to 5% in the PCC-treated group. Dr. Negar Asdaghi:                       Now, the cost analysis of the study is very interesting. The authors found that Andexanet, for its incremental effectiveness in gaining quality-adjusted life year, had an incremental cost over PCC. This cost-effectiveness ratio was close to $220,000 US dollar per quality-adjusted life year gain for Andexanet. Dr. Negar Asdaghi:                       And as such, as things stand today, this therapy is not cost-effective and represents low value for reversal of factor Xa–associated intracranial hemorrhage over the standard of care, which is PCC. So, this study provides an important insight, not only for the physicians, but also for health policymakers, as they critically evaluate the merits of Andexanet therapy compared to the current standard of care. Dr. Negar Asdaghi:                       So, moving on now from oral anticoagulants to statin therapies and other medication commonly used in the secondary prevention of ischemic stroke, the second article we will discuss today in our podcast looks at the use of statins poststroke in the elderly population. About a third of stroke patients are over the age of 80, and with the aging population and increased life expectancy, this proportion is estimated to double by year 2050. Dr. Negar Asdaghi:                       Stroke survivors who are over the age of 80 have increased 30-day and one-year mortality rates and remain at higher risk for recurrent cardiovascular events as compared to their younger counterparts. Statin therapy has been shown to reduce the risk of composite cardiovascular events in stroke survivors, but randomized data regarding their safety and efficacy in the elderly population is limited. Dr. Negar Asdaghi:                       Treatment with statin is not without its own challenges in the elderly population. These patients are more likely to be on multiple medications that can interact with statins, and there's also some evidence that the frail population may be more prone to statin side effects such as muscle pain, risk of rhabdomyolysis, increased blood glucose levels, increased risk of diabetes, and liver problems that have all been reported in the setting of statin use. Dr. Negar Asdaghi:                       In this issue of the journal, Drs. Lefeber and colleagues from the Department of Geriatrics in Utrecht University in Utrecht, Netherlands, study this subject in their paper titled “Statins After Ischemic Stroke in the Oldest: A Cohort Study Using the Clinical Practice Research Datalink Database.” This was a retrospective analysis of over 5,900 patients aged 65 years and older who were hospitalized and then discharged for a first ischemic stroke during a 17-year study period from 1999 to 2016 who were not on statin prescription in the year prior to their index hospitalization. Dr. Negar Asdaghi:                       The authors compared the primary outcome, which was a composite of recurrent stroke, myocardial infarction, and cardiovascular-related mortality, within the elderly patients, those over the age of 80, to the younger population, those over 65 but under 80 years of age, based on the number of years that they had a statin prescription poststroke. That is comparing at least two years of statin prescription time with no statin treatment or less than two years of prescription time compared to no treatment at all. Dr. Negar Asdaghi:                       So, what they found was that 53% of their population were actually over the age of 80, and in over half of these elderly patients, a statin was prescribed within 90 days of the index date. And not surprisingly, 38% of this elderly population had moderate to severe frailty, an index that has been linked to statin intolerance and its common myalgia side effect. Now, in terms of their main finding, more than two years of statin prescription compared to no statin prescription was significantly associated with a lower risk of the primary endpoint for both the over and the under 80 age groups. Dr. Negar Asdaghi:                       This association remained true in their adjusted model, not only for the primary outcome, but also for all-cause mortality rates, which was significantly lower in the statin-treated patients. After a correction for the mortality rate of close to 24% during the first two years, the number needed to treat for reduction of composite recurrent stroke, myocardial infarction, and cardiovascular-related mortality was 64 and the number needed to treat for reduction of all-cause mortality was 19 in the group over 80 on a statin prescription during a median follow-up of 3.9 years. Dr. Negar Asdaghi:                       So, in the absence of data from randomized controlled trials, this study provides reassuring results regarding the efficacy of statins in reduction of cardiovascular events in the patients aged 80 and older, keeping in mind that a third of the elderly population in the study was significantly frail, at risk for development of possible statin-related adverse effects. Dr. Negar Asdaghi:                       Much has changed in the field of reperfusion therapies since the publication of the positive results of the thrombectomy trials in 2015. Advances in patient selection processes, rapid access to advanced neuroimaging, the use of newer generations of thrombectomy devices, and improvement in systems of care have all played important roles in the growing success of endovascular therapy. Dr. Negar Asdaghi:                       But even with today's rigorous selection criteria and fast thrombectomy timelines, there remains a significant proportion of endovascularly treated patients in whom the successful radiographic recanalization do not translate into early neurological improvement. In our previous podcast, we report how the odds of favorable outcomes with thrombectomy decreases with an increase in the number of retrieval attempts during the procedure amongst successfully recanalized patients. Today, we dive deeper and look into other independent variables that may predict odds of futile recanalization. Dr. Negar Asdaghi:                       Joining me now is Dr. Simon Nagel from Department of Neurology at Heidelberg University Hospital in Germany, who is the senior author of the study titled “Predictors for Failure of Early Neurological Improvement After Successful Thrombectomy in the Anterior Circulation.” Good morning, Simon, and thank you for joining us. Dr. Simon Nagel:                           Good morning, or even good evening, from Germany. Thank you, Negar. It's a pleasure to be here, of course, especially in these times when you don't get to personally speak to a lot of international colleagues. Dr. Negar Asdaghi:                        That's great, Simon. Can you start us off, please, with some background on futile recanalization? What do we know about this medical work, and what prompted you to look into this topic in more detail? Dr. Simon Nagel:                           I guess, in most studies, futile recanalization is defined as a technically successful recanalization by a TICI score of 2b upwards, but an outcome on day 90 of only three to six points on the modified Rankin scale. And many papers have examined a selected number of parameters for the association with futile recanalization being either clinical, radiological, laboratory or procedural, which is why we wanted to be very comprehensive in our approach by including 38 different variables from the above-mentioned spectrum in our own analysis from our monocentric registry in Heidelberg. Dr. Negar Asdaghi:                        Perfect, so a very important concept to keep in mind in light of the increased demand to perform endovascular therapy. So, can you tell us, you alluded to it, but can tell us a bit more about the study design, the population you studied, and specifically why you choose failure of early neurological improvement at the time of discharge as opposed to that more conventional outcome measure of modified Rankin scale at day 90 poststroke? Dr. Simon Nagel:                           That's a good point, Negar, and you're right, we did maybe choose an unconventional end point since the definition of early neurological improvement is usually based on the NIHSS at 24 hours, but this study was driven from a very clinical perspective, that is the one from the stroke physician on the ward who is receiving the patient after the procedure, after all the acute decisions have been made. And then we have to do our best during the following days managing the complications, the deficit, and finding out why the stroke happened in the first place, until the patient is then either discharged home or back to the referring facility or to a normal board or to rehabilitation. Dr. Simon Nagel:                           But a considerable amount of patients, we found, did not improve until this discharge, although the procedure was a technical success. So some reasons for that are obvious, but some of them are not, and we wanted to find more about this, especially since early neurological improvement has been proposed as a surrogate for good outcome later on. Dr. Negar Asdaghi:                        Right. So we're very excited, Simon, to hear about the main study results. What were some of the predictors of failure of early neurological improvement in your study, and were you at all surprised by any of those developments? Dr. Simon Nagel:                           A lot of known factors that have been previously described to show an association with early neurological improvement or failure of that were found in our univariate analysis, namely 21 of 38, but only a few remained independent predictors after selecting with the elastic net approach and logistic regression modeling. Some of them are obvious by definition, which is symptomatic intracranial hemorrhage. Then, of course, the ASPECTS on follow-up was a predictor, and this obviously beat the baseline ASPECTS and also potentially the collateral score, which was significant in univariate analysis, but we included also over 20% of patients with a premorbid disability of more than two on the Rankin scale so premorbid condition was an independent predictor. Dr. Simon Nagel:                           We had eight patients with end stage renal failure in our analysis, so we did include that as well, and dialysis is a very strong predictor of failure of early neurological improvement. But also, admission glucose was, so higher levels of that, and then procedural parameters like reaching thrombolysis. So, if you do imply this, this was a factor that was positively associated with early neurological improvement. And then, also, the time from groin puncture to final recanalization was associated, so the longer it took, and this obviously beat also the stent retriever attempts in the analysis, the longer it took, the more likely that it was that failure of early neurological improvement was observed. And last but not least, general anesthesia was associated with that, but there is a sense of bias in this analysis because we have a SOP that we generally perform awake sedation. That means only patients that are not eligible for that, that are not doing well, will be treated under general anesthesia, so this variable has to be interpreted with caution. Dr. Negar Asdaghi:                        So, very interesting, Simon. I want to emphasize to our listeners that in your study, 20%, that is one in five successfully recanalized patient, did not clinically improve post-thrombectomy up until discharge. This is a considerable percentage to keep in mind. Now, in our day-to-day practice, many of us also accept a TICI 2b as a measure of a successful recanalization. In your study, you included a more rigorous definition of successful recanalization. How do you think your results would have changed had you included those who have achieved a TICI 2b, and why did you exclude that population? Dr. Simon Nagel:                           According to the mTICI definition, 2b means that more than half of the previously occluded vessel is reperfused, which also means that almost 50% is not. That might have been a success in the advent of thrombectomy and when this was defined in 2013, but I don't think it's adequate to call this a successful recanalization these days. When this was re-defined by David Liebeskind in 2018 with a eTICI score, 2b is still not considered anything more than two-third of the territory, and only 2c is a nearly complete reperfusion, leaving just 10% of the vessel territory occluded or not reperfused. Dr. Simon Nagel:                           This is why we thought it is a more appropriate definition of successful thrombectomy, and this is what we think should be attempted in day-to-day practice. In our cohort, almost 50% achieve TICI 2c or 3, and if we would have included 2b, 83% of patients would have achieved that. I can't tell you what our analysis would have looked like if we included 2b, it might have been different, but I can tell you that that would require a new analysis of the data. Dr. Negar Asdaghi:                        Yes, and we keep that in mind for sure that the new way of definition is to keep 2c or better. So Simon, I agree that definitely your study has given us a clear roadmap regarding early outcome expectations in patients undergoing thrombectomy. What should be our final take-away from your study? Dr. Simon Nagel:                           I guess, before I can tell you, you have to bear in mind that this is a monocentric retrospective analysis, hence, there is bias to be expected, and choosing a different definition of early neurological improvement then may be useful, might have given us a different result. It is also important to be clear from what perspective you are looking at the data. For example, this analysis does not necessarily help with predictors for outcome that help you make a decision if you should treat the patient or not since we included many parameters that are not yet available at that point in time when you need to make the decision to treat the patient. Dr. Simon Nagel:                           But, I think it's fair to say that you should, according to our results, apply thrombolysis whenever indicated, that you should be as quick as possible with your procedure, and that you should manage blood sugar well, as well as other medical complications, and that you should not expect too much early improvement in case the patient has a premorbid condition or if the motor cortex is involved, which was also a significant outcome, which I didn't mention earlier, and, of course, by definition, if symptomatic hemorrhage occurs. Dr. Simon Nagel:                           Hemorrhagic transformations, on the other side, do not seem to independently influence failure of early neurological improvement. Dr. Negar Asdaghi:                        Dr. Simon Nagel, it's always a pleasure speaking with you, and thank you for being with us. And this concludes our podcast for the April 2021 issue of Stroke. And as I leave you today, I want to remind us all that for every minute left untreated a brain under an ischemic attack loses an average of 1.9 million neurons. So whether you're just starting off or you're a well-established clinician or researcher in the field of vascular neurology, your work and that of your colleagues are part of a quest to save the most valuable commodity of human life, which is the brain, and, for that, we're proud to review your work in stroke and highlight the best in vascular neurology in our future podcasts. So until our next podcast, stay alert with Stroke Alert.

The question of the role of the private sector in providing health care in Canada is both complex and politically charged. In this presentation, Dr. McCabe will seek to separate out issues of fact from issues of value and explore the importance of each in assessing the impact of different potential models of private health care in the Canadian context. Speaker:Dr. Christopher McCabe CEO & Executive Director of the Institute of Health Economics (IHE). Dr. McCabe brings more than 25 years of experience as a health economist to his role with the organization. He trained and worked for 20 years in the UK before emigrating to Canada. During this time, he held Full Professorships at the Universities of Sheffield, Warwick and Leeds. He was more recently a Professor of Health Economics at the University of Alberta, where he was appointed Capital Health Endowed Research Chair at the University of Alberta. In this position he led two Genome Canada funded research groups focused on the evaluation, adoption and implementation of Precision Medicine technologies. He also served on the Canadian Agency for Drugs and Technologies in Health Care (CADTH) Health Economics Working Group, which authored the 4th Edition of the CADTH Guidelines for the Economic Evaluation of Health Technologies in 2017. He was lead author of the 2019 addendum to the CADTH Guidelines focused on co-dependent therapies. More recently Dr. McCabe advised the Patented Medicines Price Review Board on the technical issues related to the revision of their regulations for setting the price of new drugs in Canada. He is currently Chair of the Royal Society of Canada COVID Task Force Working Group on the Economy. Date and time: Thursday March 18, 2021 – 10:00 AM (MST) YouTube Live link: https://youtu.be/Pg4DT3xH1F8 In order to ask questions of our speaker in the chat feature of YouTube, you must have a YouTube account and be signed in. Please do so well ahead of the scheduled start time, so you'll be ready. Go the YouTube Live link provided in this session flyer and on the top right of your browser click the “sign in” button. If you have Google or Gmail accounts, they can be used to sign in. If you don't, click “Create Account” and follow along. Once you are signed in, you can return to the live stream and use the chat feature to ask your questions of the speaker. Remember you can only participate in the chat feature while we are livestreaming. Link to SACPA's YouTube Channel: https://www.youtube.com/channel/UCFUQ5mUHv1gfmMFVr8d9dNA

Welcome back to the VTE Dublin Podcast where you’ll find all the recent talks from the VTE Dublin Conference. Be sure to subscribe to the VTE Dublin Podcast Thromboprophylaxis for lower limb immobilisation after injury (TiLLI): Systematic review and economic evaluation Prof. Dan Horner | Professor of the Royal College of Emergency Medicine | Consultant […]

Editorial

Hvordan regner man, økonomisk på helse? Og når vi har en offentlig finansiert helsesektor og vi felles tar regning, blir det da en bedre eller dårligere helsetjeneste? I denne episoden av #LØRN snakker Silvija med førsteamanuensis og PhD ved Universitetet i Oslo, Eline Aas, om viktigheten av at helseøkonomiske perspektiv inkluderes i kliniske forsøk. — Hvilke metoder vi benytter kan være nyttige, ikke bare til å evaluere nye behandlinger og legemidler i kjølvannet av kliniske forsøk, men også som et nyttig verktøy i innovasjonsprosjekter, forteller hun i episoden. Dette lørner du: HelseøkonomiEffektanalyserPresisjonsmedisinEksperimentelle behandlinger Offentlig vs privat helsetjenesteAnbefalt litteratur: Jan Abel Olsen – Helseøkonomi, effektivitet og rettferdighetMike Drummond og medforfattere (Methods for Economic Evaluation of Health Care interventions)Peter Neuman og kollegaer (Cost-effectiveness in Health and Medicine)Denne episoden er laget i samarbeid med Bigmed prosjektet ved Oslo Universitetssykehus See acast.com/privacy for privacy and opt-out information.

Madame Sandrine Monot et le Docteur Messika du service de réanimation médico-chirurgicale du centre hospitalier Louis Mourier de Colombe nous parlent de la musicothérapie en réanimation Articles en lien :Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trialJAMA. 2013 Jun 12, doi: 10.1001/jama.2013.5670. A musical intervention for respiratory comfort during noninvasive ventilation in the ICU.Eur Respir J. 2019 Jan 17, doi: 10.1183/13993003.01873-2018. The influence of music during mechanical ventilation and weaning from mechanical ventilation: A reviewHeart Lung. 2015 Sep-Oct, doi: 10.1016/j.hrtlng.2015.06.010. Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support, Crit care med 2018, doi: 10.1097/CCM.0000000000003199

Interview with Ivo Abraham, PhD, author of Economic Evaluation of Talimogene Laherparepvec Plus Ipilimumab Combination Therapy vs Ipilimumab Monotherapy in Patients With Advanced Unresectable Melanoma

Interview with Ivo Abraham, PhD, author of Economic Evaluation of Talimogene Laherparepvec Plus Ipilimumab Combination Therapy vs Ipilimumab Monotherapy in Patients With Advanced Unresectable Melanoma

Sarina Isenberg, interviewed by Ross Upshur, discusses palliative care from the lens of a scientist and health researcher committed to making a difference for those who receive such care in the course of their disease. Sarina’s first experience with palliative care was at a relatively young age when two loved ones were in palliative care in the course of their terminal illnesses. Later, her studies in health-related subjects landed Sarina in palliative care study and research, which is a subject area with great challenges in any health system in the world in terms of complexity, cost and degree of needed care. As mentioned in the podcast, palliative care is no longer limited to end-of-life care. The shifting face of palliative care, in light of the aging population in Canada, is a great opportunity for Sarina and others to research palliative care with the intent of improving access to, and the quality of palliative care. Sarina Isenberg is a Scientist at the Temmy Latner Centre for Palliative Care and the Lunenfeld-Tanenbaum Research Institute (both at Sinai Health System), as well as an Assistant Professor in the Department of Family and Community Medicine – Division of Palliative Care at the University of Toronto. Her research has leveraged  varied health services approaches—both quantitative and qualitative—to assess access to and quality of palliative care,(1, 2) evaluate the cost effectiveness of palliative care inpatient services,(3, 4) and test interventions for improving advance care planning discussions.(5-7) Sarina’s ongoing work also relates to evaluating the cost effectiveness of home-based palliative care, assessing the patient and caregiver experience of receiving palliative care, transitioning across palliative care settings, and designing and implementing quality improvement initiatives in palliative care. Sarina’s central research goal is to apply a public health approach to palliative care research that is translatable to decision-makers, practitioners, patients, and their companions. Sarina has worked with knowledge users translating research into practice and policy through collaborations with Ontario Palliative Care Network, Veterans Affairs Canada,(8) the American Society of Clinical Oncology,(9) and the Agency for Health Research and Quality. (10) Sarina received her PhD in Social and Behavioral Sciences at the Johns Hopkins Bloomberg School of Public Health. She has previously worked as a management consultant on Deloitte’s National Health Services Team (Canada). Prior to consulting, Sarina received her MA in English Literature from Queen’s University and her BA in English Literature from McGill University. Find out how she puts those humanities degrees to work in her role as a scientist in this podcast. Link to some of Sarina’s articles on PubMed, so far.  References in this article: 1. Aslakson R, Dy SM, Wilson RF, et al. Patient and caregiver-reported assessment tools for palliative care: summary of the 2017 AHRQ Technical Brief. J Pain Symptom Manage. 2017 Aug 14. PubMed PMID: 28818633. Epub 2017/08/19. eng. 2. Dy SM, Al Hamayel NA, Hannum SM, et al. A survey to evaluate facilitators and barriers to quality measurement and improvement: Adapting tools for implementation research in palliative care programs. J Pain Symptom Manage. 2017 Aug 08. PubMed PMID: 28801007. Epub 2017/08/13. eng. 3. Isenberg SR, Lu C, McQuade J, et al. Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions. Journal of Oncology Practice. 2017;epub ahead of print. 4. Isenberg SR, Lu C, McQuade J, et al. Economic Evaluation of a Hospital-Based Palliative Care Program. Journal of Oncology Practice. 2017;epub ahead of print. 5. Aslakson RA, Isenberg SR, Crossnohere NL, et al. Utilizing Advance Care Planning Videos to Empower Perioperative Patients and Families: The Protocol...

“Don’t be afraid to try new things” - James Hasegawa This is a special episode in Health Economics and Outcomes Research (HEOR) with James Hasegawa. James is a director at Abbott and is responsible for HEOR projects. In this episode, James shares insights on how healthcare reimbursement works as it related to clinical trials. We also dig into the world of Health Technology Assessment (HTA) groups and what it takes to model reimbursement for a medical product. If you’re interested in breaking from the silos of clinical research and learn about important adjacent functions such as HEOR, this episode is for you. Do you have a topic idea for my next podcast episode? If so, leave me your suggestion is the comments section below. Listen to it on iTunes.Stream by clicking here.Download as an MP3 by right-clicking here and choosing “save as.” Selected Links from the Episode Connect with James LinkedIn Medicare International Society for Pharmacoeconomics and Outcomes Research (IPSOR) BIO conference Stanford Biodesign Program Centre for Health Economics at University of York The National Institute for Health and Care Excellence (NICE) What is a MAC? Hospital Readmissions Reduction Program Books Mentioned: Leading at Mach 2 by Steve Sullivan Good to Great by Jim Collins The Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell Biodesign: The Process of Innovating Medical Technologies by Paul G. Yock and Stefanos Zenios Methods for the Economic Evaluation of Health Care Programmes (Oxford Medical Publications) by Michael F. Drummond,‎ Mark J. Sculpher,‎ Karl Claxton,‎ Greg L. Stoddart,‎ George W. Torrance Show Notes: What is Health Economics [01:52] James’s personal story: career path to HEOR [06:09] Daily routine of HEOR professionals [13:26] NICE and other HTA [14:30] HTA in the United States [15:15] HTA vs. MAC [16:30] The future of HEOR [18:59] Hospital Readmissions Reduction Program (HRRP) [19:58] Economic value and what should a medical product start-up do? [24:17] How to find HEOR consultants [25:00] Qualities of HEOR people [28:06] Health economic model: how to make one? [28:57] Working with Medicare Administrative Contractor (MAC) [31:38] The future of HEOR (continued) [33:20] On Big Data [34:57] Leveraging HEOR data in countries such as US and Japan [36:52] How does HTA function in the US [38:26] Resources and guidance documents on HTAs [40:23] HTA review process in Japan [43:30] Trick to learning other therapeutic areas [47:55] What was most useful for you in this episode? Leave me a comment below and thanks for listening.

In this episode Dr Alastair Canaway (Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick) presents the findings of  study which aimed to develop an outcome measure suitable for use in economic evaluation that captures the benefits of end-of-life care to those close to the dying. Full paper from: http://journals.sagepub.com/doi/abs/10.1177/0269216316650616

Economic evaluation for informed decision-making in health care.

Ensuring consistency between economic evaluations in health care.

Economic evaluation of healthcare interventions follows the guideline produced by the National Institute for Health and Care Excellence (NICE). NICE recommends a Cost Utility Analysis (CUA) approach where outcomes are health effects on patients (and carers where relevant) expressed in terms of Quality Adjusted Life Years (QALYs), and costs are restricted to only those falling on the budgets of the NHS and Social Services. An individual-level simulation is developed to estimate all costs and consequences of several healthcare interventions for dementia. Then, two different decision making approaches are applied to determine which option has the best value for money. These approaches account for a broad range of costs and consequences for both the NHS, people with dementia, and informal caregivers. The research will contribute to the development of a new decision making framework at national level to approve health care interventions for people with dementia.

Nick Sherwood discusses the Herefordshire Economic Evaluation, Opportunities to grow our local economy, which can be downloaded from http://www.reconomy.org/herefordshire-economic-evaluation-reports-now-available/.

Background: Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. Methods: To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. Results: The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. Conclusions: The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test.

This podcast covers the JBJS issue for July 2011. Featured are articles covering: Adjacent-Level Cervical Ossification After Bryan Cervical Disc Arthroplasty Versus ACDF; recorded commentary by Dr. Hart; Pediatric Pedicle Screws - Comparative Effectiveness and Safety; Venous Thromboembolism in Patients Having Knee Replacement and Receiving Thromboprophylaxis; recorded commentary by Dr. Leopold; An Economic Evaluation of a Systems-Based Strategy to Expedite Surgical Treatment of Hip Fractures.

This podcast covers the JBJS issue for July 2011. Featured are articles covering: Adjacent-Level Cervical Ossification After Bryan Cervical Disc Arthroplasty Versus ACDF; recorded commentary by Dr. Hart; Pediatric Pedicle Screws - Comparative Effectiveness and Safety; Venous Thromboembolism in Patients Having Knee Replacement and Receiving Thromboprophylaxis; recorded commentary by Dr. Leopold; An Economic Evaluation of a Systems-Based Strategy to Expedite Surgical Treatment of Hip Fractures.

Professor Simon Gowers speaks about the clinical effectiveness of treatments for anorexia and the cost-effectiveness of three treatment strategies for adolescents with anorexia nervosa.

Christopher Cox, MD, and Shannon Carson, MD, discuss an article published in the August 2007 issue of Critical Care Medicine, titled "An economic evaluation of prolonged mechanical ventilation." Dr. Cox, the lead author of this article, is an assistant professor at Duke University and Dr. Carson is an associate professor at the University of North Carolina. (Crit Care Med 2007; 35(8):1918)