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Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial.

Neilson AR, Bruhn H, Bond CM, Elliott AM, Smith BH, Hannaford PC, Holland R, Lee AJ, Watson M, Wright D, McNamee P - BMJ Open (2015)

Bottom Line: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212).Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248).

View Article: PubMed Central - PubMed

Affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.

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Related in: MedlinePlus

Value of expected value of sample information (EVSI) analysis. The expected net benefit of sampling at specified randomised controlled trial (RCT) sizes using a threshold of £20 000 per quality-adjusted life years (QALY) gained for (A) Prescribing versus treatment as usual (TAU), (C) Review versus TAU and using a threshold of £30 000 per QALY gained for (B) Prescribing versus TAU and (D) Review versus TAU. From regression analysis with adjustment for baseline costs, baseline short form six-dimension (SF-6D), and other patient characteristics (including age, sex, material status, education, work status, income chronic pain grade (CPG)-intensity). The number of participants with data on all these baseline variables: prescribing (n=35), review (n=39), TAU (n=34). ENG, expected net gain; EVSI, expected value of sample information; n, number of patients in each arm; SS, sample size.
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BMJOPEN2014006874F2: Value of expected value of sample information (EVSI) analysis. The expected net benefit of sampling at specified randomised controlled trial (RCT) sizes using a threshold of £20 000 per quality-adjusted life years (QALY) gained for (A) Prescribing versus treatment as usual (TAU), (C) Review versus TAU and using a threshold of £30 000 per QALY gained for (B) Prescribing versus TAU and (D) Review versus TAU. From regression analysis with adjustment for baseline costs, baseline short form six-dimension (SF-6D), and other patient characteristics (including age, sex, material status, education, work status, income chronic pain grade (CPG)-intensity). The number of participants with data on all these baseline variables: prescribing (n=35), review (n=39), TAU (n=34). ENG, expected net gain; EVSI, expected value of sample information; n, number of patients in each arm; SS, sample size.

Mentions: The EVSI investigated the cost-effectiveness of carrying out a larger RCT of pharmacist prescribing and pharmacist review versus TAU. The parameters used in the EVSI calculation and the resulting expected EVSI is given in figure 2, which also shows the expected costs of the RCT and the resultant ENG. The expected costs of running the proposed trial rise linearly as the sample size (n) is increased; however, the expected benefits diminish as the sample size increases after a certain point, giving the optimal number of patients in each arm of the RCT. The ‘optimal trial size’ (SS) is estimated as 780 per arm (prescribing vs TAU comparison) and 540 per arm (review vs TAU comparison) using a cost per QALY threshold of £20 000 and 690 per arm (prescribing vs TAU comparison), and 460 per arm (review vs TAU comparison) using a cost per QALY threshold of £30 000.


Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial.

Neilson AR, Bruhn H, Bond CM, Elliott AM, Smith BH, Hannaford PC, Holland R, Lee AJ, Watson M, Wright D, McNamee P - BMJ Open (2015)

Value of expected value of sample information (EVSI) analysis. The expected net benefit of sampling at specified randomised controlled trial (RCT) sizes using a threshold of £20 000 per quality-adjusted life years (QALY) gained for (A) Prescribing versus treatment as usual (TAU), (C) Review versus TAU and using a threshold of £30 000 per QALY gained for (B) Prescribing versus TAU and (D) Review versus TAU. From regression analysis with adjustment for baseline costs, baseline short form six-dimension (SF-6D), and other patient characteristics (including age, sex, material status, education, work status, income chronic pain grade (CPG)-intensity). The number of participants with data on all these baseline variables: prescribing (n=35), review (n=39), TAU (n=34). ENG, expected net gain; EVSI, expected value of sample information; n, number of patients in each arm; SS, sample size.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390732&req=5

BMJOPEN2014006874F2: Value of expected value of sample information (EVSI) analysis. The expected net benefit of sampling at specified randomised controlled trial (RCT) sizes using a threshold of £20 000 per quality-adjusted life years (QALY) gained for (A) Prescribing versus treatment as usual (TAU), (C) Review versus TAU and using a threshold of £30 000 per QALY gained for (B) Prescribing versus TAU and (D) Review versus TAU. From regression analysis with adjustment for baseline costs, baseline short form six-dimension (SF-6D), and other patient characteristics (including age, sex, material status, education, work status, income chronic pain grade (CPG)-intensity). The number of participants with data on all these baseline variables: prescribing (n=35), review (n=39), TAU (n=34). ENG, expected net gain; EVSI, expected value of sample information; n, number of patients in each arm; SS, sample size.
Mentions: The EVSI investigated the cost-effectiveness of carrying out a larger RCT of pharmacist prescribing and pharmacist review versus TAU. The parameters used in the EVSI calculation and the resulting expected EVSI is given in figure 2, which also shows the expected costs of the RCT and the resultant ENG. The expected costs of running the proposed trial rise linearly as the sample size (n) is increased; however, the expected benefits diminish as the sample size increases after a certain point, giving the optimal number of patients in each arm of the RCT. The ‘optimal trial size’ (SS) is estimated as 780 per arm (prescribing vs TAU comparison) and 540 per arm (review vs TAU comparison) using a cost per QALY threshold of £20 000 and 690 per arm (prescribing vs TAU comparison), and 460 per arm (review vs TAU comparison) using a cost per QALY threshold of £30 000.

Bottom Line: Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6 months and EVSI for sample size calculation.After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI -82 to 237) and £54 for review (95% CI -103 to 212).Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI -0.0091 to 0.0229) and 0.0097 for review (95% CI -0.0054 to 0.0248).

View Article: PubMed Central - PubMed

Affiliation: Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.

Show MeSH
Related in: MedlinePlus