Pub. 160268 [email protected] Également disponible en français sous le ti... more Pub. 160268 [email protected] Également disponible en français sous le titre : Promotion de la santé et prévention des maladies chroniques au Canada : Recherche, politiques et pratiques Submission guidelines and information on article types are available at: http://www.phac-aspc.gc.ca/publicat/hpcdp-pspmc/authinfo-eng.php Inside this issue 35 Editorial-The weight of our nation 37 Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts 49 The cost of diabetes in Canada over 10 years: applying attributable health care costs to a diabetes incidence prediction model 54 The burden of generalized anxiety disorder in Canada 63 Other PHAC publications
Canadians spent an estimated $228 billion on health care in 2016. That represents 11.1% of our to... more Canadians spent an estimated $228 billion on health care in 2016. That represents 11.1% of our total economy, or $6,299 per person. Almost 40% of all public expenditures are allocated to fund health care. 1 Put succinctly, that is a lot of money! This issue of Health Promotion and Chronic Disease Prevention in Canada places a spotlight on three diseases that contribute to this economic burden of health care in Canada.
Promotion de la santé et prévention des maladies chroniques au Canada, 2017
En 2016, les Canadiens ont dépensé environ 228 milliards de dollars en soins de santé, soit 11,1 ... more En 2016, les Canadiens ont dépensé environ 228 milliards de dollars en soins de santé, soit 11,1 % de notre économie totale, ou 6 299 dollars par habitant. Presque 40 % des dépenses publiques sont consacrées au financement des soins de santé 1. En résumé, cela fait beaucoup d'argent! Ce numéro de Promotion de la santé et prévention des maladies chroniques au Canada met l'accent sur trois maladies contribuant à ce fardeau économique des soins de santé au Canada.
The details of our base model have been previously published. 16 In short, we used an approach ba... more The details of our base model have been previously published. 16 In short, we used an approach based on population attributable
OBJECTIVES: Tobacco smoking, excess weight and physical inactivity contribute substantially to th... more OBJECTIVES: Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to determine the potential reduction in economic burden if all provinces achieved prevalence rates of these three risk factors (RFs) equivalent to those of the province with the lowest rates, and to update and address a limitation noted in our previous model. METHODS: We used a previously developed approach based on population attributable fractions to estimate the economic burden associated with these RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling. The previous model was updated using the most current data for developing resource allocation weights. RESULTS: In 2012, the prevalence of tobacco smoking, excess weight and physical inactivity was the lowest in British Columbia. If age-and sex-specific prevalence rates from BC were applied to populations living in the other provinces, the annual economic burden attributable to these three RFs would be reduced by $5.3 billion. Updating the model resulted in a considerable shift in economic burden from smoking to excess weight, with the estimated annual economic burden attributable to excess weight now 25% higher compared to that of tobacco smoking ($23.3 vs. $18.7 billion). CONCLUSION: Achieving RF prevalence rates equivalent to those of the province with the lowest rates would result in a 10% reduction in economic burden attributable to excess weight, smoking and physical inactivity in Canada. This study shows that using current resource use data is important for this type of economic modelling.
OBJECTIVES: The objectives of this study were to determine the proportion of the population that ... more OBJECTIVES: The objectives of this study were to determine the proportion of the population that meets or exceeds Canada's Food Guide (CFG) recommendations regarding the number of daily servings of fruits and vegetables (F/V), to assess trends in this proportion between 2000 and 2013, to estimate the annual economic burden attributable to inadequate F/V consumption within the context of other important risk factors, and to estimate the short-and long-term costs that could be avoided if modest improvements were made to F/V consumption in Canada. METHODS: We used a previously developed methodology based on population-attributable fractions and a prevalence-based cost-of-illness approach to estimate the economic burden associated with low F/V consumption. RESULTS: Over three quarters of Canadians are not meeting CFG recommendations regarding the number of daily servings of F/V, leading to an annual economic burden of $4.39 billion. If a 1% relative increase in F/V consumption occurred annually between 2013 and 2036, the cumulative reduction in economic burden over the 23-year period would reach $8.4 billion. Consumption levels of F/V, and the resulting economic burden, varied by sex, age and province. CONCLUSION: A significant majority of Canadians are not consuming the recommended daily servings of F/V, with important consequences to their health and the Canadian economy. Programs and policies are required to encourage F/V consumption in Canada.
BackgroundDespite the long-standing experience of rating the evidence for clinical preventive ser... more BackgroundDespite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing.MethodsWe calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year g...
Previous estimates of the number and prevalence of individuals experiencing the effects of stroke... more Previous estimates of the number and prevalence of individuals experiencing the effects of stroke in Canada are out of date and exclude critical population groups. It is essential to have complete data that report on stroke disability for monitoring and planning purposes. The objective was to provide an updated estimate of the number of individuals experiencing the effects of stroke in Canada (and its regions), trending since 2000 and forecasted prevalence to 2038. The prevalence, trends, and projected number of individuals experiencing the effects of stroke were estimated using region-specific survey data and adjusted to account for children aged <12 years and individuals living in homes for the aged. In 2013, we estimate that there were 405 000 individuals experiencing the effects of stroke in Canada, yielding a prevalence of 1.15%. This value is expected to increase to between 654 000 and 726 000 by 2038. Trends in stroke data between 2000 and 2012 suggest a nonsignificant dec...
Type 1 diabetes is the most common form of diabetes among children; however, the proportion of ca... more Type 1 diabetes is the most common form of diabetes among children; however, the proportion of cases of childhood type 2 diabetes is increasing. In Canada, the National Diabetes Surveillance System (NDSS) uses administrative health data to describe trends in the epidemiology of diabetes, but does not specify diabetes type. The objective of this study was to validate algorithms to classify diabetes type in children &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 yr identified using the NDSS methodology. We applied the NDSS case definition to children living in British Columbia between 1 April 1996 and 31 March 2007. Through an iterative process, four potential classification algorithms were developed based on demographic characteristics and drug-utilization patterns. Each algorithm was then validated against a gold standard clinical database. Algorithms based primarily on an age rule (i.e., age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 at diagnosis categorized type 1 diabetes) were most sensitive in the identification of type 1 diabetes; algorithms with restrictions on drug utilization (i.e., no prescriptions for insulin ± glucose monitoring strips categorized type 2 diabetes) were most sensitive for identifying type 2 diabetes. One algorithm was identified as having the optimal balance of sensitivity (Sn) and specificity (Sp) for the identification of both type 1 (Sn: 98.6%; Sp: 78.2%; PPV: 97.8%) and type 2 diabetes (Sn: 83.2%; Sp: 97.5%; PPV: 73.7%). Demographic characteristics in combination with drug-utilization patterns can be used to differentiate diabetes type among cases of pediatric diabetes identified within administrative health databases. Validation of similar algorithms in other regions is warranted.
Objective To describe adherence to clinical practice guidelines for the treatment of childhood ty... more Objective To describe adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes and identify associated patient and system level factors. Study design This prospective cohort study used population-based administrative data to describe individuals aged 1-24 years who had been diagnosed with type 1 diabetes at <20 years of age (1472 unique individuals and 5883 person-years over a 7-year period) living in British Columbia, Canada. The outcome measure was proportion 'at goal,' which was defined as having optimal adherence (3 diabetes-related physician visits/year, 3 hemoglobin A1c (HbA1c) tests/year, 1 glucagon prescription dispensed/year, and appropriate screening for diabetes-related comorbidity [ie, hypothyroidism] and complications [ie, retinopathy and nephropathy]), or good adherence to guidelines (2 diabetes-related physician visits/year, 2 HbA1c tests/year, and appropriate screening for diabetes-related comorbidity and complications). Statistical methods included descriptive statistics and logistic regression modeling. Results Fifty-four percent person-years had poor adherence to guidelines (<2 diabetes-related physician visits and HbA1c tests/year) and 7.4% had optimal adherence. The proportion of person-years at goal was higher in females vs males (41.0% vs 37.6%; P = .007). Individuals 4-years post-diagnosis of diabetes were 78% less likely to be at goal compared with the year of diagnosis (P < .0001). Conclusions The treatment of pediatric type 1 diabetes likely does not meet national and international standards. Future studies should explore facilitators and barriers to adherence to guidelines among health care providers, patients, and families, and whether adherence to guidelines is associated with glycemic control.
Access to general practice services 55 Emergency room visits 63 Home-based professional services ... more Access to general practice services 55 Emergency room visits 63 Home-based professional services 71 Home support services 79 Diabetes 87 Congestive heart failure 95
Background and Purpose— Evidence-based stroke care has been shown to improve patient outcomes and... more Background and Purpose— Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. Methods— Several independent data sources, including the Canadian Institute of Health Information Discharge Database, the 2008–2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of...
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of basiliximab (20 mg intravenously daily on day 0 and day 4 after the transplant) for the prevention of renal allograft rejection. Basiliximab is a chimeric alpha-chain of the interleukin-2 receptor, which is important in activating the immune response. The patients were assessed at predetermined intervals during the first 12 months after transplant. Type of intervention Secondary prevention. Economic study type Cost-effectiveness analysis. Study population The study population comprised patients who had just undergone renal transplant. Setting The setting was a hospital. The economic analysis was conducted as part of a multi-centre trial that took place in Canada,
The current paper summarizes relevant recent research on the high risk of recurrence, multiple sk... more The current paper summarizes relevant recent research on the high risk of recurrence, multiple skin cancers and second primary cancers in the growing number of people with a history of skin cancer; the ultimate purpose is to better assess the burden of ...
Results: There were 79 175 people in cohort 1 and 92 320 in cohort 2. Overall, the relative propo... more Results: There were 79 175 people in cohort 1 and 92 320 in cohort 2. Overall, the relative proportion of people in each use category was similar between the 2 study periods. The most substantial changes were an increase of 2 percentage points in the proportion of people who ...
A study of the quality of life and cost-utility of renal transplantation. The objective of this s... more A study of the quality of life and cost-utility of renal transplantation. The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after ...
Solid organ transplantation has advanced over the past decade to the point at which it is now a r... more Solid organ transplantation has advanced over the past decade to the point at which it is now a realistic form of treatment for irreversible failure of many vital organs. While organ transplantation is becoming increasingly successful, the cost of the procedures is still very high. As with all high cost medical procedures, decisions need to be made about the cost-effectiveness of solid organ transplantation. A review of the available literature with respect to the quality of life of the patient and the economic evaluation of transplantation, subdivided in regard to specific organs, is presented. A number of issues which need to be taken into account and reinforced when contemplating policy decisions based on the economic evaluation of solid organ transplantation are then discussed.
Pub. 160268 [email protected] Également disponible en français sous le ti... more Pub. 160268 [email protected] Également disponible en français sous le titre : Promotion de la santé et prévention des maladies chroniques au Canada : Recherche, politiques et pratiques Submission guidelines and information on article types are available at: http://www.phac-aspc.gc.ca/publicat/hpcdp-pspmc/authinfo-eng.php Inside this issue 35 Editorial-The weight of our nation 37 Multiple sclerosis in Canada 2011 to 2031: results of a microsimulation modelling study of epidemiological and economic impacts 49 The cost of diabetes in Canada over 10 years: applying attributable health care costs to a diabetes incidence prediction model 54 The burden of generalized anxiety disorder in Canada 63 Other PHAC publications
Canadians spent an estimated $228 billion on health care in 2016. That represents 11.1% of our to... more Canadians spent an estimated $228 billion on health care in 2016. That represents 11.1% of our total economy, or $6,299 per person. Almost 40% of all public expenditures are allocated to fund health care. 1 Put succinctly, that is a lot of money! This issue of Health Promotion and Chronic Disease Prevention in Canada places a spotlight on three diseases that contribute to this economic burden of health care in Canada.
Promotion de la santé et prévention des maladies chroniques au Canada, 2017
En 2016, les Canadiens ont dépensé environ 228 milliards de dollars en soins de santé, soit 11,1 ... more En 2016, les Canadiens ont dépensé environ 228 milliards de dollars en soins de santé, soit 11,1 % de notre économie totale, ou 6 299 dollars par habitant. Presque 40 % des dépenses publiques sont consacrées au financement des soins de santé 1. En résumé, cela fait beaucoup d'argent! Ce numéro de Promotion de la santé et prévention des maladies chroniques au Canada met l'accent sur trois maladies contribuant à ce fardeau économique des soins de santé au Canada.
The details of our base model have been previously published. 16 In short, we used an approach ba... more The details of our base model have been previously published. 16 In short, we used an approach based on population attributable
OBJECTIVES: Tobacco smoking, excess weight and physical inactivity contribute substantially to th... more OBJECTIVES: Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to determine the potential reduction in economic burden if all provinces achieved prevalence rates of these three risk factors (RFs) equivalent to those of the province with the lowest rates, and to update and address a limitation noted in our previous model. METHODS: We used a previously developed approach based on population attributable fractions to estimate the economic burden associated with these RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling. The previous model was updated using the most current data for developing resource allocation weights. RESULTS: In 2012, the prevalence of tobacco smoking, excess weight and physical inactivity was the lowest in British Columbia. If age-and sex-specific prevalence rates from BC were applied to populations living in the other provinces, the annual economic burden attributable to these three RFs would be reduced by $5.3 billion. Updating the model resulted in a considerable shift in economic burden from smoking to excess weight, with the estimated annual economic burden attributable to excess weight now 25% higher compared to that of tobacco smoking ($23.3 vs. $18.7 billion). CONCLUSION: Achieving RF prevalence rates equivalent to those of the province with the lowest rates would result in a 10% reduction in economic burden attributable to excess weight, smoking and physical inactivity in Canada. This study shows that using current resource use data is important for this type of economic modelling.
OBJECTIVES: The objectives of this study were to determine the proportion of the population that ... more OBJECTIVES: The objectives of this study were to determine the proportion of the population that meets or exceeds Canada's Food Guide (CFG) recommendations regarding the number of daily servings of fruits and vegetables (F/V), to assess trends in this proportion between 2000 and 2013, to estimate the annual economic burden attributable to inadequate F/V consumption within the context of other important risk factors, and to estimate the short-and long-term costs that could be avoided if modest improvements were made to F/V consumption in Canada. METHODS: We used a previously developed methodology based on population-attributable fractions and a prevalence-based cost-of-illness approach to estimate the economic burden associated with low F/V consumption. RESULTS: Over three quarters of Canadians are not meeting CFG recommendations regarding the number of daily servings of F/V, leading to an annual economic burden of $4.39 billion. If a 1% relative increase in F/V consumption occurred annually between 2013 and 2036, the cumulative reduction in economic burden over the 23-year period would reach $8.4 billion. Consumption levels of F/V, and the resulting economic burden, varied by sex, age and province. CONCLUSION: A significant majority of Canadians are not consuming the recommended daily servings of F/V, with important consequences to their health and the Canadian economy. Programs and policies are required to encourage F/V consumption in Canada.
BackgroundDespite the long-standing experience of rating the evidence for clinical preventive ser... more BackgroundDespite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing.MethodsWe calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year g...
Previous estimates of the number and prevalence of individuals experiencing the effects of stroke... more Previous estimates of the number and prevalence of individuals experiencing the effects of stroke in Canada are out of date and exclude critical population groups. It is essential to have complete data that report on stroke disability for monitoring and planning purposes. The objective was to provide an updated estimate of the number of individuals experiencing the effects of stroke in Canada (and its regions), trending since 2000 and forecasted prevalence to 2038. The prevalence, trends, and projected number of individuals experiencing the effects of stroke were estimated using region-specific survey data and adjusted to account for children aged <12 years and individuals living in homes for the aged. In 2013, we estimate that there were 405 000 individuals experiencing the effects of stroke in Canada, yielding a prevalence of 1.15%. This value is expected to increase to between 654 000 and 726 000 by 2038. Trends in stroke data between 2000 and 2012 suggest a nonsignificant dec...
Type 1 diabetes is the most common form of diabetes among children; however, the proportion of ca... more Type 1 diabetes is the most common form of diabetes among children; however, the proportion of cases of childhood type 2 diabetes is increasing. In Canada, the National Diabetes Surveillance System (NDSS) uses administrative health data to describe trends in the epidemiology of diabetes, but does not specify diabetes type. The objective of this study was to validate algorithms to classify diabetes type in children &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20 yr identified using the NDSS methodology. We applied the NDSS case definition to children living in British Columbia between 1 April 1996 and 31 March 2007. Through an iterative process, four potential classification algorithms were developed based on demographic characteristics and drug-utilization patterns. Each algorithm was then validated against a gold standard clinical database. Algorithms based primarily on an age rule (i.e., age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 at diagnosis categorized type 1 diabetes) were most sensitive in the identification of type 1 diabetes; algorithms with restrictions on drug utilization (i.e., no prescriptions for insulin ± glucose monitoring strips categorized type 2 diabetes) were most sensitive for identifying type 2 diabetes. One algorithm was identified as having the optimal balance of sensitivity (Sn) and specificity (Sp) for the identification of both type 1 (Sn: 98.6%; Sp: 78.2%; PPV: 97.8%) and type 2 diabetes (Sn: 83.2%; Sp: 97.5%; PPV: 73.7%). Demographic characteristics in combination with drug-utilization patterns can be used to differentiate diabetes type among cases of pediatric diabetes identified within administrative health databases. Validation of similar algorithms in other regions is warranted.
Objective To describe adherence to clinical practice guidelines for the treatment of childhood ty... more Objective To describe adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes and identify associated patient and system level factors. Study design This prospective cohort study used population-based administrative data to describe individuals aged 1-24 years who had been diagnosed with type 1 diabetes at <20 years of age (1472 unique individuals and 5883 person-years over a 7-year period) living in British Columbia, Canada. The outcome measure was proportion 'at goal,' which was defined as having optimal adherence (3 diabetes-related physician visits/year, 3 hemoglobin A1c (HbA1c) tests/year, 1 glucagon prescription dispensed/year, and appropriate screening for diabetes-related comorbidity [ie, hypothyroidism] and complications [ie, retinopathy and nephropathy]), or good adherence to guidelines (2 diabetes-related physician visits/year, 2 HbA1c tests/year, and appropriate screening for diabetes-related comorbidity and complications). Statistical methods included descriptive statistics and logistic regression modeling. Results Fifty-four percent person-years had poor adherence to guidelines (<2 diabetes-related physician visits and HbA1c tests/year) and 7.4% had optimal adherence. The proportion of person-years at goal was higher in females vs males (41.0% vs 37.6%; P = .007). Individuals 4-years post-diagnosis of diabetes were 78% less likely to be at goal compared with the year of diagnosis (P < .0001). Conclusions The treatment of pediatric type 1 diabetes likely does not meet national and international standards. Future studies should explore facilitators and barriers to adherence to guidelines among health care providers, patients, and families, and whether adherence to guidelines is associated with glycemic control.
Access to general practice services 55 Emergency room visits 63 Home-based professional services ... more Access to general practice services 55 Emergency room visits 63 Home-based professional services 71 Home support services 79 Diabetes 87 Congestive heart failure 95
Background and Purpose— Evidence-based stroke care has been shown to improve patient outcomes and... more Background and Purpose— Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. Methods— Several independent data sources, including the Canadian Institute of Health Information Discharge Database, the 2008–2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of...
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of basiliximab (20 mg intravenously daily on day 0 and day 4 after the transplant) for the prevention of renal allograft rejection. Basiliximab is a chimeric alpha-chain of the interleukin-2 receptor, which is important in activating the immune response. The patients were assessed at predetermined intervals during the first 12 months after transplant. Type of intervention Secondary prevention. Economic study type Cost-effectiveness analysis. Study population The study population comprised patients who had just undergone renal transplant. Setting The setting was a hospital. The economic analysis was conducted as part of a multi-centre trial that took place in Canada,
The current paper summarizes relevant recent research on the high risk of recurrence, multiple sk... more The current paper summarizes relevant recent research on the high risk of recurrence, multiple skin cancers and second primary cancers in the growing number of people with a history of skin cancer; the ultimate purpose is to better assess the burden of ...
Results: There were 79 175 people in cohort 1 and 92 320 in cohort 2. Overall, the relative propo... more Results: There were 79 175 people in cohort 1 and 92 320 in cohort 2. Overall, the relative proportion of people in each use category was similar between the 2 study periods. The most substantial changes were an increase of 2 percentage points in the proportion of people who ...
A study of the quality of life and cost-utility of renal transplantation. The objective of this s... more A study of the quality of life and cost-utility of renal transplantation. The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after ...
Solid organ transplantation has advanced over the past decade to the point at which it is now a r... more Solid organ transplantation has advanced over the past decade to the point at which it is now a realistic form of treatment for irreversible failure of many vital organs. While organ transplantation is becoming increasingly successful, the cost of the procedures is still very high. As with all high cost medical procedures, decisions need to be made about the cost-effectiveness of solid organ transplantation. A review of the available literature with respect to the quality of life of the patient and the economic evaluation of transplantation, subdivided in regard to specific organs, is presented. A number of issues which need to be taken into account and reinforced when contemplating policy decisions based on the economic evaluation of solid organ transplantation are then discussed.
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Papers by Hans Krueger