Resources Repository
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ArticlePublication 2020Incorporating Perspective into Clinical Decisions
Part of a six-part series of articles on clinical decision making, in this article, the …
Part of a six-part series of articles on clinical decision making, in this article, the authors discuss how to incorporate perspective into clinical decisions, explicitly acknowledging that the treating physician is not the only stakeholder in these decisions. The authors use 2 case studies to demonstrate how changes in perspective can alter the clinical decision as well lead to both intended and unintended consequences to the outcomes.
Preferences/Values | Clinical Care | Priority Setting/Ethics | Health Outcomes | Health Systems | Health/Medicine -
ArticlePublication 2019Cost-Effectiveness of Community-Based Childhood Obesity Prevention Interventions in Australia
This study examined the cost-effectiveness of community-based obesity prevention interventions (CBIs) consisting of strategies to …
This study examined the cost-effectiveness of community-based obesity prevention interventions (CBIs) consisting of strategies to promote healthy eating and physical activity for Australian children aged between 5-18 years. A multiple cohort Markov model that simulates diseases associated with overweight and obesity was used to estimate the health benefits, measured as health-adjusted life years (HALYs) and healthcare-related cost offsets from diseases averted due to exposure to the intervention. Health and cost outcomes were estimated over the…
Clinical Care | Health Outcomes | State-Transition | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Food/Agriculture | Health/Medicine | Oceania -
ArticlePublication 2020Weighing Evidence to Inform Clinical Decisions
The authors use a clinical example to simulate how treatment discussions can be complicated when new evidence is introduced …
The authors use a clinical example to simulate how treatment discussions can be complicated when new evidence is introduced that conflicts with existing guidelines. Even when evidence is consistent, the authors point out that current guidelines can have interpretations that don't agree with available evidence. They develop a step-wise algorithm to help guide individual clinical decisions even in the absence of general consensus related to appropriate testing and treatment.
Evidence Synthesis | Clinical Care | Priority Setting/Ethics | Health/Medicine -
ArticlePublication 2020Translating Population Evidence to Individual Patients
In this paper, the authors describe the differences in population level outcomes compared to individual …
In this paper, the authors describe the differences in population level outcomes compared to individual patients and discuss ways that these are differences. The authors cover topics including the difference between relative and absolute risk and benefit. They use an example of the decision to start anticoagulation in new-onset atrial fibrillation to discuss translating population level evidence to treatment of an individual. These options include generalizability, subgroup analysis, prediction rules, following response to therapy, and even…
Evidence Synthesis | Clinical Care | Test Performance | Health Systems | Health/Medicine -
ArticlePublication 2020Clinical Decision Making: Using a Diagnostic Test
This article is part of a 6-part series on clinical decision making. The authors use …
This article is part of a 6-part series on clinical decision making. The authors use two clinical examples to review the principles of interpreting diagnostic test results. They outline an approach that can be used to determine how to select and apply tests and their results to the practice of internal medicine. Topics covered in the two case studies include sensitivity and specificity, positive predictive and negative predictive value of tests, and how to estimate…
Probability/Bayes | Clinical Care | Test Performance | Health/Medicine -
ArticlePublication 2019Cost-Effectiveness of Clinic, Home, or Ambulatory Blood Pressure Measurement for Hypertension Diagnosis
This study compared three methods of blood pressure (BP) measurement for diagnosing hypertension in primary …
This study compared three methods of blood pressure (BP) measurement for diagnosing hypertension in primary care settings, accounting for the possibility of false-positive (white-coat hypertension) and false-negative (masked hypertension) clinic measurements. Outcomes included quality-adjusted life years (QALYs) and lifetime costs associated with clinic BP measurement, home BP monitoring, and ambulatory blood pressure monitoring (ABPM) under two scenarios: positive and negative initial screening. Data were from published literature, public data sources, and expert input. In the…
Clinical Care | Mathematical Models | Cost-Effectiveness Analysis | Chronic Disease/Risk | Health/Medicine | North America -
ArticlePublication 2017Costing of National STI Program Implementation, 2016-2021
In 2016 the World Health Assembly adopted the Global Strategy on Sexually Transmitted Infections (STI) …
In 2016 the World Health Assembly adopted the Global Strategy on Sexually Transmitted Infections (STI) 2016–2021 aiming to reduce curable STIs by 90% by 2030. This analysis costed scaling-up priority interventions to achieve coverage targets. Strategy-targeted declines in Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis were applied to WHO-estimated regional burdens at 2012 levels. Case management was costed for the curable STIs, symptomatic Herpes Simplex Virus 2 (HSV-2), and non-STI vaginal syndromes, with incrementally expanding diagnoses. Service…
Evidence Synthesis | Clinical Care | Costing Methods | Infectious Diseases | Economics/Finance | Health/Medicine | Global -
ArticlePublication 2017Cost-Effectiveness of Screening for Hypertension and Counseling for Prevention
This article aimed to compare the health and economic impact of 3 services recommended by …
This article aimed to compare the health and economic impact of 3 services recommended by the US Preventive Services Task Force for the primary prevention of cardiovascular disease (CVD): (1) aspirin counseling for the primary prevention of CVD and colorectal cancer, (2) screening and treatment for lipid disorders (usually high cholesterol), and (3) screening and treatment for hypertension. A microsimulation model was used to compare lifetime outcomes from the societal perspective for a US-representative birth…
Clinical Care | Microsimulation | Cost-Effectiveness Analysis | Chronic Disease/Risk | Policy/Regulation | Health/Medicine | North America -
ArticlePublication 2017Changing the South African National ART Guidelines: The Role of Cost Modelling
This analysis was motivated by the South African Department of Health's request to assess the …
This analysis was motivated by the South African Department of Health's request to assess the cost implications of adopting sets of ART guidelines issued by the World Health Organization between 2010 and 2016.Using data from large South African ART clinics (n = 24,244 patients), projections of patients in need of ART, and cost data from bottom-up cost analyses, the authors constructed a population-level health-state transition model with 6-monthly transitions between health states depending on patients’ age,…
Clinical Care | Costing Methods | State-Transition | Infectious Diseases | Health Systems | Economics/Finance | Health/Medicine | Sub-Saharan Africa