The Experts below are selected from a list of 117 Experts worldwide ranked by ideXlab platform
Steve Goodacre - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness of point of care biomarker Assessment for suspected myocardial infarction the randomized Assessment of treatment using Panel assay of cardiac markers ratpac trial
Academic Emergency Medicine, 2011Co-Authors: Patrick Fitzgerald, Steve Goodacre, Elizabeth Cross, Simon DixonAbstract:ACADEMIC EMERGENCY MEDICINE 2011; 18:488–495 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: Chest pain due to suspected myocardial infarction (MI) is responsible for many hospital admissions and consumes substantial health care resources. The Randomized Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic Assessment using a point-of-care (POC) cardiac biomarker Panel consisting of CK-MB, myoglobin, and troponin increased the proportion of patients successfully discharged after emergency department (ED) Assessment. In this economic analysis, the authors aimed to determine whether POC biomarker Panel Assessment reduced health care costs and was likely to be cost-effective. Methods: The RATPAC trial was a multicenter individual patient randomized controlled trial comparing diagnostic Assessment using a POC biomarker Panel (CK-MB, myoglobin, and troponin, measured at baseline and 90 minutes) to standard care without the POC Panel in patients attending six EDs with acute chest pain due to suspected MI (n = 2,243). Individual patient resource use data were collected from all participants up to 3 months after hospital attendance using self-completed questionnaires at 1 and 3 months and case note review. ED staff and POC testing costs were estimated through a microcosting study of 246 participants. Resource use was valued using national unit costs. Health utility was measured using the EQ-5D self-completed questionnaire, mailed at 1 and 3 months. Quality-adjusted life-years (QALYs) were calculated by the trapezium rule using the EQ-5D tariff values at all follow-up points. Mean costs per patient were compared between the two treatment groups. Cost-effectiveness was estimated in terms of probability of dominance and incremental cost per QALY. Results: Point-of-care Panel Assessment was associated with higher ED costs, coronary care costs, and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217.14 (standard deviation [SD] ± 3164.93), or $1,987.14 (SD ±$4,939.25), with POC versus £1005.91 (SD ±£1907.55), or $1,568.64 (SD ±$2,975.78), with standard care (p = 0.056). Mean QALYs were 0.158 (SD ± 0.052) versus 0.161 (SD ± 0.056; p = 0.250). The probability of standard care being dominant (i.e., cheaper and more effective) was 0.888, while the probability of the POC Panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the POC Panel and excluding intensive care costs. Conclusions: Point-of-care Panel Assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of health care resources.
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the randomised Assessment of treatment using Panel assay of cardiac markers ratpac trial a randomised controlled trial of point of care cardiac markers in the emergency department
Heart, 2011Co-Authors: Steve Goodacre, Mike Bradburn, Elizabeth Cross, Paul O Collinson, Alasdair Gray, Alistair S HallAbstract:Objectives To determine whether using a point-of-care cardiac biomarker Panel would increase the rate of successful discharge home after emergency department Assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events. Design and setting Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK. Participants Patients attending with acute chest pain due to suspected myocardial infarction (N=2243). Interventions Diagnostic Assessment using a point-of-care biomarker Panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care Panel. Main outcome measures The primary outcome was successful discharge home, defined as having left hospital or awaiting transport home by 4 h after attendance and no major adverse events up to 3 months. Secondary outcome measures included length of stay, use of coronary care, cardiac interventions and inpatient beds, emergency department attendances, subsequent admissions, outpatient visits and major adverse events. Results Point-of-care Panel Assessment was associated with an increased rate of successful discharge (358/1125 (32%) vs 146/1118 (13%); OR 3.81, 95% CI 3.01 to 4.82; p Conclusions Point-of-care Panel Assessment increases successful discharge home and reduces median length of stay, but does not alter overall hospital bed use. Trial registration Current controlled trials ISRCTN37823923.
Simon Dixon - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness of point of care biomarker Assessment for suspected myocardial infarction the randomized Assessment of treatment using Panel assay of cardiac markers ratpac trial
Academic Emergency Medicine, 2011Co-Authors: Patrick Fitzgerald, Steve Goodacre, Elizabeth Cross, Simon DixonAbstract:ACADEMIC EMERGENCY MEDICINE 2011; 18:488–495 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: Chest pain due to suspected myocardial infarction (MI) is responsible for many hospital admissions and consumes substantial health care resources. The Randomized Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic Assessment using a point-of-care (POC) cardiac biomarker Panel consisting of CK-MB, myoglobin, and troponin increased the proportion of patients successfully discharged after emergency department (ED) Assessment. In this economic analysis, the authors aimed to determine whether POC biomarker Panel Assessment reduced health care costs and was likely to be cost-effective. Methods: The RATPAC trial was a multicenter individual patient randomized controlled trial comparing diagnostic Assessment using a POC biomarker Panel (CK-MB, myoglobin, and troponin, measured at baseline and 90 minutes) to standard care without the POC Panel in patients attending six EDs with acute chest pain due to suspected MI (n = 2,243). Individual patient resource use data were collected from all participants up to 3 months after hospital attendance using self-completed questionnaires at 1 and 3 months and case note review. ED staff and POC testing costs were estimated through a microcosting study of 246 participants. Resource use was valued using national unit costs. Health utility was measured using the EQ-5D self-completed questionnaire, mailed at 1 and 3 months. Quality-adjusted life-years (QALYs) were calculated by the trapezium rule using the EQ-5D tariff values at all follow-up points. Mean costs per patient were compared between the two treatment groups. Cost-effectiveness was estimated in terms of probability of dominance and incremental cost per QALY. Results: Point-of-care Panel Assessment was associated with higher ED costs, coronary care costs, and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217.14 (standard deviation [SD] ± 3164.93), or $1,987.14 (SD ±$4,939.25), with POC versus £1005.91 (SD ±£1907.55), or $1,568.64 (SD ±$2,975.78), with standard care (p = 0.056). Mean QALYs were 0.158 (SD ± 0.052) versus 0.161 (SD ± 0.056; p = 0.250). The probability of standard care being dominant (i.e., cheaper and more effective) was 0.888, while the probability of the POC Panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the POC Panel and excluding intensive care costs. Conclusions: Point-of-care Panel Assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of health care resources.
Elizabeth Cross - One of the best experts on this subject based on the ideXlab platform.
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cost effectiveness of point of care biomarker Assessment for suspected myocardial infarction the randomized Assessment of treatment using Panel assay of cardiac markers ratpac trial
Academic Emergency Medicine, 2011Co-Authors: Patrick Fitzgerald, Steve Goodacre, Elizabeth Cross, Simon DixonAbstract:ACADEMIC EMERGENCY MEDICINE 2011; 18:488–495 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: Chest pain due to suspected myocardial infarction (MI) is responsible for many hospital admissions and consumes substantial health care resources. The Randomized Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic Assessment using a point-of-care (POC) cardiac biomarker Panel consisting of CK-MB, myoglobin, and troponin increased the proportion of patients successfully discharged after emergency department (ED) Assessment. In this economic analysis, the authors aimed to determine whether POC biomarker Panel Assessment reduced health care costs and was likely to be cost-effective. Methods: The RATPAC trial was a multicenter individual patient randomized controlled trial comparing diagnostic Assessment using a POC biomarker Panel (CK-MB, myoglobin, and troponin, measured at baseline and 90 minutes) to standard care without the POC Panel in patients attending six EDs with acute chest pain due to suspected MI (n = 2,243). Individual patient resource use data were collected from all participants up to 3 months after hospital attendance using self-completed questionnaires at 1 and 3 months and case note review. ED staff and POC testing costs were estimated through a microcosting study of 246 participants. Resource use was valued using national unit costs. Health utility was measured using the EQ-5D self-completed questionnaire, mailed at 1 and 3 months. Quality-adjusted life-years (QALYs) were calculated by the trapezium rule using the EQ-5D tariff values at all follow-up points. Mean costs per patient were compared between the two treatment groups. Cost-effectiveness was estimated in terms of probability of dominance and incremental cost per QALY. Results: Point-of-care Panel Assessment was associated with higher ED costs, coronary care costs, and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217.14 (standard deviation [SD] ± 3164.93), or $1,987.14 (SD ±$4,939.25), with POC versus £1005.91 (SD ±£1907.55), or $1,568.64 (SD ±$2,975.78), with standard care (p = 0.056). Mean QALYs were 0.158 (SD ± 0.052) versus 0.161 (SD ± 0.056; p = 0.250). The probability of standard care being dominant (i.e., cheaper and more effective) was 0.888, while the probability of the POC Panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the POC Panel and excluding intensive care costs. Conclusions: Point-of-care Panel Assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of health care resources.
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the randomised Assessment of treatment using Panel assay of cardiac markers ratpac trial a randomised controlled trial of point of care cardiac markers in the emergency department
Heart, 2011Co-Authors: Steve Goodacre, Mike Bradburn, Elizabeth Cross, Paul O Collinson, Alasdair Gray, Alistair S HallAbstract:Objectives To determine whether using a point-of-care cardiac biomarker Panel would increase the rate of successful discharge home after emergency department Assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events. Design and setting Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK. Participants Patients attending with acute chest pain due to suspected myocardial infarction (N=2243). Interventions Diagnostic Assessment using a point-of-care biomarker Panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care Panel. Main outcome measures The primary outcome was successful discharge home, defined as having left hospital or awaiting transport home by 4 h after attendance and no major adverse events up to 3 months. Secondary outcome measures included length of stay, use of coronary care, cardiac interventions and inpatient beds, emergency department attendances, subsequent admissions, outpatient visits and major adverse events. Results Point-of-care Panel Assessment was associated with an increased rate of successful discharge (358/1125 (32%) vs 146/1118 (13%); OR 3.81, 95% CI 3.01 to 4.82; p Conclusions Point-of-care Panel Assessment increases successful discharge home and reduces median length of stay, but does not alter overall hospital bed use. Trial registration Current controlled trials ISRCTN37823923.
Juan Gonzalez Alegre - One of the best experts on this subject based on the ideXlab platform.
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economic growth and budgetary components a Panel Assessment for the eu
Empirical Economics, 2011Co-Authors: Antonio Afonso, Juan Gonzalez AlegreAbstract:In this article, we test to determine whether a reallocation of government budgetary components can enhance long-term GDP growth in a set of 15 EU countries. We apply Panel data techniques to the period 1971–2006, and use three alternative dependent variables in a growth regression: economic growth, total factor productivity and labour productivity. Our results also identify the distortions induced by public expenditure in the private factors allocation. In particular, we detect a strong crowding-in effect associated to public investment, which has enhanced economic growth by boosting private investment. We also associate a dependence of productivity on public expenditure on social security.
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economic growth and budgetary components a Panel Assessment for the eu
Research Papers in Economics, 2008Co-Authors: Antonio Afonso, Juan Gonzalez AlegreAbstract:In this paper we test whether a reallocation of government budget items can enhance long-term GDP growth in a set of European countries. We apply modern Panel data techniques to the period 1970-2006, and we use three alternative dependent variables in a growth regression: economic growth, total factor productivity and labour productivity. Our results are able to identify also the distortions induced by public expenditure in the private factors allocation. In particular, we detect a strong crowding-in effect associated to public investment, which have enhanced economic growth by boosting private investment. We also associate a significant dependence of productivity on public expenditure on education as well as the role of social security and health issues in growth and the labour market. JEL Classification: C23, E62, H50, O40
Alistair S Hall - One of the best experts on this subject based on the ideXlab platform.
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the randomised Assessment of treatment using Panel assay of cardiac markers ratpac trial a randomised controlled trial of point of care cardiac markers in the emergency department
Heart, 2011Co-Authors: Steve Goodacre, Mike Bradburn, Elizabeth Cross, Paul O Collinson, Alasdair Gray, Alistair S HallAbstract:Objectives To determine whether using a point-of-care cardiac biomarker Panel would increase the rate of successful discharge home after emergency department Assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events. Design and setting Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK. Participants Patients attending with acute chest pain due to suspected myocardial infarction (N=2243). Interventions Diagnostic Assessment using a point-of-care biomarker Panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care Panel. Main outcome measures The primary outcome was successful discharge home, defined as having left hospital or awaiting transport home by 4 h after attendance and no major adverse events up to 3 months. Secondary outcome measures included length of stay, use of coronary care, cardiac interventions and inpatient beds, emergency department attendances, subsequent admissions, outpatient visits and major adverse events. Results Point-of-care Panel Assessment was associated with an increased rate of successful discharge (358/1125 (32%) vs 146/1118 (13%); OR 3.81, 95% CI 3.01 to 4.82; p Conclusions Point-of-care Panel Assessment increases successful discharge home and reduces median length of stay, but does not alter overall hospital bed use. Trial registration Current controlled trials ISRCTN37823923.
