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Start Over Author "Thain, Jenny" Topic coronary artery disease
2 results on '"Thain, Jenny"'

1. Cost-Effectiveness Analysis of Frailty Assessment in Older Patients Undergoing Coronary Artery Bypass Grafting Surgery.

Author

Li Z, Habbous S, Thain J, Hall DE, Nagpal AD, Bagur R, Kiaii B, and John-Baptiste A

Subjects
Aged, Aged, 80 and over, Coronary Artery Disease complications, Decision Trees, Frailty complications, Humans, Markov Chains, Quality-Adjusted Life Years, Coronary Artery Bypass, Coronary Artery Disease surgery, Cost-Benefit Analysis, Frailty diagnosis, Frailty economics, Geriatric Assessment, Perioperative Care
Abstract

Background: In perioperative settings, frailty assessment has been shown to reduce mortality. This study examined the cost effectiveness of frailty assessment among patients aged 65 with coronary artery disease under consideration for coronary artery bypass grafting surgery., Methods: A combined decision tree and Markov model was developed to estimate costs and quality-adjusted life years (QALYs) over a 21-year time horizon. Clinical parameters were obtained from published literature. Utilities were derived from the literature and the Canadian Community Health Survey. Costs were obtained from the Ontario fee schedule and published literature. Sensitivity and scenario analyses were conducted to assess the robustness of the results. Expected value of perfect information (EVPI) analysis was conducted to estimate the value of further research., Results: The frailty assessment initiative had a lower average cost than no frailty assessment ($19,567 compared with $20,062). QALYs with frailty assessment were 0.47 years more than with no frailty assessment. Thus, frailty assessment was dominant compared with no frailty assessment. Results were robust to changes in the input parameters. At a willingness to pay (WTP) threshold of $50,000/QALY, there was 100% probability of frailty assessment being cost-effective, and the EVPI per patient was $0. Scenario and sensitivity analysis showed frailty screening remained cost effective when changing the cohort average age, removing health benefits for nonfrail patients, and using subjective judgement to modify effectiveness parameters., Conclusions: Frailty assessment may be good value for money. However, limited availability of geriatric consultation services, may hinder implementation. Thus, the estimated benefits of frailty screening may not be achievable in practice., (Copyright © 2019 Canadian Cardiovascular Society. All rights reserved.)

Published
2020
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2. Cost-effectiveness analysis of frailty assessment 1 in older patients undergoing coronary artery bypass grafting (CABG) surgery

Author

Li, Zhe, Habbous, Steven, Thain, Jenny, Hall, Daniel E., Nagpal, Dave, Bagur, Rodrigo, Kiaii, Bob, and John-Baptiste, Ava

Subjects
Aged, 80 and over, Frailty, Cost-Benefit Analysis, Decision Trees, Coronary Artery Disease, Article, Markov Chains, Perioperative Care, Humans, Quality-Adjusted Life Years, Coronary Artery Bypass, Geriatric Assessment, health care economics and organizations, Aged
Abstract

BACKGROUND: In perioperative settings, formal frailty assessment has been shown to reduce mortality. This study examined the cost-effectiveness associated with a frailty assessment initiative among patients aged 65 with coronary artery disease who are under consideration for CABG. METHODS: A combined decision tree and Markov model was developed to estimate costs and quality-adjusted life years (QALYs) over a 21-year time horizon. Clinical parameters were obtained from published literature. Utilities were derived from the published literature and Canadian Community Health Survey. Costs were obtained from the Ontario fee schedule and published literature. Sensitivity analysis and scenario analysis were conducted to assess the robustness of results. Expected value of perfect information (EVPI) analysis was conducted to estimate the expected value of further research. RESULTS: The frailty assessment initiative had a lower average cost per patient than no frailty assessment ($19,567 compared to $20,062). QALYs with frailty assessment were 6.82, which was 0.47 years more than with no frailty assessment. Frailty assessment was dominant compared to no frailty assessment. Results were robust to changes in the input parameters. Probabilistic sensitivity analysis showed frailty assessment was cost-effective. At a willingness to pay (WTP) threshold of $50,000/QALY, there was 100% probability of frailty assessment being cost-effective and the EVPI per patient was $0. Scenario and sensitivity analysis showed frailty screening remained cost-effective when changing the cohort average age, removing health benefits for non-frail patients and using subjective judgement to modify effectiveness parameters. CONCLUSIONS: Frailty assessment may be good value for money. However, when considering the the Ontario health care system, and limited availability of geriatric consultation services, inadequate health system capacity may hinder full implementation of frailty assessment. Thus, the estimated benefits of frailty screening may not be achievable in practice.

Published
2019

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