Lan Gao

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i-10 index

Research Field

Economic evaluation of a randomized controlled trial of an intervention to reduce office workers’ sitting time: the "Stand Up Victoria" trial

Scandinavian Journal of Work Environment & Health (2018)

Lan Gao Anna Flego David W. Dunstan Elisabeth Winkler Geneviève N. Healy

Objectives This study aimed to assess the economic credentials of a workplace-delivered intervention to reduce sitting time among desk-based workers. Methods We performed within-trial cost-efficacy analysis and long-term cost-effectiveness analysis (CEA) and recruited 231 desk-based workers, aged 24-65 years, across 14 worksites of one organization. Multicomponent workplace-delivered intervention was compared to usual practice. Main outcome measures including total device-measured workplace sitting time, body mass index (BMI), self-reported health-related quality of life (Assessment of Quality of Life-8D, AQoL-8D), and absenteeism measured at 12 months. Results Compared to usual practice, the intervention was associated with greater cost (AU$431/person), benefits in terms of reduced workplace sitting time [-46.8 minutes/8-hour workday, 95% confidence interval (CI): -69.9- -23.7] and increased workplace standing time (42.2 minutes/8-hour workday, 95% CI 23.8-60.6). However, there were no significant benefits for BMI [0.148 kg/m 2(95% CI-1.407-1.703)], QoL-8D [-0.006 (95% CI -0.074-0.063)] and absenteeism [2.12 days (95% CI -2.01-6.26)]. The incremental cost-efficacy ratios (ICER) ranged from AU$9.94 cost/minute reduction in workplace sitting time to AU$13.37/minute reduction in overall sitting time. CEA showed the intervention contributed to higher life year (LY) gains [0.01 (95% CI 0.009-0.011)], higher health-adjusted life year (HALY) gains [0.012 (95% CI 0.0105 - 0.0135)], and higher net costs [AU$344 (95% CI $331-358)], with corresponding ICER of AU$34 443/LY and AU$28 703/HALY if the intervention effects were to be sustained for five-years. CEA results were sensitive to assumptions surrounding intervention-effect decay rate and discount rate. Conclusions The intervention was cost-effective over the lifetime of the cohort when scaled up to the national workforce and provides important.

Sitting

10.5271/sjweh.3740

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Citations (36)

Cost-effectiveness of tenecteplase versus alteplase for stroke thrombolysis evaluation trial in the ambulance

European Stroke Journal (2023)

Lan Gao Mark Parsons Leonid Churilov Henry Zhao Bruce Campbell

Tenecteplase administered to patients with ischaemic stroke in a mobile stroke unit (MSU) has been shown to reduce the perfusion lesion volumes and result in ultra-early recovery. We now seek to assess the cost-effectiveness of tenecteplase in the MSU.A within-trial (TASTE-A) economic analysis and a model-based long-term cost-effectiveness analysis were performed. This post hoc within-trial economic analysis utilised the patient-level data (intention to treat, ITT) prospectively collected over the trial to calculate the difference in both healthcare costs and quality-adjusted life years (QALYs, estimated from modified Rankin scale score). A Markov microsimulation model was developed to simulate the long-term costs and benefits.In total, there were 104 patients with ischaemic stroke randomised to tenecteplase (n = 55) or alteplase (n = 49) treatment groups, respectively in the TASTE-A trial. The ITT-based analysis showed that treatment with tenecteplase was associated with non-signficantly lower costs (A$28,903 vs A$40,150 (p = 0.056)) and greater benefits (0.171 vs 0.158 (p = 0.457)) than that for the alteplase group over the first 90 days post the index stroke. The long-term model showed that tenecteplase led to greater savings in costs (-A$18,610) and more health benefits (0.47 QALY or 0.31 LY gains). Tenecteplase-treated patients had reduced costs for rehospitalisation (-A$1464), nursing home care (-A$16,767) and nonmedical care (-A$620) per patient.Treatment of ischaemic stroke patients with tenecteplase appeared to be cost-effective and improve QALYs in the MSU setting based on Phase II data. The reduced total cost from tenecteplase was driven by savings from acute hospitalisation and reduce need for nursing home care.

Tenecteplase

Stroke

Fibrinolytic agent

Ischaemic stroke

10.1177/23969873231165086

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Citations (27)

Corrigendum to ‘Temporal Change in the Remaining Life Expectancy in People Who Underwent Percutaneous Coronary Intervention’ The American Journal of Cardiology Volume 187, 15 January 2023, Pages 154-161

The American Journal of Cardiology (2023)

Lan Gao Dieu Nguyen Marj Moodie Angela Brennan Diem Dinh

Ventricular volume

10.1016/j.amjcard.2022.12.020

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Citations (2)

Modelling the potential health and economic benefits of reducing population sitting time in Australia

International Journal of Behavioral Nutrition and Physical Activity (2022)

Phuong Nguyen Jaithri Ananthapavan Eng Joo Tan Paul Crosland Steven J. Bowe

Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives.

Population Health

Clinical nutrition

Behavioural sciences

Health Economics

Sitting

Animal ecology

10.1186/s12966-022-01276-2

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Citations (16)

Telestroke: Maintaining Quality Acute Stroke Care During the COVID-19 Pandemic

Telemedicine Journal and e-Health (2021)

Theresa Sevilis M McDonald Amanda Avila Gregory W. Heath Lan Gao

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted acute stroke care globally. Decreased stroke presentations and concern for delays in acute stroke care have been identified. This study evaluated the impact of COVID-19 on the timely treatment of patients with thrombolytics at hospitals utilizing telestroke acute stroke services. Methods: Acute stroke consultations seen in 171 hospitals (19 states) via telestroke from December 1, 2019, to June 27, 2020, were extracted from the TeleCare™ database. The consults were divided into pre-COVID and COVID groups (March 15, 2020, start of COVID group). The consults were reviewed for age, sex, hospital, state, date seen, last known normal, arrival time, consult call time, needle time, thrombolytic candidate, and National Institutes of Health Stroke Scale (NIHSS) score. The total number of consults, median door to needle (DTN) time for emergency department (ED) patients, and call to needle (CTN) time for inpatients were calculated. Results: Pre-COVID, 15,226 stroke consults were evaluated compared with 11,105 in the COVID group, a 27% decrease. Pre-COVID, 1,071 ED patients (7.9%) received thrombolytics and 66 inpatients (4.0%), while COVID, 813 ED patients (8.2%) and 70 inpatients (5.7%). The median DTN time for ED patients pre-COVID was 42 (32, 55) versus 40 (31, 52) in the COVID group, with no statistically significant difference between groups. CTN time pre-COVID was 53 (35, 67) versus 46 (35, 61) in the COVID group, with no statistically significant difference between groups. Conclusions: Telestroke assessments allowed for uninterrupted acute stroke care and treatment stability despite nursing and other resource realignments triggered by the COVID-19 pandemic.

Stroke

Pandemic

Acute stroke

10.1089/tmj.2021.0149

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Citations (14)

Practical utility of the ACT-FAST triage algorithm from a primary stroke centre perspective

BMJ Neurology Open (2022)

Shuangyue Tan Karen Stephens Lan Gao Elise Tan Tanya Frost

Rapid reperfusion in ischaemic stroke with emergent large vessel occlusion (ELVO) reduces morbidity and mortality. Limited distribution of endovascular clot retrieval (ECR) capable comprehensive stroke centres (CSCs) necessitates development of pre-hospital models of care to provide equitable and economical access to reperfusion therapy. We examine the time metrics of the traditional secondary transfer strategy in comparison to the direct bypass strategy and the potential utility of the ACT-FAST prehospital triage algorithm on a large volume Melbourne primary stroke centre (PSC).Retrospective analysis of consecutive patients presenting to a PSC from 1 January 2020 to 31 December 2020. Clinical records were interrogated for ACT-FAST positive patients. Time metrics were established using Google Maps traffic modelling and local/published door-to-needle, door-in-door out and door-to-groin data.88 patients during the study period were ACT-FAST positive. Of these, 49/88 (56%) cases had ELVO ischaemic strokes, 24/88 (27%) cases had intracranial haemorrhages and the remaining 15/88 (17%) had non ELVO ischaemic strokes or mimics (seizure, complex migraine, etc). 28/88 (32%) cases met indication for and were subsequently transferred to a CSC for consideration of ECR. The modelled median scene to groin time for the direct bypass strategy is 94 min whereas the median scene to groin time for the secondary transfer strategy is 109 min, giving a difference of 15 min.Time savings to groin puncture for the direct bypass strategy is substantially less than previous estimates and suggests that the secondary transfer strategy continues to be a viable pathway for a high efficiency PSC.

Triage

Primary (astronomy)

10.1136/bmjno-2022-000325

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Citations (2)

Efficacy and Safety of Thrombin-Receptor Antagonist (Atopaxar and Vorapaxar) in Patients with Acute Coronary Syndrome or Coronary Artery Disease—A Meta-Analysis of Randomized Controlled Trials

Value in Health Regional Issues (2015)

Lan Gao Fei-Li Zhao Shu‐Chuen Li

10.1016/j.vhri.2015.01.003

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Citations (7)

Validation of the Chinese version of the NUCOG cognitive screening tool in patients with epilepsy, dementia and other neurological disorders

Journal of Clinical Neuroscience (2013)

Lan Gao Shu‐Chuen Li Xia Li Songqing Pan Dennis Velakoulis

Stroke

Mini–Mental State Examination

10.1016/j.jocn.2013.09.020

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Citations (7)

Cost-Effectiveness of Treating Acute Coronary Syndrome Patients with Rivaroxban in Australia

Value in Health (2014)

Lan Gao Shu Li

Stroke

10.1016/j.jval.2014.08.255

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Citations (0)

Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children

JAMA Pediatrics (2021)

Chris Lonsdale Taren Sanders Philip D. Parker Michael Noetel Timothy B. Hartwig

Importance

Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear.

Objective

To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools.

Design, Setting, and Participants

In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020.

Interventions

The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months).

Main Outcomes and Measures

Multistage 20-m shuttle run test for cardiorespiratory fitness.

Results

Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26).

Conclusions and Relevance

In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level.

Trial Registration

http://anzctr.org.auIdentifier:ACTRN12616000731493

10.1001/jamapediatrics.2021.0417

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Citations (21)