Edward Broughton

Pfizer (United States)

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S Teitsson

Bristol-Myers Squibb (United Kingdom)

Murat Kurt

Bristol-Myers Squibb (United States)

JR May

Bristol-Myers Squibb (United Kingdom)

C Alleman

Département Environnement et Agronomie

Dean F. Bajorin

Memorial Sloan Kettering Cancer Center

Jürgen E. Gschwend

Klinikum rechts der Isar

Julia Braverman

Bristol-Myers Squibb (United States)

J. Alfred Witjes

Radboud University Nijmegen

A. Lambert

Adelphi Group (United Kingdom)

Trong Kim Le

Bristol-Myers Squibb (United States)

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University Research Co (United States)

Bristol-Myers Squibb (United States)

Pfizer (United States)

United States Agency for International Development

Adelphi Group (United Kingdom)

Dana-Farber Cancer Institute

Icahn School of Medicine at Mount Sinai

Swaziland National Trust Commission

Johns Hopkins University

Harvard University

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ISQUA16-3178HOSPITAL HEALTH SERVICE QUALITY AND UNIVERSAL HEALTH CARE IN INDONESIA

International Journal for Quality in Health Care (2016)

Edward Broughton Kamaluddin Latief

Full implementation by 2019 of Indonesia’ Jaminan Kesehatan Nasional (JNK), will provide the country's 250 million people with financial coverage for comprehensive medical care. The objective of this study is to determine how the first 2.5 years since introduction has affected the quality of hospital health care and project how it will continue to do so as it is fully implemented in the coming years. The hospital accreditation process impact evaluation (HAPIE) is a 4 years study that examined the quality of services in nine …

Universal Coverage

Universal health care

10.1093/intqhc/mzw104.52

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Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua

Nursing Research and Practice (2014)

Edward Broughton Danilo Nunez I Fernández Moreno

Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers' perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%-34%) and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29-$249). The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.

10.1155/2014/232046

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POSC56 Healthcare Resource Use (HCRU), Cost Inputs, and Cost-Effectiveness Analysis (CEA) for Patients with Muscle Invasive Urothelial Carcinoma (MIUC) Treated with Radical Resection (RR): A Systematic Literature Review (SLR)

Value in Health (2022)

AM Trip N Chami S Teitsson Edward Broughton JR May

10.1016/j.jval.2021.11.461

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Effect of neoadjuvant chemotherapy (NAC) on patient preferences for adjuvant treatment in muscle-invasive urothelial carcinoma (MIUC): A multi-country discrete choice experiment (DCE).

Journal of Clinical Oncology (2022)

Edward Broughton Gary D. Steinberg Michael R. Harrison Julia Braverman Dena H. Jaffe

454 Background: Patient preference is an important factor in selecting appropriate treatment choices. Although underutilized, the standard of care for MIUC is with NAC, whereas evidence for adjuvant therapy is less clear. With the introduction of novel adjuvant treatments such as immune checkpoint inhibitors, treatment options are expected to expand. This study examines whether preferences for adjuvant therapy is impacted in MIUC patients receiving NAC. Methods: A cross-sectional, web-based survey included patients ≥ 18 years old who self-reported being diagnosed with MIUC and underwent radical cystectomy or nephroureterectomy without recurrence. Patients were recruited from the US, UK, Canada, France, and Germany (May–Sep 2021). A DCE using 2 adjuvant treatment profiles included 8 attributes: cancer-free survival, overall survival (OS), hypothyroidism requiring life-long hormone therapy, risk of a serious adverse event (requiring medical intervention/possible hospitalization), nausea, fatigue, diarrhea, and a dosing regimen (frequency of treatment and monitoring); an opt-out option of no treatment was also shown. Patients were grouped according to self-reported receipt of NAC. Descriptive statistics and hierarchical Bayesian logistic model with estimated preference weights were used. Relative importance estimates (mean ± standard error), or how much the attribute ranges accounted for the variation in preferences, were computed for each attribute. Bivariate comparisons used t-tests. Results: This interim analysis identified 205 patients (70.7% of target sample; US, n = 99; Germany, n = 60; UK, n = 31; Canada, n = 14; France, n = 1). Of 82 patients (40.0%) receiving NAC, 32.7% were patients > 65 years and 55.1% were male; receipt of NAC did not differ by age ( P = 0.248) or sex ( P = 0.731). Patients were willing to accept increased risk in toxicities for increased treatment efficacy. Specifically, mean relative importance of treatment attributes showed that difference in median OS (25 months compared to 78 months) was most important (34.6% ± 1.6), although less so for those who did not receive NAC (30.2% ± 2.4 vs 37.5% ± 2.0; P = 0.022). Patients chose an adjuvant treatment option over ‘no treatment’ 91% of the time, with similar findings by NAC status. Conclusions: Preliminary data indicates that receipt of NAC impacts preferences for adjuvant treatment attributes. However, regardless of these attributes, patients still preferred adjuvant treatment over none. These results suggest that providing standard of care NAC does not reduce patient preference for adjuvant therapy; rather, patient preferences for adjuvant treatment attributes vary by treatment history, with implications for improving quality of care and outcomes.

Regimen

Interim analysis

Adjuvant Therapy

10.1200/jco.2022.40.6_suppl.454

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POSB53 Healthcare Resource Utilization (HCRU) and Cost Studies in Patients Receiving First-Line (1L) Therapy for Advanced or Metastatic Urothelial Carcinoma (MUC): A Systematic Literature Review (SLR)

Value in Health (2022)

P Auti N. Braun Eduardo Aguilar Arca S Teitsson Edward Broughton

10.1016/j.jval.2021.11.326

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Effectiveness, Safety, and Patterns of Real-World Isavuconazole Use in Europe (2015–2019)

Infectious Diseases and Therapy (2024)

Dionysios Neofytos Antonio Pagliuca Katherine Houghton Edward Broughton Maria Lavinea Novis de Figueiredo Valente

Real-world data from multinational observational studies are required to better understand the role and performance of isavuconazole in real-world practice in Europe. A retrospective medical record review was conducted at 16 sites in Europe (France, Germany, Italy, Spain, and the United Kingdom). Eligible records were from patients aged ≥ 18 years at the time of isavuconazole initiation and received at least one dose of isavuconazole for suspected or confirmed invasive aspergillosis (IA) or invasive mucormycosis (IM) during the eligibility period (October 15, 2015 to June 30, 2019). Data were descriptively analysed. Success rates, overall survival, and times to these events were descriptively analysed. Data were abstracted from 218 patients (201, IA; 17, IM) who received isavuconazole as monotherapy (initiated as infusion, 52%; oral, 46%). Isavuconazole was initiated as primary therapy in 92 patients (42.2%) and salvage therapy in 121 patients (55.5%) (unknown for five patients). Mean (standard deviation) age was 56.8 (15.6) years, 66% were men and 62% had at least three comorbidities, most frequently haematologic malignancy (62%). Estimated clinical response rate at week 24 was 54.5% (95% confidence interval [CI], 38.2–66.5%) for primary treatment and 73.5% (95% CI, 62.7–81.1%) for salvage therapy. Overall, 45 patients (21%) experienced at least one adverse event (AE). Serious AEs were experienced by 37 patients (17%), with seven related to isavuconazole; five patients (2.3%) discontinued isavuconazole monotherapy due to the serious AE. A total of 137 patients (63%) died, with 17 deaths (12.4%) related to their invasive fungal infection, 11 of whom initiated isavuconazole as salvage therapy. This study adds to the growing body of evidence that whether used as first-line therapy or after the failure of other antifungal therapies, isavuconazole appears to have a promising clinical response and a good safety profile as an antifungal agent in patients with varied underlying conditions.

Real world evidence

Real world data

Safety profile

10.1007/s40121-024-01064-4

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Treatment of muscle-invasive urothelial cancer with nivolumab (CheckMate 274 study): a plain language summary

Future Oncology (2023)

Dean F. Bajorin J. Alfred Witjes Jürgen E. Gschwend Michael Schenker Begoña P. Valderrama

What is this summary about? This is a summary of a paper published in a medical journal that describes the results of a study called CheckMate 274. This study looked at a new treatment for muscle-invasive urothelial cancer, a type of cancer found in the urinary tract that has spread from the inner lining of the urinary tract or bladder and into the surrounding muscle wall where it can then spread to other parts of the body. The standard treatment for muscle-invasive urothelial cancer is surgery to remove affected parts of the urinary tract. However, cancer returns in more than half of people after this surgery. Adjuvant therapy is given to people after surgery with muscle-invasive urothelial cancer with a goal to reduce the risk of the cancer coming back; however, at the time this study started, there was no standard adjuvant treatment. What happened in the study? In the CheckMate 274 study, researchers compared nivolumab with a placebo as an adjuvant treatment for people with muscle-invasive urothelial cancer. The aim of the study was to understand how well nivolumab worked to reduce the chance of the cancer returning after surgery. The study also looked at what side effects (unwanted or unexpected results or conditions that are possibly related to the use of a medication) people had with treatment. What do the results mean? The results showed that people who received nivolumab versus placebo: Survived longer before the cancer was detected again, including people who had programmed death ligand-1 (shortened to PD-L1) on their cancer cells. Survived longer before a secondary cancer outside of the urinary tract was detected. Experienced no differences in health-related quality of life (the impact of the treatment on a person's mental and physical health). Had similar side effects to the people who received nivolumab in other studies. Clinical Trial Registration: NCT02632409 (ClinicalTrials.gov)

Urothelial cancer

Kidney cancer

10.2217/fon-2022-1294

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Methodological Issues & Statistical Help the ‘how' and ‘why' of Cost-Effectiveness Analysis for Care Pathways

International Journal of Care Pathways (2011)

Edward Broughton

Health service improvement interventions such as care pathways should be evaluated for cost-effectiveness the same way other health interventions are. I describe what cost-effectiveness analyses (CEAs) for care pathways are, how they are conducted and how their results are interpreted. CEAs should clearly state what perspective they are taking, what time frame is being considered and what research question is being addressed. Effectiveness measured by tangible patient outcomes (deaths averted, bed-days saved or QALYs [quality-adjusted life-years] gained) are preferable to process measures because they are easier for non-specialists to understand. Having a control group is highly desirable to enhance the case for attributability. Costs include explicit and opportunity costs of implementing the care pathway. Cost consequences include the change in expenditures attributable to changes associated with the care pathway. Dividing incremental cost by incremental effects gives an incremental cost-effectiveness ratio, the common measure of relative cost-effectiveness. Care pathways that decrease cost and improve outcomes should be implemented unequivocally. Those that improve outcomes but increase costs need to be considered according to the funder's willingness to pay for improved outcomes. CEAs for care pathways are as important as for any other health intervention and are necessary to provide information for decision makers.

Care pathway

10.1258/jicp.2011.011004

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Citations (6)

POSB8 Efficacy and Safety Results from Randomized Controlled Trials (RCTS) Evaluating Adjuvant Treatment after Radical Resection (RR) of Muscle Invasive Urothelial Carcinoma (MIUC): A Systematic Literature Review (SLR)

Value in Health (2022)

AM Trip A Shree D Rekowska S Teitsson Edward Broughton

10.1016/j.jval.2021.11.118

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Controlling New Jersey’s Health Care Costs (Whitepaper)

Sharon Glied Edward Broughton

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