Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer.

BACKGROUND: The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery. METHODS: This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62). RESULTS: The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted. CONCLUSION: Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.

Using general practice clinical information system data for research: the case in Australia.

General practice is often a patient's first point of contact with the health system and the gateway to specialist services. In Australia, different aspects of the health system are managed by the Commonwealth Government and individual state / territory governments. Although there is a long history of research using administrative data in Australia, this split in the management and funding of services has hindered whole-system research. Additionally, the administrative data typically available for research are often collected for reimbursement purposes and lack clinical information. General practices collect a range of patient information including diagnoses, medications prescribed, results of pathology tests ordered and so on. Practices are increasingly using clinical information systems and data extraction tools to make use of this information. This paper describes approaches used on several research projects to access clinical, as opposed to administrative, general practice data which to date has seen little use as a resource for research. This information was accessed in three ways. The first was by working directly with practices to access clinical and management data to support research. The second involved accessing general practice data through collaboration with Primary Health Networks, recently established in Australia to increase the efficiency and effectiveness of health services for patients. The third was via NPS MedicineWise's MedicineInsight program, which collects data from consenting practices across Australia and makes these data available to researchers. We describe each approach including data access requirements and the advantages and challenges of each method. All approaches provide the opportunity to better understand data previously unavailable for research in Australia. The challenge of linking general practice data to other sources, currently being explored for general practice data, is discussed. Finally, we describe some general practice data collections used for research internationally and how these compare to collections available in Australia.

Health related migration: evidence of reduced "urban-drift".

The aim of this study was to determine if the onset of serious disease triggers a different intra-state migratory response from patterns observed in the healthy population. The analysis was carried out using linked administrative data. The onset of serious disease triggered a reduction in the rate of endocentric migration in remote and rural populations. Urban drift occurred only in people with mental illness in rural locations. Rural and remote communities appear to suffer from an unhealthy selection force, with persons unable to migrate centrally to access services due to the onset of the physical illness they require treatment for.

99mTc-DMSA absolute uptake: normal pediatric values at 2-4 hours.

OBJECTIVE: This study aims to determine if normal absolute uptake values of dimercaptosuccinic acid (DMSA) can be predicted accurately over the optimal time for imaging. METHODS: Eighty-eight normal kidneys were analyzed from 44 children with a median age of 4 y. The mean time between injection and scan was 171.7 min. The absolute uptake of DMSA in milligrams was calculated for each kidney. RESULTS: A strong positive linear relationship was found between the absolute uptake of DMSA and the amount of DMSA injected in milligrams (corr = 0.940 [P< 0.0005]), and the age of the child (corr = 0.770 (P<0.0005)). Multiple linear regression showed that these 2 factors accounted for 92.2% of the change in absolute DMSA uptake. CONCLUSION: The absolute uptake of DMSA can be accurately predicted using a linear regression equation incorporating the amount of DMSA injected in milligrams and the patient's age. Time between injection and scan appears to play little role in the absolute uptake of DMSA over 2-4 h.