An empirical comparison of sleep-specific versus generic quality of life instruments among Australians with sleep disorders.

PURPOSE: In Australian adults diagnosed with a sleep disorder(s), this cross-sectional study compares the empirical relationships between two generic QoL instruments, the EuroQoL 5-dimension 5-level (EQ-5D-5L) and ICEpop CAPability measure for Adults (ICECAP-A), and three sleep-specific metrics, the Epworth Sleepiness Scale (ESS), 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10), and Pittsburgh Sleep Quality Index (PSQI). METHODS: Convergent and divergent validity between item/dimension scores was examined using Kendall's Tau-B correlation, with correlations below 0.30 considered weak, between 0.30 and 0.50 moderate and those above 0.50 strong (indicating that instruments were measuring similar constructs). Exploratory factor analysis (EFA) was conducted to identify shared underlying constructs. RESULTS: A total of 1509 participants (aged 18-86 years) were included in the analysis. Convergent validity between dimensions/items of different instruments was weak to moderate. A 5-factor EFA solution, representing 'daytime dysfunction', 'fatigue', 'wellbeing', 'physical health', and 'perceived sleep quality', was simplest with close fit and fewest cross-loadings. Each instrument's dimensions/items primarily loaded onto their own factor, except for the EQ-5D-5L and PSQI. Nearly two-thirds of salient loadings were of excellent magnitude (0.72 to 0.91). CONCLUSION: Moderate overlap between the constructs assessed by generic and sleep-specific instruments indicates that neither can fully capture the complexity of QoL alone in general disordered sleep populations. Therefore, both are required within economic evaluations. A combination of the EQ-5D-5L and, depending on context, ESS or PSQI offers the broadest measurement of QoL in evaluating sleep health interventions.

Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review.

BACKGROUND: Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES: This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS: A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS: Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS: This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.

Thirty-Day Unplanned Readmissions Following Hospitalisation for Atrial Fibrillation in Australia and New Zealand.

AIMS: Atrial fibrillation (AF) is a leading cause of hospitalisations, yet little is known about 30-day readmissions following discharge despite increasing policy focus on reducing readmissions. We assessed the rate, timing, causes and predictors of 30-day unplanned readmission following an acute and elective AF hospitalisation using population-wide data. METHODS: We studied all patients hospitalised for AF from 2010 to 2015 at all public and most private hospitals in Australia and New Zealand. The main outcome measures were unplanned readmissions within 30 days of discharge, primary diagnosis associated with these readmissions, and their predictors as modelled by logistic regression. RESULTS: Among 301,654 patients hospitalised for AF (mean age 69.2±13.6 yrs, 55.6% female, 65.2% acute presentations), 29,750 (9.9%) experienced an unplanned readmission within 30 days with 62.6% occurring by 14 days. Unplanned readmissions occurred more frequently following an acute versus elective AF hospitalisations (12.5% vs 4.9%, p<0.001). The most common diagnoses associated with readmissions were recurrence of AF (n=9,890, 33.2%), and preventable conditions including heart failure (n=2,683, 9.0%), pneumonia (n=724, 2.4%) and acute myocardial infarction (n=510, 1.7%). A higher risk of 30-day readmission was associated with congenital cardiac/circulatory defect (OR 2.18, CI 1.44-3.30), congestive heart failure (OR 1.34, CI 1.30-1.39), and arrhythmia/conduction disorders (OR 1.25, CI 1.21-1.28). CONCLUSION: Almost 1 in 10 AF hospitalisations resulted in unplanned readmission within 30-days, mostly for AF recurrence. Improved clinical management of AF and transitional care planning are required to reduce unplanned readmissions following AF hospitalisations.

A preference for quality: Australian general public's willingness to pay for home and residential aged care.

In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.

Economic evaluations considering costs and outcomes of diabetic foot ulcer infections: A systematic review.

BACKGROUND: Diabetic foot ulcer (DFU) is a severe complication of diabetes and particularly susceptible to infection. DFU infection intervention efficacy is declining due to antimicrobial resistance and a systematic review of economic evaluations considering their economic feasibility is timely and required. AIM: To obtain and critically appraise all available full economic evaluations jointly considering costs and outcomes of infected DFUs. METHODS: A literature search was conducted across MedLine, CINAHL, Scopus and Cochrane Database seeking evaluations published from inception to 2019 using specific key concepts. Eligibility criteria were defined to guide study selection. Articles were identified by screening of titles and abstracts, followed by a full-text review before inclusion. We identified 352 papers that report economic analysis of the costs and outcomes of interventions aimed at diabetic foot ulcer infections. Key characteristics of eligible economic evaluations were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: 542 records were screened and 39 full-texts assessed for eligibility. A total of 19 papers were included in the final analysis. All studies except one identified cost-saving or cost-effective interventions. The evaluations included in the final analysis were so heterogeneous that comparison of them was not possible. All studies were of "excellent", "very good" or "good" quality when assessed against the CHEERS checklist. CONCLUSIONS: Consistent identification of cost-effective and cost-saving interventions may help to reduce the DFU healthcare burden. Future research should involve clinical implementation of interventions with parallel economic evaluation rather than model-based evaluations.

A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients.

INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission. METHODS AND ANALYSIS: We will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran's Q and I2 statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs. ETHICS AND DISSEMINATION: Formal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42019132017.