Ciaran O'neill - Academia.edu (original) (raw)

Papers by Ciaran O'neill

Research paper thumbnail of P158 The cost of steroid induced morbidity among severe asthma patients in the UK: Abstract P158 Table 1

Research paper thumbnail of Detection and Management of Diabetes in England: Results from the Health Survey for England

Diabetes Therapy, 2017

Introduction: As part of a control strategy current guidance in the UK recommends more intense su... more Introduction: As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of Southeast Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings. Methods: Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socioeconomic gradient in disease detection and control among and between ethnic groups. Results: In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis. Conclusion: In the UK current guidance recommends practitioners consider testing for diabetes among Southeast Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

Research paper thumbnail of Health related quality of life two to five years after gestational diabetes mellitus: cross-sectional comparative study in the ATLANTIC DIP cohort

BMC pregnancy and childbirth, Jan 24, 2015

There is no consensus on the effect of gestational diabetes mellitus (GDM) on health-related qual... more There is no consensus on the effect of gestational diabetes mellitus (GDM) on health-related quality of life (HRQOL) for the mother in the short or long term. In this study we examined HRQOL in a group of women who had GDM in the index pregnancy 2 to 5 years previously and compared it to a group of women with normal glucose tolerance (NGT) in the index pregnancy during the same time period. The sample included 234 women who met International Association of Diabetes Study Groups (IADPSG) criteria for GDM in the index pregnancy and 108 who had NGT. The sample was drawn from the ATLATIC-DIP (Diabetes In Pregnancy) cohort - a network of antenatal centers along the Irish Atlantic seaboard serving a population of approximately 500,000 people. HRQOL was measured using the visual analogue component of the EQ-5D-3 L instrument in a cross-sectional survey. The difference in HRQOL between GDM and NGT groups was not significant when adjusted for the effects of the covariates. HRQOL was negative...

Research paper thumbnail of Securing a sustainable and fit-for-purpose UK health and care workforce

The Lancet, 2021

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite su... more Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, smallscale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2•4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.

Research paper thumbnail of Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model

The Lancet Global Health, 2019

Background Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of gl... more Background Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of global blindness. Nearly half of all people with PACG are of Chinese descent. Population-level glaucoma screening has generally not been found to be cost-effective in high-income countries; however, this assessment has rarely been done in lowincome or middle-income countries. We aimed to assess the cost-effectiveness and cost-utility of population-level glaucoma screening in China. Methods We developed decision-analytic Markov models for separate and combined screening for PACG and primary open angle glaucoma (POAG) to evaluate costs and benefits of community-level screening versus opportunistic case finding from a societal perspective. A cohort of individuals was followed in the model from age 50 years through a total of 30 1-year Markov cycles. Analyses were done separately for rural and urban settings. We did a meta-analysis of glaucoma prevalence studies in China to obtain prevalence estimates for PACG and POAG. Screening costs were taken from a Chinese screening programme and treatment costs from a tertiary Chinese eye hospital. Main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) using years of blindness avoided. We did one-way deterministic and simulated probabilistic sensitivity analyses to reflect uncertainty around ICURs and ICERs. Findings Compared with no screening, combined screening of POAG and PACG in rural China is predicted to result in an ICUR of US$569 (95% CI 17 to 4180) and an ICER of $1280 (−58 to 7940), both of which are below the WHO cost-effectiveness threshold of one to three times rural gross domestic product. For the urban China setting, combined screening is predicted to result in fewer net costs and greater gain in health benefits than no screening. Findings were robust in all sensitivity analyses. Over 30 years, a total of 246 (95% CI 63 to 628) and 1325 (510 to 2828) years of blindness are predicted to be avoided for every 100 000 rural and urban residents screened, respectively. Interpretation Population screening for glaucoma (POAG and PACG combined) is likely to be cost-effective in both urban and rural China. Future studies should investigate the effectiveness of interventions to improve acceptance of definitive care among people screened.

Research paper thumbnail of Quantifying the costs of having cancer for patients and their families: out-of-pocket payments made by colorectal cancer survivors

Research paper thumbnail of A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa

Ophthalmic Epidemiology, 2021

To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (S... more To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (SSA).A complete search was conducted on PubMed, Medline and African Journals Online (AJOL) to obtain relevant published articles, which were included in this review. All relevant articles on prevalence of glaucoma in SSA and among other African-derived populations, severity of glaucoma, cost of diagnosis and management, clinical effectiveness of glaucoma screening and treatment and the different glaucoma screening strategies in SSA were reviewed.Population screening interventions for glaucoma may be considered as follows: standalone screening for glaucoma, screening for glaucoma during cataract outreach, and screening incorporated with diabetic retinopathy image review using tele-ophthalmology. Our review suggests that cost of glaucoma treatment is relatively low with cost of medical treatment ranging from USD 273 to USD 480 per year/patient and surgical treatment cost of USD 283 per patient as with other developing countries. Compliance with medication is moderate to good in about 50% of glaucoma patients. Prevalence of glaucoma is much higher in SSA and almost 50% of glaucoma patients are blind in at least one eye at presentation in clinics (without outreach screening). Our review suggests a moderate sensitivity and specificity in identifying glaucoma with basic equipment (direct ophthalmoscope, contact tonometer and frequency doubling technology) during outreach screening although about a third or fewer take up glaucoma services in clinics.Our review provides the necessary information to conduct a cost-effective analysis of glaucoma screening in SSA using the decision Markov model.

Research paper thumbnail of Health preferences and preventive care utilisation: How EQ-5D-5L health preferences may affect uptake

Preventive Medicine Reports, 2021

Despite the economic and health benefits of preventive care being well established, the uptake of... more Despite the economic and health benefits of preventive care being well established, the uptake of many cost-effective preventive services remains lower than desired in many cases, especially among specific sub-populations. The value an individual places on health can influence their uptake of preventive care. One way to capture the value an individual places on health and future health status is to examine their health preferences. This study used a novel use of EQ-5D-5L health preferences to determine if health preferences are associated with the uptake of a range of preventive care services, including a cancer screening, blood pressure check, cholesterol check, blood test and urine test. We collected EQ-5D-5L composite time trade-off data in 2018/2019 on 242 respondents residing in Ireland. We estimated an initial tobit model to predict an individual’s health preference to capture health preferences as a regressor. We then estimated a bivariate probit model to examine the uptake of each preventive service and GP use. Each model controlled for health preferences, education, sex, type of health coverage, self-reported health, employment status, age and marital status. Health preferences are a significant determinant of all five preventive services while controlling for other covariates. The results shows that the higher an individual values good health, the more likely they are to avail of preventive care. Health preferences can be noted as a potential determinant of preventive care use that could guide policy responses seeking to increase demand-side factors for preventive care uptake.

Research paper thumbnail of Do people with private health insurance attach a higher value to health than those without insurance? Results from an EQ-5D-5 L valuation study in ireland

Health Policy, 2020

Insurance status has been shown to be a significant determinant of healthcare utilization in Irel... more Insurance status has been shown to be a significant determinant of healthcare utilization in Ireland after need has been controlled for. Our analysis provides no compelling evidence that there exist material differences in the values accorded health between those with and without health insurance. In consequence, it is reasonable to assume that observed differences in healthcare use related to insurance status reflect differences in access rather than differences in preferences. In this context, the continued State subsidization of private health insurance appears contrary to explicit policy statements in Ireland regarding the pursuit of equity in access to care.

Research paper thumbnail of Predictors of unmet needs and family debt among children and adolescents with an autism spectrum disorder: Evidence from Ireland

Health Policy, 2020

Autism Spectrum Disorders (ASDs) are a lifelong neurodevelopmental condition where individuals af... more Autism Spectrum Disorders (ASDs) are a lifelong neurodevelopmental condition where individuals affected and their families require varying intensities of services and supports. A growing body of evidence provides consensus that early intervention may improve long-term outcomes. The purpose of the paper is to identify the factors that explain variations between families raising a child/children with an ASD in their experience of specific unmet needs and/or experience of debt. Analysis was based on data collected as part of a larger study that examined the economics of autism spectrum disorder in Ireland among 195 families with 222 children aged between 2-18 years of age in 2014/2015. The findings from parental reported responses show over 74 % of children did not receive one or more services in the previous 12 months. Average debt per year per family was D 3259. Regression analyses showed that families that had two or more children with an ASD were more likely to experience unmet needs and incur debt specifically because of the child's condition than families with one child with an ASD. The study shows there is a significant level of unmet need and economic hardship, as evident in the level of ASD related debt which may make current met needs unsustainable in the future. Issues of capacity and geographic inequity that warrant a policy response were also evident.

Research paper thumbnail of A comparative examination of healthcare use related to hearing impairment in Europe

Global & Regional Health Technology Assessment: Italian; Northern Europe and Spanish, 2018

Introduction: The economic burden of hearing impairment is an area of increased interest. In this... more Introduction: The economic burden of hearing impairment is an area of increased interest. In this paper we examine the relationship between hearing impairment and service use in 14 European countries. Methods: Based on the Survey of Health Ageing and Retirement in Europe (SHARE) undertaken in 2013, Poisson regression models are used to analyse the relationship between the number of visits/number of nights in hospital, and hearing impairment controlling for a number of covariates. Results: We find that hearing impairment is generally associated with increased use of primary and secondary healthcare services when other aspects of health have been controlled. Comparative analysis revealed that where access to hearing assistive technology was greatest the additional use of services was least. Conclusions: The comparative analysis suggests that variations exist across countries in respect of the additional healthcare use occasioned by hearing impairment. They may also provide valuable insights into how the burden of illness might be reduced.

Research paper thumbnail of Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria

European Journal of Endocrinology, 2016

Objective An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated acr... more Objective An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this. Design Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy. Methods Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan–Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance. Results Twenty-six percent of women with...

Research paper thumbnail of Socioeconomic disparities across ethnicities: an application to cervical cancer screening

The American journal of managed care, 2015

Our aim is to investigate socioeconomic disparities in cervical cancer screening utilization amon... more Our aim is to investigate socioeconomic disparities in cervical cancer screening utilization among and between ethnic groups in the United States. Observational study. Data on 26,338 women aged 21 to 64 years were obtained from the 2007 to 2011 years of the Medical Expenditure Panel Survey. Data on cervical cancer screening utilization in the preceding 12 months and 3 years, and a range of sociodemographic characteristics were included. Analyses were undertaken for all women and across racial/ethnic grouping (ie, white, black, Hispanic, and other). Concentration indices were used to measure the socioeconomic gradient across ethnic groups. Probit regression analyses were used to examine variations in utilization related to socioeconomic factors across ethnic groups controlling for a range of pertinent characteristics. Annual utilization rates are high in the United States (60.15%) and greatest among black women (66.25%). Disparities, as measured by concentration indices (CIs), are la...

Research paper thumbnail of Factors influencing hospital costs of lung cancer patients in Northern Ireland

The European Journal of Health Economics, 2008

Research paper thumbnail of Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis

HRB Open Research

Background: Spatial accessibility has consistently been shown to influence utilisation of care an... more Background: Spatial accessibility has consistently been shown to influence utilisation of care and health outcomes, compared against local population needs. We sought to identify how appropriately nursing homes (NHs) are distributed in Ireland, as its NH market lacks central planning. Methods: We used multiple criteria decision analysis (MCDA) approaches to develop composite indices of both access (incorporating measures of availability, choice, quality and affordability) and local NH need for over 65s (relating to the proportion living alone, with cognitive disabilities or with low self-rated health, estimated scores for activities of daily living and instrumental activities of daily living, the average number of disabilities per person and the average age of this group). Data for need were derived from census data. Results were mapped to better understand underlying geographical patterns. Results: By comparing local accessibility and need, underserved areas could be identified, wh...

Research paper thumbnail of Assessing the impact on inequalities in use of orthodontic services of the introduction of an objective measure of treatment need in Northern Ireland

International Journal of Population Data Science

Background with rationalePrevious work has shown the existence of a sharp socio-economic gradient... more Background with rationalePrevious work has shown the existence of a sharp socio-economic gradient with respect to orthodontic services in Northern Ireland. The work demonstrated that those of lower socio-economic status had an odds ratio of 0.79 (95% CI 0.69 - 0.91) compared to those of higher socio-economic status with respect to the consumption of orthodontic services. In response to this, an objective measure of treatment need for such publicly funded services was introduced in 2014. Main AimThis study will use a record-linkage methodology to examine the relationship between use of publicly funded orthodontic care and the introduction of the index of treatment need (IOTN) in Northern Ireland in 2014. Methods/ApproachFollowing a similar approach to that used previously, data related to use of orthodontic services was linked to socio-economic characteristics from the 2011 Census for members of the Northern Ireland Longitudinal Study. The relationship between socio-economic status a...

Research paper thumbnail of The economic costs and its predictors for childhood autism spectrum disorders in Ireland: How is the burden distributed?

Autism : the international journal of research and practice, 2018

Autism spectrum disorders are associated with a substantial economic burden; although little is k... more Autism spectrum disorders are associated with a substantial economic burden; although little is known about the relationship between state and family out-of-pocket expenditure. The objective of this study is to estimate the societal cost of childhood autism spectrum disorders and explain the variation in costs between state and family out-of-pocket expenditure. A bottom-up prevalence based cost-of-illness methodology was implemented using data from a combination of multiple convenience samples in Ireland of 195 parents of 222 children aged between 2 and 18 years of age with a clinically diagnosed autism spectrum disorder collected in 2014/2015. The findings show the average annual cost per child for families amounted to €28,464.89 related to private autism spectrum disorder services, lost income and informal care. By comparison, annual state expenditure per child on autism spectrum disorder-related health, social and educational resources was €14,192. Regression analyses indicate th...

Research paper thumbnail of Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England

PloS one, 2018

Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated... more Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Ind...

Research paper thumbnail of The changing cost of breast cancer care: lessons from a centralised modern cancer centre

Irish journal of medical science, Jan 21, 2018

The cost of new cancer technologies has been the subject of intense debate in recent years. There... more The cost of new cancer technologies has been the subject of intense debate in recent years. There have been significant advances in therapeutic techniques for breast cancer over the past 20 years. This has been accompanied by the concentration of services in designated cancer centres. The aim of this study was to examine the changing cost of breast cancer management over an 18-year period and identify factors underlying this. We use breast cancer services data from Galway University Hospital in 1995-1996, 2005-2006 and 2011-2012 to examine the changing pattern of care costs and survival. The number of patients treated for breast cancer rose from 200 in 1995-1996, to 411 in 2005-2006 and 563 in 2011-2012. Two-year survival rose in line with national figures from 84 to 89.78 and 92.07%, in the three-time periods respectively. Adjusting for inflation, the average cost per patient rose from €14,710 (95% C.I., €13,398 to €16,022) in 1995-1996 to €30,405 (95% C.I., €38,620 to €32,189) in ...

Research paper thumbnail of Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial

The Lancet. Global health, 2018

Presbyopia, age-related decline in near vision, is the most common cause of vision impairment glo... more Presbyopia, age-related decline in near vision, is the most common cause of vision impairment globally, but no trials have assessed its workplace effects. We aimed to study the effect of near glasses on the productivity of tea workers with presbyopia. This randomised trial was done in tea pickers aged 40 years or older in Assam, India, with unaided near visual acuity (NVA) lower than 6/12 in both eyes, correctable to 6/7·5 with near glasses; unaided distance vision 6/7·5 or greater; and no eye disease. Participants were randomly assigned (1:1) to receive free glasses optimising NVA at working distance (cost including delivery US$10·20 per person), either immediately (intervention group) or at closeout (control group). Participants were stratified by age, sex, and productivity. The primary outcome (investigator-masked) was the difference between groups in the change in mean daily weight of tea picked (productivity), between the 4-week baseline period (June, 2017) and the 11-week eval...

Research paper thumbnail of P158 The cost of steroid induced morbidity among severe asthma patients in the UK: Abstract P158 Table 1

Research paper thumbnail of Detection and Management of Diabetes in England: Results from the Health Survey for England

Diabetes Therapy, 2017

Introduction: As part of a control strategy current guidance in the UK recommends more intense su... more Introduction: As part of a control strategy current guidance in the UK recommends more intense surveillance of HbA1C levels among those of Southeast Asian or Chinese ethnicity above specified BMI thresholds. The objective of this study was to determine whether disparities in the identification and control of diabetes in England persisted despite these guidelines and assess current strategies in light of these findings. Methods: Data were extracted from the 2013 Health Survey for England that included ethnicity, BMI status and HbA1C levels. Descriptive statistics and logistic regression analyses were used to examine relationships among undetected diabetes, poorly controlled diabetes and a range of covariates including ethnicity and BMI. Concentration indices were used to examine the socioeconomic gradient in disease detection and control among and between ethnic groups. Results: In regression models that controlled for a range of covariates Asians were found to have a 5% point higher risk of undetected diabetes than Whites. With respect to disease management, Bangladeshis and Pakistanis were found to be at a 28% point and 21% point higher risk of poor disease control respectively than Whites. Concentration indices revealed better disease control among more affluent Whites than poor Whites, no significant pattern between income and disease management was found among Pakistanis and poorer disease control was more evident among more affluent than poorer Bangladeshis. Conclusion: In the UK current guidance recommends practitioners consider testing for diabetes among Southeast Asians and Chinese where BMI exceeds 23. Our findings suggest that the risk experienced by Asians in disease detection is independent of BMI and may warrant a more active screening policy than currently recommended. With respect to disease management, our findings suggest that Indians and Pakistanis experience particularly high levels of poor disease control that may also be usefully reflected in guidance.

Research paper thumbnail of Health related quality of life two to five years after gestational diabetes mellitus: cross-sectional comparative study in the ATLANTIC DIP cohort

BMC pregnancy and childbirth, Jan 24, 2015

There is no consensus on the effect of gestational diabetes mellitus (GDM) on health-related qual... more There is no consensus on the effect of gestational diabetes mellitus (GDM) on health-related quality of life (HRQOL) for the mother in the short or long term. In this study we examined HRQOL in a group of women who had GDM in the index pregnancy 2 to 5 years previously and compared it to a group of women with normal glucose tolerance (NGT) in the index pregnancy during the same time period. The sample included 234 women who met International Association of Diabetes Study Groups (IADPSG) criteria for GDM in the index pregnancy and 108 who had NGT. The sample was drawn from the ATLATIC-DIP (Diabetes In Pregnancy) cohort - a network of antenatal centers along the Irish Atlantic seaboard serving a population of approximately 500,000 people. HRQOL was measured using the visual analogue component of the EQ-5D-3 L instrument in a cross-sectional survey. The difference in HRQOL between GDM and NGT groups was not significant when adjusted for the effects of the covariates. HRQOL was negative...

Research paper thumbnail of Securing a sustainable and fit-for-purpose UK health and care workforce

The Lancet, 2021

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite su... more Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, smallscale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2•4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.

Research paper thumbnail of Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model

The Lancet Global Health, 2019

Background Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of gl... more Background Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of global blindness. Nearly half of all people with PACG are of Chinese descent. Population-level glaucoma screening has generally not been found to be cost-effective in high-income countries; however, this assessment has rarely been done in lowincome or middle-income countries. We aimed to assess the cost-effectiveness and cost-utility of population-level glaucoma screening in China. Methods We developed decision-analytic Markov models for separate and combined screening for PACG and primary open angle glaucoma (POAG) to evaluate costs and benefits of community-level screening versus opportunistic case finding from a societal perspective. A cohort of individuals was followed in the model from age 50 years through a total of 30 1-year Markov cycles. Analyses were done separately for rural and urban settings. We did a meta-analysis of glaucoma prevalence studies in China to obtain prevalence estimates for PACG and POAG. Screening costs were taken from a Chinese screening programme and treatment costs from a tertiary Chinese eye hospital. Main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) using years of blindness avoided. We did one-way deterministic and simulated probabilistic sensitivity analyses to reflect uncertainty around ICURs and ICERs. Findings Compared with no screening, combined screening of POAG and PACG in rural China is predicted to result in an ICUR of US$569 (95% CI 17 to 4180) and an ICER of $1280 (−58 to 7940), both of which are below the WHO cost-effectiveness threshold of one to three times rural gross domestic product. For the urban China setting, combined screening is predicted to result in fewer net costs and greater gain in health benefits than no screening. Findings were robust in all sensitivity analyses. Over 30 years, a total of 246 (95% CI 63 to 628) and 1325 (510 to 2828) years of blindness are predicted to be avoided for every 100 000 rural and urban residents screened, respectively. Interpretation Population screening for glaucoma (POAG and PACG combined) is likely to be cost-effective in both urban and rural China. Future studies should investigate the effectiveness of interventions to improve acceptance of definitive care among people screened.

Research paper thumbnail of Quantifying the costs of having cancer for patients and their families: out-of-pocket payments made by colorectal cancer survivors

Research paper thumbnail of A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa

Ophthalmic Epidemiology, 2021

To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (S... more To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (SSA).A complete search was conducted on PubMed, Medline and African Journals Online (AJOL) to obtain relevant published articles, which were included in this review. All relevant articles on prevalence of glaucoma in SSA and among other African-derived populations, severity of glaucoma, cost of diagnosis and management, clinical effectiveness of glaucoma screening and treatment and the different glaucoma screening strategies in SSA were reviewed.Population screening interventions for glaucoma may be considered as follows: standalone screening for glaucoma, screening for glaucoma during cataract outreach, and screening incorporated with diabetic retinopathy image review using tele-ophthalmology. Our review suggests that cost of glaucoma treatment is relatively low with cost of medical treatment ranging from USD 273 to USD 480 per year/patient and surgical treatment cost of USD 283 per patient as with other developing countries. Compliance with medication is moderate to good in about 50% of glaucoma patients. Prevalence of glaucoma is much higher in SSA and almost 50% of glaucoma patients are blind in at least one eye at presentation in clinics (without outreach screening). Our review suggests a moderate sensitivity and specificity in identifying glaucoma with basic equipment (direct ophthalmoscope, contact tonometer and frequency doubling technology) during outreach screening although about a third or fewer take up glaucoma services in clinics.Our review provides the necessary information to conduct a cost-effective analysis of glaucoma screening in SSA using the decision Markov model.

Research paper thumbnail of Health preferences and preventive care utilisation: How EQ-5D-5L health preferences may affect uptake

Preventive Medicine Reports, 2021

Despite the economic and health benefits of preventive care being well established, the uptake of... more Despite the economic and health benefits of preventive care being well established, the uptake of many cost-effective preventive services remains lower than desired in many cases, especially among specific sub-populations. The value an individual places on health can influence their uptake of preventive care. One way to capture the value an individual places on health and future health status is to examine their health preferences. This study used a novel use of EQ-5D-5L health preferences to determine if health preferences are associated with the uptake of a range of preventive care services, including a cancer screening, blood pressure check, cholesterol check, blood test and urine test. We collected EQ-5D-5L composite time trade-off data in 2018/2019 on 242 respondents residing in Ireland. We estimated an initial tobit model to predict an individual’s health preference to capture health preferences as a regressor. We then estimated a bivariate probit model to examine the uptake of each preventive service and GP use. Each model controlled for health preferences, education, sex, type of health coverage, self-reported health, employment status, age and marital status. Health preferences are a significant determinant of all five preventive services while controlling for other covariates. The results shows that the higher an individual values good health, the more likely they are to avail of preventive care. Health preferences can be noted as a potential determinant of preventive care use that could guide policy responses seeking to increase demand-side factors for preventive care uptake.

Research paper thumbnail of Do people with private health insurance attach a higher value to health than those without insurance? Results from an EQ-5D-5 L valuation study in ireland

Health Policy, 2020

Insurance status has been shown to be a significant determinant of healthcare utilization in Irel... more Insurance status has been shown to be a significant determinant of healthcare utilization in Ireland after need has been controlled for. Our analysis provides no compelling evidence that there exist material differences in the values accorded health between those with and without health insurance. In consequence, it is reasonable to assume that observed differences in healthcare use related to insurance status reflect differences in access rather than differences in preferences. In this context, the continued State subsidization of private health insurance appears contrary to explicit policy statements in Ireland regarding the pursuit of equity in access to care.

Research paper thumbnail of Predictors of unmet needs and family debt among children and adolescents with an autism spectrum disorder: Evidence from Ireland

Health Policy, 2020

Autism Spectrum Disorders (ASDs) are a lifelong neurodevelopmental condition where individuals af... more Autism Spectrum Disorders (ASDs) are a lifelong neurodevelopmental condition where individuals affected and their families require varying intensities of services and supports. A growing body of evidence provides consensus that early intervention may improve long-term outcomes. The purpose of the paper is to identify the factors that explain variations between families raising a child/children with an ASD in their experience of specific unmet needs and/or experience of debt. Analysis was based on data collected as part of a larger study that examined the economics of autism spectrum disorder in Ireland among 195 families with 222 children aged between 2-18 years of age in 2014/2015. The findings from parental reported responses show over 74 % of children did not receive one or more services in the previous 12 months. Average debt per year per family was D 3259. Regression analyses showed that families that had two or more children with an ASD were more likely to experience unmet needs and incur debt specifically because of the child's condition than families with one child with an ASD. The study shows there is a significant level of unmet need and economic hardship, as evident in the level of ASD related debt which may make current met needs unsustainable in the future. Issues of capacity and geographic inequity that warrant a policy response were also evident.

Research paper thumbnail of A comparative examination of healthcare use related to hearing impairment in Europe

Global & Regional Health Technology Assessment: Italian; Northern Europe and Spanish, 2018

Introduction: The economic burden of hearing impairment is an area of increased interest. In this... more Introduction: The economic burden of hearing impairment is an area of increased interest. In this paper we examine the relationship between hearing impairment and service use in 14 European countries. Methods: Based on the Survey of Health Ageing and Retirement in Europe (SHARE) undertaken in 2013, Poisson regression models are used to analyse the relationship between the number of visits/number of nights in hospital, and hearing impairment controlling for a number of covariates. Results: We find that hearing impairment is generally associated with increased use of primary and secondary healthcare services when other aspects of health have been controlled. Comparative analysis revealed that where access to hearing assistive technology was greatest the additional use of services was least. Conclusions: The comparative analysis suggests that variations exist across countries in respect of the additional healthcare use occasioned by hearing impairment. They may also provide valuable insights into how the burden of illness might be reduced.

Research paper thumbnail of Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria

European Journal of Endocrinology, 2016

Objective An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated acr... more Objective An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this. Design Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy. Methods Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan–Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance. Results Twenty-six percent of women with...

Research paper thumbnail of Socioeconomic disparities across ethnicities: an application to cervical cancer screening

The American journal of managed care, 2015

Our aim is to investigate socioeconomic disparities in cervical cancer screening utilization amon... more Our aim is to investigate socioeconomic disparities in cervical cancer screening utilization among and between ethnic groups in the United States. Observational study. Data on 26,338 women aged 21 to 64 years were obtained from the 2007 to 2011 years of the Medical Expenditure Panel Survey. Data on cervical cancer screening utilization in the preceding 12 months and 3 years, and a range of sociodemographic characteristics were included. Analyses were undertaken for all women and across racial/ethnic grouping (ie, white, black, Hispanic, and other). Concentration indices were used to measure the socioeconomic gradient across ethnic groups. Probit regression analyses were used to examine variations in utilization related to socioeconomic factors across ethnic groups controlling for a range of pertinent characteristics. Annual utilization rates are high in the United States (60.15%) and greatest among black women (66.25%). Disparities, as measured by concentration indices (CIs), are la...

Research paper thumbnail of Factors influencing hospital costs of lung cancer patients in Northern Ireland

The European Journal of Health Economics, 2008

Research paper thumbnail of Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis

HRB Open Research

Background: Spatial accessibility has consistently been shown to influence utilisation of care an... more Background: Spatial accessibility has consistently been shown to influence utilisation of care and health outcomes, compared against local population needs. We sought to identify how appropriately nursing homes (NHs) are distributed in Ireland, as its NH market lacks central planning. Methods: We used multiple criteria decision analysis (MCDA) approaches to develop composite indices of both access (incorporating measures of availability, choice, quality and affordability) and local NH need for over 65s (relating to the proportion living alone, with cognitive disabilities or with low self-rated health, estimated scores for activities of daily living and instrumental activities of daily living, the average number of disabilities per person and the average age of this group). Data for need were derived from census data. Results were mapped to better understand underlying geographical patterns. Results: By comparing local accessibility and need, underserved areas could be identified, wh...

Research paper thumbnail of Assessing the impact on inequalities in use of orthodontic services of the introduction of an objective measure of treatment need in Northern Ireland

International Journal of Population Data Science

Background with rationalePrevious work has shown the existence of a sharp socio-economic gradient... more Background with rationalePrevious work has shown the existence of a sharp socio-economic gradient with respect to orthodontic services in Northern Ireland. The work demonstrated that those of lower socio-economic status had an odds ratio of 0.79 (95% CI 0.69 - 0.91) compared to those of higher socio-economic status with respect to the consumption of orthodontic services. In response to this, an objective measure of treatment need for such publicly funded services was introduced in 2014. Main AimThis study will use a record-linkage methodology to examine the relationship between use of publicly funded orthodontic care and the introduction of the index of treatment need (IOTN) in Northern Ireland in 2014. Methods/ApproachFollowing a similar approach to that used previously, data related to use of orthodontic services was linked to socio-economic characteristics from the 2011 Census for members of the Northern Ireland Longitudinal Study. The relationship between socio-economic status a...

Research paper thumbnail of The economic costs and its predictors for childhood autism spectrum disorders in Ireland: How is the burden distributed?

Autism : the international journal of research and practice, 2018

Autism spectrum disorders are associated with a substantial economic burden; although little is k... more Autism spectrum disorders are associated with a substantial economic burden; although little is known about the relationship between state and family out-of-pocket expenditure. The objective of this study is to estimate the societal cost of childhood autism spectrum disorders and explain the variation in costs between state and family out-of-pocket expenditure. A bottom-up prevalence based cost-of-illness methodology was implemented using data from a combination of multiple convenience samples in Ireland of 195 parents of 222 children aged between 2 and 18 years of age with a clinically diagnosed autism spectrum disorder collected in 2014/2015. The findings show the average annual cost per child for families amounted to €28,464.89 related to private autism spectrum disorder services, lost income and informal care. By comparison, annual state expenditure per child on autism spectrum disorder-related health, social and educational resources was €14,192. Regression analyses indicate th...

Research paper thumbnail of Chronic kidney disease, health-related quality of life and their associated economic burden among a nationally representative sample of community dwelling adults in England

PloS one, 2018

Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated... more Chronic kidney disease (CKD) affects up to 15% of the adult population and is strongly associated with other non-communicable chronic diseases including diabetes. However, there is limited information on a population basis of the relationship between CKD and health-related quality of life (HRQoL) and the consequent economic cost. We investigated this relationship in a representative sample in England using the 2010 Health Survey for England. Multivariable Tobit models were used to examine the relationship between HRQoL and CKD severity. HRQoL was converted to quality adjusted life year (QALY) measures by combining decrements in quality of life with reductions in life expectancy associated with increased disease severity. QALYs were adjusted for discounting and monetised using the UK threshold for reimbursement of £30,000. The QALYs were then used in conjunction with forecasted prevalence to estimate the HRQoL burden associated with CKD among individuals with diabetes up to 2025. Ind...

Research paper thumbnail of The changing cost of breast cancer care: lessons from a centralised modern cancer centre

Irish journal of medical science, Jan 21, 2018

The cost of new cancer technologies has been the subject of intense debate in recent years. There... more The cost of new cancer technologies has been the subject of intense debate in recent years. There have been significant advances in therapeutic techniques for breast cancer over the past 20 years. This has been accompanied by the concentration of services in designated cancer centres. The aim of this study was to examine the changing cost of breast cancer management over an 18-year period and identify factors underlying this. We use breast cancer services data from Galway University Hospital in 1995-1996, 2005-2006 and 2011-2012 to examine the changing pattern of care costs and survival. The number of patients treated for breast cancer rose from 200 in 1995-1996, to 411 in 2005-2006 and 563 in 2011-2012. Two-year survival rose in line with national figures from 84 to 89.78 and 92.07%, in the three-time periods respectively. Adjusting for inflation, the average cost per patient rose from €14,710 (95% C.I., €13,398 to €16,022) in 1995-1996 to €30,405 (95% C.I., €38,620 to €32,189) in ...

Research paper thumbnail of Effect of providing near glasses on productivity among rural Indian tea workers with presbyopia (PROSPER): a randomised trial

The Lancet. Global health, 2018

Presbyopia, age-related decline in near vision, is the most common cause of vision impairment glo... more Presbyopia, age-related decline in near vision, is the most common cause of vision impairment globally, but no trials have assessed its workplace effects. We aimed to study the effect of near glasses on the productivity of tea workers with presbyopia. This randomised trial was done in tea pickers aged 40 years or older in Assam, India, with unaided near visual acuity (NVA) lower than 6/12 in both eyes, correctable to 6/7·5 with near glasses; unaided distance vision 6/7·5 or greater; and no eye disease. Participants were randomly assigned (1:1) to receive free glasses optimising NVA at working distance (cost including delivery US$10·20 per person), either immediately (intervention group) or at closeout (control group). Participants were stratified by age, sex, and productivity. The primary outcome (investigator-masked) was the difference between groups in the change in mean daily weight of tea picked (productivity), between the 4-week baseline period (June, 2017) and the 11-week eval...