julia langham - Academia.edu (original) (raw)
Papers by julia langham
The Lancet Psychiatry, Dec 31, 2023
Ophthalmology, Dec 1, 2009
PubMed, Oct 1, 2002
Background: Sub-optimal management of cardiovascular disease (CVD) patients is widespread in prim... more Background: Sub-optimal management of cardiovascular disease (CVD) patients is widespread in primary and secondary care, with risk factors frequently unrecorded or untreated. Aim: To investigate the effectiveness of educational interventions developed in primary care, on recording, prescribing and control of risk factors among all patients recorded by their general practitioner as having CVD. Design of study: Factorial, duster-randomised controlled trial. Setting: Primary care teams representing the range of practice development in a geographically defined area in inner London. Method: Participating practices were randomly allocated to one of the four intervention groups: information, evidence, both or neither. Interventions were tailored to suit individual practice needs. At a mean of 19 months after baseline, and three months after the end of intervention, practices carried out the follow-up assessment of recording, treatment, and control of risk factors in the same CVD patients. Results: Adequate recording of all three risk factors, found inapproximately a third of patients at baseline, increased non-significantly by 10.5% (95% confidence interval [CI] = 3.9 to 24.9) in the information (versus not information) group and by 6.6% (95% [CI] = 8.9 to 22.0) in the evidence (versus not evidence) group. Factorial improvements in prescribing and control of risk factors tended not to be significant. Adequate recording of an three risk factors showed the greatest improvement in the information plus evidence group (19.9% increase, P for heterogeneity across the four groups < or = 0.001). Mean change from baseline to follow-up within the four intervention groups suggested improvements in the combined information plus evidence group in cholesterol recording (22.5% increase), prescribing of lipid lowering drugs (4.4% increase) and mean cholesterol (0.7 mmol/l decrease). Conclusions: Adequate risk factor recording did not differ between the information (versus not information) or the evidence (versus not evidence) intervention groups. Combined training in information systems and evidence-based medicine should be considered in the design of future interventions, to improve secondary prevention of CVD.
Respiratory Research, Nov 4, 2019
Annals of Emergency Medicine, Jul 1, 1999
Study objective: As part of an ongoing project to identify all the randomized controlled trials (... more Study objective: As part of an ongoing project to identify all the randomized controlled trials (RCTs) in the emergency medicine literature, in association with the Cochrane Collaboration, 2 discrete studies were undertaken; the first, to compare motives for active ...
Bjog: An International Journal Of Obstetrics And Gynaecology, Oct 3, 2022
ObjectiveTo describe the rates of and risk factors associated with iatrogenic and spontaneous pre... more ObjectiveTo describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals.DesignCohort study using electronic health records.SettingEnglish National Health Service.PopulationSingleton births between 1 April 2015 and 31 March 2017.MethodsMultivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors.Main outcome measuresPreterm births (<37 weeks of gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour.ResultsOf the births, 6.1% were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub‐groups were associated with previous preterm birth, extremes of maternal age, socio‐economic deprivation and smoking. Iatrogenic preterm birth was associated with higher body mass index (BMI) (BMI >40 kg/m2 adjRR 1.59, 95% CI 1.50–1.69) and previous caesarean (adjRR 1.88, 95% CI 1.83–1.95). Spontaneous preterm birth was less common in women with a higher BMI (BMI >40 kg/m2 adjRR 0.77, 95% CI 0.70–0.84) and in women with a previous caesarean (adjRR 0.87, 95% CI 0.83–0.90). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared with spontaneous, preterm births.ConclusionsJust over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub‐groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data.
Rheumatology and therapy, Jul 3, 2023
Value in Health, Nov 1, 2014
Value in Health, Oct 1, 2017
Due to the widely-dispersed small number of patients with a given rare disease (RD), there is gen... more Due to the widely-dispersed small number of patients with a given rare disease (RD), there is generally a lack of validated biomarkers and endpoints in RDs. This poses a major challenge for generating clinical data for healthcare decision-making in RD. Registries can provide a rich source of real-world evidence to aid healthcare providers, payers, and regulators in decision making. This review aimed to identify and assess key characteristics of the RD registries reporting data from EU5 countries. MethOds: Registries were identified through a systematic search of MEDLINE® and EMBASE® databases for the last 15 years. Any data on RD patients from EU5 countries were included. Registry publications (English language only) and websites were assessed for information on patient demographics and disease characteristics, epidemiology, disease management, resource use, patientreported outcomes (PROs) and funding agency. Results: The review identified 52 registries reporting data for RDs. Six were multinational, while 46 were national. Twenty registries collected data from the UK, 15 from France, 12 from Germany, 10 from Italy, and nine from Spain; 31 registries collected data for a specific RD, while 21 registries collected data for various RDs. The number of included patients varied from 61 to 12,500. Of these registries, 41% were initiated during the last 10 years and 14% were industry-funded, 55% were non-industry-funded, while funding information was unclear for 31% registries. Data were available for baseline demographics (in 96% of registries), patient and disease-related characteristics (96%), incidence/prevalence (77%), mortality (69%), treatment-related information (42%), PROs (6%), and cost/resource use (4%). A dedicated website was available for 62% of registries; however, information on data accessibility was not clearly available for most of these registries. cOnclusiOns: Our review demonstrates that registries can provide valuable real-world information on patients with RD, supplementing the limited findings from clinical trials, to inform health-care decision-making.
Rheumatology and Therapy
Introduction: This analysis was conducted to assess the incidence of adverse clinical outcomes, h... more Introduction: This analysis was conducted to assess the incidence of adverse clinical outcomes, healthcare resource use (HCRU), and the costs associated with systemic corticosteroid (SCS) use in adults with systemic lupus erythematosus (SLE) in the UK. Methods: We identified incident SLE cases using the Clinical Practice Research Datalink GOLD, Hospital Episode Statistics-linked healthcare, and Office for National Statistics mortality databases from January 1, 2005, to June 30, 2019. Adverse clinical outcomes, HCRU, and costs were captured for patients with and without prescribed SCS. Results: Of 715 patients, 301 (42%) had initiated SCS use (mean [standard deviation (SD)] 3.2 [6.0] mg/day) and 414 (58%) had no recorded SCS use post-SLE diagnosis. Cumulative incidence of any adverse clinical outcome over 10-year follow-up was 50% (SCS group) and 22% (non-SCS group), with osteoporosis diagnosis/fracture most frequently reported. SCS exposure in the past 90 days was associated with an adjusted hazard ratio of 2.41 (95% confidence interval 1.77-3.26) for any adverse clinical outcome, with increased hazard for osteoporosis diagnosis/fracture (5.26, 3.61-7.65)
Annals of the Rheumatic Diseases, 2020
Background: There is limited real-world evidence demonstrating the long-term direct costs associa... more Background: There is limited real-world evidence demonstrating the long-term direct costs associated with systemic lupus erythematosus (SLE) in the United Kingdom (UK). Objectives: To describe health care resource utilization and costs in adults with SLE in the UK over time and document costs by disease severity and type of encounter, including primary care, hospitalizations, outpatient visits, and prescription drugs. Methods: Patients aged ≥18 years with SLE were identified in the linked Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have data from ≥12 months before and after the index date, defined as the date of earliest diagnosis available in the data set. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm.1 Costs were calculated in 2017 UK pounds from the UK national health care system perspective. We estimated all-cause hea...
Value in Health, 2019
Objectives: To determine the complications (exacerbations, pneumonia) in patients with inhaled co... more Objectives: To determine the complications (exacerbations, pneumonia) in patients with inhaled corticosteroids (IC) replaced by long-acting muscarinic antagonists (LAMA) in dual therapy for the treatment of COPD usual clinical practice. Methods: Retrospective, observational study (before/after with control group) carried out by review of medical records. The study included patients aged 40yearswhohadbeenontreatmentfor40 years who had been on treatment for 40yearswhohadbeenontreatmentfor 1 year with IC/long-acting beta agonists (LABA) in whom IC were replaced by a LAMA (index-date) during 2014-2017 (recruitment period). Study groups: a) IC/LABA (without replacement, dual therapy) and b) LABA/LAMA (replacement of IC, dual bronchodilation). Data were collected for a reference period before the index date and a follow up period of one year. Each patient in the LABA/LAMA group was matched with one in the IC/ LABA group by propensity score matching (PSM). Main measures: comorbidity, medication, IC dose, exacerbations and pneumonia. The statistical analysis was carried out using multivariate-models (p,0.05). Results: 2,366 patients were recruited, and IC were replaced by LAMA in 19.9% (N = 464). After PSM the study groups were: a) IC/LABA N = 462, and b) LABA/LAMA N = 462, the mean age was 71.8 years and 80.3% were male (Charlson index: 0.9). The mortality rate was 10.4%, severe COPD 35.5%, 13.9 received high daily IC doses, FEV1 was 54.9% and 8.5% received home oxygen therapy. By study groups, the results were similar: 22.4% showed some type of exacerbation (IC/LABA: 21.4% vs. LABA/LAMA: 23.4%; p=0.478). Severe exacerbations (IC/LABA: 5.6% vs. 6.3%, p=0.675), and total exacerbations before the study period (22.7% vs. 22.9%, p=0.938) were similar. Conclusions: Relatively few patients received replacement of IC by LAMA. Comparisons showed IC/LABA (dual therapy) and LABA/LAMA (dual bronchodilation) were associated with similar rates of exacerbation, pneumonia and use of health resources. However, further studies will be needed to reinforce the consistency of the results.
Value in Health, 2018
OBJECTIVES: The American and European societies for cancer, ASCO and ESMO, introduced value frame... more OBJECTIVES: The American and European societies for cancer, ASCO and ESMO, introduced value frameworks to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies. In addition, also HTA bodies form their reimbursement decisions based on a treatments benefit. However, it is unclear whether assessment outcomes of these clinical outcomes would match national reimbursement recommendations. First, we aimed to assess the relationship between these clinical value frameworks. Then, we assessed the relationship between these frameworks and added benefit decisions of three HTA bodies. METHODS: ESMO and ASCO scores were calculated for 21 cancer treatments. Both scores were standardized by calculating the frequency of each score compared to the total score. First, Spearman's rank correlation coefficient was estimated to assess the relationship between these clinical value frameworks. A chi-square test of independence was performed to examine the relation between the ESMO framework (Substantial improvement: Yes/No) and added benefit decisions by NICE, GBA and HAS. RESULTS: The average standardized ESMO and ASCO score for all examined treatments was 70% (SD¼0.22) and 41% (SD¼0.14), respectively. By applying the Spearman's rank correlation coefficient, we found a moderate correlation (0.4 < R < 0.6) between ASCO and ESMO overall cancer score (r¼0.53; p¼0.01). Moreover, a significant relation between ESMO substantial and HAS added benefit decisions (X2, p¼0.03) were found. However, for GBA and NICE, no significant relations to ESMO substantial benefit decisions were observed (X2, p¼0.3 and X2, p¼1, respectively). CONCLUSIONS: There seem to be a moderate association between American and European cancer clinical value frameworks. However, substantial improvement by ESMO scale doesn't necessarily translate into positive added benefit decisions. This is more evident for NICE, where cancer treatments are evaluated primarily within a cost-effectiveness framework.
Annals of the Rheumatic Diseases, 2020
Background:There is limited real-world evidence describing the presentation and treatment pattern... more Background:There is limited real-world evidence describing the presentation and treatment patterns of systemic lupus erythematosus (SLE) in the United Kingdom (UK).Objectives:To characterize disease severity, comorbid conditions, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK.Methods:Patients aged ≥18 years with SLE were identified in the Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have ≥12 months of data before and after index date (date of earliest SLE diagnosis available). SLE disease severity and flares were classified as mild, moderate, or severe using adapted claims-based algorithms1,2that use SLE-related conditions (eg, end-stage renal disease), medications (eg, antimalarials, immunosuppressants, and corticosteroids), and health service use (eg, hospitalizations and emergency department visits).Results:Of 802 patients with SLE, 369 (46.0%)...
Epidemiology, one of the key disciplines in public health, is concerned with describing the patte... more Epidemiology, one of the key disciplines in public health, is concerned with describing the patterns of diseases, identifying their causes and evaluating the effectiveness of health care and public health interventions. Such information helps to promote health and treat disease. This book introduces the key elements of epidemiological methods. The book examines: • Concepts and applications of epidemiology • Population measures of health and disease • Descriptive and analytical study designs • Intervention studies • Risk assessment and preventive strategies • Surveillance and screenin
Rheumatology Advances in Practice, 2021
Objectives To characterize disease severity, clinical manifestations, treatment patterns, and fla... more Objectives To characterize disease severity, clinical manifestations, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK. Methods Adults with SLE were identified in the Clinical Practice Research Datalink–Hospital Episode Statistics database (1/1/2005–31/12/2017). Patients were required to have ≥12 months of data before and after index date (earliest SLE diagnosis date available). SLE disease severity and flares were classified using adapted claims-based algorithms, which utilize SLE-related conditions, medications, and health service use. Results Of 802 patients, 369 had mild, 345 had moderate, and 88 had severe SLE at baseline. A total of 692 initiated treatment in the first year after diagnosis. 557 received antimalarials, 203 received immunosuppressants and 416 received oral corticosteroids. Information on biologic use in hospitals was unavailable. The mean (S.D.) time to initiating any medication was 177 (385.3) days. The median time to first f...
Lancet, 2005
The relation between chronic stress and the metabolic syndrome might also help explain why the wo... more The relation between chronic stress and the metabolic syndrome might also help explain why the worldwide epidemic of obesity is not restricted to industrialised nations. I declare that I have no conflict of interest.
The Lancet Psychiatry, Dec 31, 2023
Ophthalmology, Dec 1, 2009
PubMed, Oct 1, 2002
Background: Sub-optimal management of cardiovascular disease (CVD) patients is widespread in prim... more Background: Sub-optimal management of cardiovascular disease (CVD) patients is widespread in primary and secondary care, with risk factors frequently unrecorded or untreated. Aim: To investigate the effectiveness of educational interventions developed in primary care, on recording, prescribing and control of risk factors among all patients recorded by their general practitioner as having CVD. Design of study: Factorial, duster-randomised controlled trial. Setting: Primary care teams representing the range of practice development in a geographically defined area in inner London. Method: Participating practices were randomly allocated to one of the four intervention groups: information, evidence, both or neither. Interventions were tailored to suit individual practice needs. At a mean of 19 months after baseline, and three months after the end of intervention, practices carried out the follow-up assessment of recording, treatment, and control of risk factors in the same CVD patients. Results: Adequate recording of all three risk factors, found inapproximately a third of patients at baseline, increased non-significantly by 10.5% (95% confidence interval [CI] = 3.9 to 24.9) in the information (versus not information) group and by 6.6% (95% [CI] = 8.9 to 22.0) in the evidence (versus not evidence) group. Factorial improvements in prescribing and control of risk factors tended not to be significant. Adequate recording of an three risk factors showed the greatest improvement in the information plus evidence group (19.9% increase, P for heterogeneity across the four groups < or = 0.001). Mean change from baseline to follow-up within the four intervention groups suggested improvements in the combined information plus evidence group in cholesterol recording (22.5% increase), prescribing of lipid lowering drugs (4.4% increase) and mean cholesterol (0.7 mmol/l decrease). Conclusions: Adequate risk factor recording did not differ between the information (versus not information) or the evidence (versus not evidence) intervention groups. Combined training in information systems and evidence-based medicine should be considered in the design of future interventions, to improve secondary prevention of CVD.
Respiratory Research, Nov 4, 2019
Annals of Emergency Medicine, Jul 1, 1999
Study objective: As part of an ongoing project to identify all the randomized controlled trials (... more Study objective: As part of an ongoing project to identify all the randomized controlled trials (RCTs) in the emergency medicine literature, in association with the Cochrane Collaboration, 2 discrete studies were undertaken; the first, to compare motives for active ...
Bjog: An International Journal Of Obstetrics And Gynaecology, Oct 3, 2022
ObjectiveTo describe the rates of and risk factors associated with iatrogenic and spontaneous pre... more ObjectiveTo describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals.DesignCohort study using electronic health records.SettingEnglish National Health Service.PopulationSingleton births between 1 April 2015 and 31 March 2017.MethodsMultivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors.Main outcome measuresPreterm births (<37 weeks of gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour.ResultsOf the births, 6.1% were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub‐groups were associated with previous preterm birth, extremes of maternal age, socio‐economic deprivation and smoking. Iatrogenic preterm birth was associated with higher body mass index (BMI) (BMI >40 kg/m2 adjRR 1.59, 95% CI 1.50–1.69) and previous caesarean (adjRR 1.88, 95% CI 1.83–1.95). Spontaneous preterm birth was less common in women with a higher BMI (BMI >40 kg/m2 adjRR 0.77, 95% CI 0.70–0.84) and in women with a previous caesarean (adjRR 0.87, 95% CI 0.83–0.90). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared with spontaneous, preterm births.ConclusionsJust over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub‐groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data.
Rheumatology and therapy, Jul 3, 2023
Value in Health, Nov 1, 2014
Value in Health, Oct 1, 2017
Due to the widely-dispersed small number of patients with a given rare disease (RD), there is gen... more Due to the widely-dispersed small number of patients with a given rare disease (RD), there is generally a lack of validated biomarkers and endpoints in RDs. This poses a major challenge for generating clinical data for healthcare decision-making in RD. Registries can provide a rich source of real-world evidence to aid healthcare providers, payers, and regulators in decision making. This review aimed to identify and assess key characteristics of the RD registries reporting data from EU5 countries. MethOds: Registries were identified through a systematic search of MEDLINE® and EMBASE® databases for the last 15 years. Any data on RD patients from EU5 countries were included. Registry publications (English language only) and websites were assessed for information on patient demographics and disease characteristics, epidemiology, disease management, resource use, patientreported outcomes (PROs) and funding agency. Results: The review identified 52 registries reporting data for RDs. Six were multinational, while 46 were national. Twenty registries collected data from the UK, 15 from France, 12 from Germany, 10 from Italy, and nine from Spain; 31 registries collected data for a specific RD, while 21 registries collected data for various RDs. The number of included patients varied from 61 to 12,500. Of these registries, 41% were initiated during the last 10 years and 14% were industry-funded, 55% were non-industry-funded, while funding information was unclear for 31% registries. Data were available for baseline demographics (in 96% of registries), patient and disease-related characteristics (96%), incidence/prevalence (77%), mortality (69%), treatment-related information (42%), PROs (6%), and cost/resource use (4%). A dedicated website was available for 62% of registries; however, information on data accessibility was not clearly available for most of these registries. cOnclusiOns: Our review demonstrates that registries can provide valuable real-world information on patients with RD, supplementing the limited findings from clinical trials, to inform health-care decision-making.
Rheumatology and Therapy
Introduction: This analysis was conducted to assess the incidence of adverse clinical outcomes, h... more Introduction: This analysis was conducted to assess the incidence of adverse clinical outcomes, healthcare resource use (HCRU), and the costs associated with systemic corticosteroid (SCS) use in adults with systemic lupus erythematosus (SLE) in the UK. Methods: We identified incident SLE cases using the Clinical Practice Research Datalink GOLD, Hospital Episode Statistics-linked healthcare, and Office for National Statistics mortality databases from January 1, 2005, to June 30, 2019. Adverse clinical outcomes, HCRU, and costs were captured for patients with and without prescribed SCS. Results: Of 715 patients, 301 (42%) had initiated SCS use (mean [standard deviation (SD)] 3.2 [6.0] mg/day) and 414 (58%) had no recorded SCS use post-SLE diagnosis. Cumulative incidence of any adverse clinical outcome over 10-year follow-up was 50% (SCS group) and 22% (non-SCS group), with osteoporosis diagnosis/fracture most frequently reported. SCS exposure in the past 90 days was associated with an adjusted hazard ratio of 2.41 (95% confidence interval 1.77-3.26) for any adverse clinical outcome, with increased hazard for osteoporosis diagnosis/fracture (5.26, 3.61-7.65)
Annals of the Rheumatic Diseases, 2020
Background: There is limited real-world evidence demonstrating the long-term direct costs associa... more Background: There is limited real-world evidence demonstrating the long-term direct costs associated with systemic lupus erythematosus (SLE) in the United Kingdom (UK). Objectives: To describe health care resource utilization and costs in adults with SLE in the UK over time and document costs by disease severity and type of encounter, including primary care, hospitalizations, outpatient visits, and prescription drugs. Methods: Patients aged ≥18 years with SLE were identified in the linked Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have data from ≥12 months before and after the index date, defined as the date of earliest diagnosis available in the data set. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm.1 Costs were calculated in 2017 UK pounds from the UK national health care system perspective. We estimated all-cause hea...
Value in Health, 2019
Objectives: To determine the complications (exacerbations, pneumonia) in patients with inhaled co... more Objectives: To determine the complications (exacerbations, pneumonia) in patients with inhaled corticosteroids (IC) replaced by long-acting muscarinic antagonists (LAMA) in dual therapy for the treatment of COPD usual clinical practice. Methods: Retrospective, observational study (before/after with control group) carried out by review of medical records. The study included patients aged 40yearswhohadbeenontreatmentfor40 years who had been on treatment for 40yearswhohadbeenontreatmentfor 1 year with IC/long-acting beta agonists (LABA) in whom IC were replaced by a LAMA (index-date) during 2014-2017 (recruitment period). Study groups: a) IC/LABA (without replacement, dual therapy) and b) LABA/LAMA (replacement of IC, dual bronchodilation). Data were collected for a reference period before the index date and a follow up period of one year. Each patient in the LABA/LAMA group was matched with one in the IC/ LABA group by propensity score matching (PSM). Main measures: comorbidity, medication, IC dose, exacerbations and pneumonia. The statistical analysis was carried out using multivariate-models (p,0.05). Results: 2,366 patients were recruited, and IC were replaced by LAMA in 19.9% (N = 464). After PSM the study groups were: a) IC/LABA N = 462, and b) LABA/LAMA N = 462, the mean age was 71.8 years and 80.3% were male (Charlson index: 0.9). The mortality rate was 10.4%, severe COPD 35.5%, 13.9 received high daily IC doses, FEV1 was 54.9% and 8.5% received home oxygen therapy. By study groups, the results were similar: 22.4% showed some type of exacerbation (IC/LABA: 21.4% vs. LABA/LAMA: 23.4%; p=0.478). Severe exacerbations (IC/LABA: 5.6% vs. 6.3%, p=0.675), and total exacerbations before the study period (22.7% vs. 22.9%, p=0.938) were similar. Conclusions: Relatively few patients received replacement of IC by LAMA. Comparisons showed IC/LABA (dual therapy) and LABA/LAMA (dual bronchodilation) were associated with similar rates of exacerbation, pneumonia and use of health resources. However, further studies will be needed to reinforce the consistency of the results.
Value in Health, 2018
OBJECTIVES: The American and European societies for cancer, ASCO and ESMO, introduced value frame... more OBJECTIVES: The American and European societies for cancer, ASCO and ESMO, introduced value frameworks to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies. In addition, also HTA bodies form their reimbursement decisions based on a treatments benefit. However, it is unclear whether assessment outcomes of these clinical outcomes would match national reimbursement recommendations. First, we aimed to assess the relationship between these clinical value frameworks. Then, we assessed the relationship between these frameworks and added benefit decisions of three HTA bodies. METHODS: ESMO and ASCO scores were calculated for 21 cancer treatments. Both scores were standardized by calculating the frequency of each score compared to the total score. First, Spearman's rank correlation coefficient was estimated to assess the relationship between these clinical value frameworks. A chi-square test of independence was performed to examine the relation between the ESMO framework (Substantial improvement: Yes/No) and added benefit decisions by NICE, GBA and HAS. RESULTS: The average standardized ESMO and ASCO score for all examined treatments was 70% (SD¼0.22) and 41% (SD¼0.14), respectively. By applying the Spearman's rank correlation coefficient, we found a moderate correlation (0.4 < R < 0.6) between ASCO and ESMO overall cancer score (r¼0.53; p¼0.01). Moreover, a significant relation between ESMO substantial and HAS added benefit decisions (X2, p¼0.03) were found. However, for GBA and NICE, no significant relations to ESMO substantial benefit decisions were observed (X2, p¼0.3 and X2, p¼1, respectively). CONCLUSIONS: There seem to be a moderate association between American and European cancer clinical value frameworks. However, substantial improvement by ESMO scale doesn't necessarily translate into positive added benefit decisions. This is more evident for NICE, where cancer treatments are evaluated primarily within a cost-effectiveness framework.
Annals of the Rheumatic Diseases, 2020
Background:There is limited real-world evidence describing the presentation and treatment pattern... more Background:There is limited real-world evidence describing the presentation and treatment patterns of systemic lupus erythematosus (SLE) in the United Kingdom (UK).Objectives:To characterize disease severity, comorbid conditions, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK.Methods:Patients aged ≥18 years with SLE were identified in the Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have ≥12 months of data before and after index date (date of earliest SLE diagnosis available). SLE disease severity and flares were classified as mild, moderate, or severe using adapted claims-based algorithms1,2that use SLE-related conditions (eg, end-stage renal disease), medications (eg, antimalarials, immunosuppressants, and corticosteroids), and health service use (eg, hospitalizations and emergency department visits).Results:Of 802 patients with SLE, 369 (46.0%)...
Epidemiology, one of the key disciplines in public health, is concerned with describing the patte... more Epidemiology, one of the key disciplines in public health, is concerned with describing the patterns of diseases, identifying their causes and evaluating the effectiveness of health care and public health interventions. Such information helps to promote health and treat disease. This book introduces the key elements of epidemiological methods. The book examines: • Concepts and applications of epidemiology • Population measures of health and disease • Descriptive and analytical study designs • Intervention studies • Risk assessment and preventive strategies • Surveillance and screenin
Rheumatology Advances in Practice, 2021
Objectives To characterize disease severity, clinical manifestations, treatment patterns, and fla... more Objectives To characterize disease severity, clinical manifestations, treatment patterns, and flares in a longitudinal cohort of adults with SLE in the UK. Methods Adults with SLE were identified in the Clinical Practice Research Datalink–Hospital Episode Statistics database (1/1/2005–31/12/2017). Patients were required to have ≥12 months of data before and after index date (earliest SLE diagnosis date available). SLE disease severity and flares were classified using adapted claims-based algorithms, which utilize SLE-related conditions, medications, and health service use. Results Of 802 patients, 369 had mild, 345 had moderate, and 88 had severe SLE at baseline. A total of 692 initiated treatment in the first year after diagnosis. 557 received antimalarials, 203 received immunosuppressants and 416 received oral corticosteroids. Information on biologic use in hospitals was unavailable. The mean (S.D.) time to initiating any medication was 177 (385.3) days. The median time to first f...
Lancet, 2005
The relation between chronic stress and the metabolic syndrome might also help explain why the wo... more The relation between chronic stress and the metabolic syndrome might also help explain why the worldwide epidemic of obesity is not restricted to industrialised nations. I declare that I have no conflict of interest.