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Smart Professional Surveillance System (Smart PSS) is to manage small quantity security surveillance devices. It is widely used in small. This guide will show how to download and install SmartPSS. SmartPSS V2 0 0 R 190426; Computer; Internet.
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Visual acuity data for patients undergoing cataract extraction were taken from the report of the US National Cataract PORT. The post-operative visual acuity of the second-eye surgery was assumed to be equal to that of the first eye, i.e. 20/27.Complication rates associated with cataract extraction were taken from a previous study for initial cataract surgery. Complications included in the model were PCO, endophthalmitis, cystoid macular oedema, lost lens fragments, intraocular lens dislocation, pseudophakic bullous keratopathy, and PCO with subsequent retinal detachment.
The health-care costs associated with each of the primary costs of cataract surgery and the costs of defined cataract complications were derived from multiple sources.The costs of ambulatory procedures and surgical procedures were obtained from US Medicare statistics for 2001 (reference no longer available). Drug expenditure costs associated with cataract surgery, including the medical and post-operative managements, were obtained from the 2001 Drug Topics Red Book. When multiple evidence-based treatment options were available for management of complications associated with cataract surgery, an estimate of the costs for a certain complication was derived from the weighted average of the costs relating to each treatment option.
Cost itemTotal costsBusbee et al. (2003)Brown and Brown (2004)Cataract surgery$2314$2318Posterior capsular opacification$231$244Endophthalmitis – tap and inject$844$903Endophthalmitis – pars plana vitrectomy$4735$2536Intraocular lens dislocation$2035$1730Intraocular lens dislocation with pars plana vitrectomy$4757$2666Cystoid macular oedema$201$118Pseudophakic bullous keratopathy – surgical$2763$2750Pseudophakic bullous keratopathy –medical$1319$3076Lost lens fragments$4573$2295Retinal detachment – scleral buckle$4700$2551Retinal detachment – vitrectomy$5118$3223. For the Busbee study, the utility value corresponding to unilateral pseudophakia was 0.858. The reference case utility value for an ocular health state after second-eye cataract surgery was 0.967.
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These visual outcomes for each complication after treatment, with the exception of PCO, were assigned a utility value of 0.858. For PCO without retinal detachment, it was assumed that visual acuity returned to 20/27 in the operated eye, and had a utility value of 0.97.The Brown study uses slightly different utility values to those in Busbee and colleagues. The mean utility associated with cataract surgery and 20/27 vision in one eye (with vision ≤ 20/40 in the second eye) is 0.86. The mean utility when the visual acuity is 20/27 in both eyes is 0.97. ModellingIf a model was used, describe the type of model used (e.g. Markov state transition model, discrete event simulation). Was this a newly developed model or was it adapted from a previously reported model?
If an adaptation, give the source of the original. What was the purpose of the model (i.e. Why was a model required in this evaluation)?
What are the main components of the model (e.g. Health states within a Markov model)? Are sources for assumptions over model structure (e.g. Allowable transitions) reported – list them if reported. A decision tree model was developed in TreeAge (TreeAge Software, Inc., Williamstown, MA, USA).
The model incorporated costs and consequences associated with second-eye cataract surgery compared with unilateral pseudophakia (20/27), including complications associated with cataract surgery (over 4 months).It was assumed that the theoretical patient presented with visual acuity in the pseudophakia eye equal to the mean post-operative visual acuity reported by the PORT study, and that the post-operative visual acuity for the second-eye surgery was equal to that of the first-eye surgery (20/27). Posterior capsule opacification occurs at a rate of 28% over a five year post-operative period.
The mean time of treatment after surgery was assumed to be 2 years. Retinal detachment was assumed to occur at a rate of 0.81% after cataract surgery, at a mean time of 1 year after surgery. Retinal detachment repair after treatment of PCO occurred three years after cataract surgery. Intraocular lens dislocation was assumed to occur at a rate of 1.1% after cataract extraction.Pseudophakic bullous keratopathy was assumed to occur at a rate of 0.3%, with a mean time to post-operative treatment of 1 year after cataract extraction. PCO with subsequent retinal detachment was assumed to occur at a 3.9-fold increase from the cumulative retinal detachment rate of 0.81%. Increasing discounted costs by 25% resulted in $3408 per QALY gained (Busbee and colleagues, 2003), whereas decreasing the costs by 25% resulted in $2045 per QALY gained.
When all utility values were increased by 25%, the cost-effectiveness was $2182 per QALY gained. By decreasing all utility values by 25%, the cost-effectiveness was $3646 per QALY gained. Varying the annual discount rate resulted in $1918 per QALY gained for a 0% rate, $3445 per QALY gained for a 5% rate, and $5964 per QALY gained for a 10% rate.
386 patients scheduled for routine cataract operation (219 available for final analysis). Mean age varied from 69 to 75 years across the three subgroups.
Effectiveness was estimated from the 15D generic 15-dimensional, standardised HRQoL instrument. Patients completed the 15D at baseline and then again approximately 6 months after the cataract operation.Best corrected visual acuity was measured before the operation in both eyes by Snellen notation at 6 metres. Best corrected visual acuity was not measured after surgery but the authors suggest that they have no reason to doubt it would have improved in most of the patients.The only statistically significant increase in the individual dimensions of the 15D was for ‘seeing’, observed across all three subgroups.Changes in utility scores for the individual domains are presented according to severity of HRQoL (levels 1 and 2 vs.
Levels 3 to 5 of the scoring dimension). They are given for the whole study rather than the three subgroups and, therefore, data have not been extracted. Direct health-care costs were obtained from the Ecomed ® clinical patient administration system (Datawell Ltd, Espoo, Finland), where all costs of treatment of individual patients in the hospital are routinely stored. Costing covered all relevant specialty-related costs including pre- and post-operative outpatient visits to the eye hospital.
However, the costs of the visits to the referring ophthalmologists who were usually also responsible for the post-operative re-examination of the patients and prescription of eyeglasses, was not included in the analysis. Indirect costs, like period of disability, were not included.Mean (SD) hospital costs at 6 months:Group A = €1318 (184)Group B = €2289 (266)Group C = €1323 (361)Whole sample = €1261 (246).No other cost or resource estimates reported. As above under ‘ 2 Effectiveness’, HRQoL was estimated directly through patients completing the 15D questionnaire before and after surgery.The generic, 15-dimensional, standardised, self-administered HRQoL instrument can be used both as a profile and a single index utility score measure. The 15D questionnaire consists of 15 dimensions: moving, seeing, hearing, breathing, sleeping, eating, speech, eliminating, usual activities, mental function, discomfort and symptoms, depression, distress, vitality and sexual activity. For each dimension, the respondent must choose one of the five levels that best describes his/her state of health at the moment (the best level = 1; the worst level = 5).
The valuation system of the 15D is based on an application of the multiattribute utility theory. A set of utility or preference weights, elicited from the general public through a three-stage valuation procedure, is used in an additive aggregation formula to generate the utility score, i.e. The 15D score (single index number) over all the dimensions. The maximum score is 1 (no problems on any dimension), and minimum score 0 (equal to being dead). In most of the important properties the 15D compares favourably with other instruments of that kind (references given).The HRQoL gain was assumed to last till the end of the remaining statistical life expectancy of each patient based on life tables from 2002 from Statistics Finland.
Whole sample, mean (SD)HRQoL baseline = 0.82 (0.13)HRQoL 6 months = 0.83 (0.14)HRQoL difference = 0.01p-value not stated, but reported to be statistically insignificant.Group A, mean (SD)HRQoL baseline = 0.85 (0.13)HRQoL 6 months = 0.85 (0.14)HRQoL difference = 0.00 (0.14); p = 0.852.Group B, mean (SD)HRQoL baseline = 0.80 (0.13)HRQoL 6 months = 0.83 (0.14)HRQoL difference = 0.03 (0.14); p =. ModellingIf a model was used, describe the type of model used (e.g. Markov state transition model, discrete event simulation). Was this a newly developed model or was it adapted from a previously reported model? If an adaptation, give the source of the original.
What was the purpose of the model (i.e. Why was a model required in this evaluation)? What are the main components of the model (e.g. Health states within a Markov model)? Are sources for assumptions over model structure (e.g.
Allowable transitions) reported – list them if reported. Authors state that the results of the one-way sensitivity analysis were relatively robust when varying costs and treatment effectiveness, but use of median values substantially increased the cost/QALY in the group of patients whose first eye had been operated on earlier (presume this is a mistake as the group mentioned – group C – did not have a cost per QALY estimated due to negative change in HRQoL. Presume they mean group A where cost per QALY increased from €8212 to €39,188).Bootstrap simulation suggested that compared with no treatment, surgery was more costly and less effective in 46.4% of simulated cases, and more costly and more effective in 53.6% of simulated cases in subgroup A (quadrant I vs. Quadrant II in figure 7). The corresponding percentages were 37.9% and 62.1% in subgroup B (figure 8), and 51.1% and 48.9% in subgroup C (figure 9), respectively. Bootstrap sensitivity analysis also suggested that at a willingness to pay threshold of €20,000 per QALY gained, the probability of cataract surgery being acceptable was 51.7% in subgroup A, 59.
0% in subgroup B and 46. 4% in subgroup C (figure 10). The utility gain from cataract surgery was small and confined to an improvement in seeing only. Possible explanations: two-thirds of patients reported only minimal pre-operative subjective seeing problems despite objective evidence of poor visual acuity in the surgical eye; the ‘real-world’ setting of a university clinic and its ‘mixed sample’; one-third of patients had a secondary ophthalmic diagnosis (which might reduce the benefit of surgery); potential insensitivity of the 15D to measure changes in HRQoL (it includes only one question relating to sight). Costs were derived from the Foss and colleagues RCT.
Patient diaries were used to collect individual patient level data on all contacts with health and social services, including care home admission, informal care, equipment and home modifications. Data were collected at 3 and 9 months through telephone interviews and at 6 and 12 months through face-to-face interviews.Lifetime costs were estimated by using a life expectancy from UK government life tables.
Annual costs for the control group were assumed to remain constant in subsequent years as that observed in the trial period. Costs in the final three-quarters of the year were rescaled to better reflect costs over a full year without a cataract operation for the intervention group. As with the control group, these costs were assumed to remain constant over the remaining lifespan. Resource use itemSurgeryNo surgeryDifferenceSecondary health careCataract operation67230643Non-cataract-related outpatients544291252Bed-days32929732A&E24717Lower limb fracture1377Upper limb fracture70−7Primary health care13811028GP93849Practice/district nurse452618PSS411750−340LA home care worker2412355Day centre visits6211755Residential care45321−275Nursing home70−7Meals on wheels315322Special equipment2524−1Patient and carer575364210Home care539313226Carer time3652−16. ModellingIf a model was used, describe the type of model used (e.g. Markov state transition model, discrete event simulation).
Was this a newly developed model or was it adapted from a previously reported model? If an adaptation, give the source of the original.
What was the purpose of the model (i.e. Why was a model required in this evaluation)? What are the main components of the model (e.g. Health states within a Markov model)? Are sources for assumptions over model structure (e.g. Allowable transitions) reported – list them if reported.
Appropriate, based upon EQ-5D elicited from cataract patients directly in a RCT. The authors discuss the potential limitations of using EQ-5D to assess cataract surgery, including possible lack of precision and responsiveness making it hard to detect small changes. EQ-5D does not incorporate sensory function in its descriptive system.The authors also suggest their results are conservative due to the assumption that the difference in quality of life between intervention and control being constant over the lifetime whereas one would expect some deterioration in the control group in utility over time (mean utility declined from 0.72 to 0.69 in the 6-month period used to measure utility in the study).Validity of estimate of costs. © Queen’s Printer and Controller of HMSO 2014. This work was produced by Frampton et al. Under the terms of a commissioning contract issued by the Secretary of State for Health.
This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.Included under terms of.
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