Publications by authors named "Trudy A Sullivan"

3 Publications

  • Page 1 of 1

Total Hip and Knee Arthroplasties Are Highly Cost-Effective Procedures: The Importance of Duration of Follow-Up.

J Arthroplasty 2021 Jan 21. Epub 2021 Jan 21.

Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.

Background: Total hip and knee arthroplasties (THA/TKA) are clinically effective but high cost procedures. The aim of this study is to perform a cost-effectiveness analysis of THA and TKA in the New Zealand (NZ) healthcare system.

Methods: Data were collected from 713 patients undergoing THA and 520 patients undergoing TKA at our local public hospital. SF-6D utility values were obtained from participants preoperatively and 1-year postoperatively, and deaths and any revision surgeries from patient records and the New Zealand Joint Registry at minimum 8-year follow-up. A continuous-time state-transition simulation model was used to estimate costs and health gains to 15 years. Quality-adjusted life years (QALYs), treatment costs, and incremental cost-effectiveness ratios (ICERs) were calculated to determine cost effectiveness. ICERs below NZ gross domestic product (GDP; NZ$60 600) and 0.5 times GDP per capita were considered "cost effective" and "highly cost effective" respectively.

Results: Cumulative health gains were 2.8 QALYs (THA) and 2.3 QALYs (TKA) over 15 years. Cost effectiveness improved from ICERs of NZ$74,400 (THA) and NZ$93,000 (TKA) at 1 year to NZ$6000 (THA) and NZ$7500 (TKA) at 15 years. THA and TKA were cost effective after 2 years and highly cost effective after 3 years. QALY gains and cost effectiveness were greater in patients with worse preoperative functional status and younger age.

Conclusion: THA and TKA are highly cost-effective procedures over longer term horizons. Although preoperative status and age were associated with cost effectiveness, both THA and TKA remained cost effective in patients with less severe preoperative scores and older ages.
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January 2021

The cost of diabetes-related hospital care to the Southern District Health Board in 2016/17.

N Z Med J 2019 10 25;132(1504):35-45. Epub 2019 Oct 25.

Senior Lecturer and Health Economist, Department of Preventive and Social Medicine, University of Otago, Dunedin.

Aim: To estimate the cost of diabetes-related hospital admissions to the Southern District Health Board for the year 2016/17.

Methods: Unidentified data with an ICD-10-AM diagnostic code for any type of diabetes were obtained for admissions to Dunedin and Southland Hospitals. Each admission was categorised according to whether the diabetes diagnostic code was listed first, second or subsequently, and by diagnostic group within each of these three categories. The case weight for each admission was multiplied by the 2016/17 cost weight value of NZ$4,824.67.

Results: There were 6,994 separate hospital admission events. The total cost was NZ$40,986,618. Admissions where diabetes was the primary, secondary or subsequent diagnosis cost NZ$2,214,172, NZ$8,057,235 and NZ$30,697,210, respectively. More than 80% of admissions were for those aged 55 years and over. Ketoacidosis was the most common primary reason for admission (n=103) among those with type 1 diabetes, costing NZ$349,892. When diabetes was not the primary or secondary diagnosis, the most common primary diagnosis was a circulatory system disease, costing NZ$8,181,324. The mean (SD) cost per admission where the primary diagnosis was coronary artery disease with and without diabetes diagnostic codes was NZ$10,407 ($20,694) and NZ$8,657 ($11,347), respectively.

Conclusions: The annual cost of diabetes-related hospital admissions is substantial. Monitoring the cost of diabetes to DHBs should be prioritised, along with implementation of interventions that reduce preventable diabetes-related hospital admissions, and new diabetes cases.
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October 2019

Economic evaluation of a multi-disciplinary community-based intervention programme for New Zealand children and adolescents with obesity.

Obes Res Clin Pract 2018 May - Jun;12(3):293-298. Epub 2018 May 17.

Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

Objective: To determine whether Whānau Pakari, a home-based, 12-month multi-disciplinary child obesity intervention programme was cost-effective when compared with the prior conventional hospital-based model of care.

Methods: Whānau Pakari trial participants were recruited January 2012-August 2014, and randomised to either a high-intensity intervention (weekly sessions for 12 months with home-based assessments and advice, n=100) or low-intensity control (home-based assessments and advice only, n=99). Trial participants were aged 5-16 years, resided in Taranaki, Aotearoa/New Zealand (NZ), with a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities. Conventional group participants (receiving paediatrician assessment with dietitian input and physical activity/nutrition support, n=44) were aged 4-15 years, and resided in the same or another NZ centre. The change in BMI standard deviation score (SDS) at 12 months from baseline and programme intervention costs, both at the participant level, were used for the economic evaluation. A limited health funder perspective with costs in 2016 NZ$ was taken.

Results: The per child 12-month Whānau Pakari programme costs were significantly lower than in the conventional group. In the low-intensity group, costs were NZ$939 (95% CI: 872, 1007) (US$648) lower than the conventional group. In the high-intensity intervention group, costs were NZ$155 (95% CI: 89, 219) (US$107) lower than in the conventional group. BMI SDS reductions were similar in the three groups.

Conclusions: A home-based, multi-disciplinary child obesity intervention had lower programme costs per child, greater reach, with similar BMI SDS outcomes at 12 months when compared with the previous hospital-based conventional model.
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April 2019