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Objectives: Telehealth is a promising tool for delivering lifestyle interventions for the management of health conditions. However, limited evidence exists regarding the cost-effectiveness of these interventions. This systematic review aimed to evaluate the current literature reporting on the cost-effectiveness of telehealth-delivered diet and/or exercise interventions. Methods: Four electronic databases (PubMed, CENTRAL, CINAHL and Embase) were searched for published literature from database inception to November 2020. This review adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines and the ISPOR Criteria for Cost-Effectiveness Review Outcomes Checklist. The quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to telehealth modality, organised into tables and reported narratively. Results: Twenty-four studies of controlled trials (11 combined diet and exercise, 9 exercise-only and 4 diet-only telehealth-delivered interventions) were included for data extraction and quality assessment. Interventions were reported as cost-effective in 12 studies (50%), five studies (21%) reported inconclusive results, and seven studies (29%) reported that the interventions were not cost-effective. Telephone interventions were applied in eight studies (33%), seven studies (29%) used internet interventions, six studies (25%) used a combination of internet and telephone interventions, and three studies (13%) evaluated mHealth interventions. Quality of study reporting varied with between 54% and 92% of Consolidated Health Economic Evaluation Reporting Standards items reported. Conclusions: This review suggests that telehealth-delivered lifestyle interventions can be cost-effective compared to traditional care. There is a need for further investigations that employ rigorous methodology and economic reporting, including appropriate decision analytical models and longer timeframes. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions Using pharmacokinetics (PK)‐guided 5‐fluorouracil (5‐FU) for metastatic colorectal cancer (mCRC) improves overall survival (OS) and decreases toxicity, yet its value for money in the Australian setting is unknown. Our study assesses the cost‐effectiveness of PK vs. body surface area (BSA) dosing of 5‐FU for patients with mCRC.We developed a semi‐Markov model with four health states to compare PK‐guided dosing within a FOLFOX regimen vs. BSA‐guided dosing for mCRC patients from an Australian healthcare system perspective. Transition probabilities were derived from fitted survival models, with utility values obtained directly from published studies. We calculated direct healthcare costs, quality‐adjusted life years (QALYs) and incremental cost‐effectiveness ratios (ICERs), and included both one‐way and probabilistic sensitivity analyses.BSA‐guided FOLFOX provided 1.291 QALYs at a cost of $36 379, compared with PK‐guided FOLFOX which delivered 1.751 QALYs at a cost of $32 564. Therefore, PK‐guided dosing emerges as the dominant strategy offering both better health outcomes and lower costs. The variables that had the greatest impact on the overall ICER were the adverse event rates in the BSA and PK groups, model time horizon, utility of progression‐free survival and PREDICT assay cost. Our univariate and multivariate sensitivity analysis confirmed that the ICER for PK FOLFOX consistently remained below $50 000 per QALY across all tested variables.PK dose management of 5‐FU‐based chemotherapy in mCRC patients appears to be a cost‐saving strategy in Australia. However, our model estimates are drawn from limited, low‐quality evidence. Further evidence from randomized controlled trials (RCTs), directly comparing PK‐based to BSA‐based dosing across a variety of current regimens, is needed to address our model's uncertainties. [ABSTRACT FROM AUTHOR]

Background: Outpatient parenteral antimicrobial therapy (OPAT) offers an alternative to inpatient (hospital bed-based) treatment of infections that require intravenous administration of antimicrobials. This meta-analysis aimed to summarise the evidence available from randomised controlled trials (RCTs) regarding the efficacy and safety of OPAT compared to inpatient parenteral antimicrobial therapy., Methods: We searched the Cochrane Library, MEDLINE, Embase, PubMed, and Web of Sciences databases for RCTs comparing outpatient versus inpatient parenteral antimicrobial therapy. We included studies without restrictions on language or publication year. Eligibility was reviewed independently by two assessors, and data extraction was cross validated. We evaluated bias risk via the Cochrane tool and determined the evidence certainty using GRADE. Meta-analysis was conducted using a random effects model. The protocol of this review was registered on PROSPERO (CRD42023460389)., Result: Thirteen RCTs, involving 1,310 participants were included. We found no difference in mortality (Risk Ratio (RR) 0.54, 95% Confidence Interval (CI) 0.23 to 1.26; p = 0.93), treatment failure (RR 1.0, CI 0.59 to 1.72; p = 0.99), adverse reaction related to antimicrobials (RR 0.89, CI 0.69 to 1.15; p = 0.38), and administration device (RR 0.58, CI 0.17 to 1.98; p = 0.87) between outpatient and inpatient parenteral antimicrobial therapy. The overall body of evidence had a low level of certainty., Conclusion: Existing evidence suggests OPAT is a safe and effective alternative to inpatient treatment. Further RCTs are warranted for a thorough comparison of inpatient and outpatient parenteral antimicrobial therapy with a high level of certainty., Competing Interests: Conflict of interest The authors declare no potential conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts., Methods: This qualitative scoping review was conducted using Arksey and O'Malley's methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works., Results: A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI., Conclusions: Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it's crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care., (© 2024. The Author(s).)