Browsing by Author "Beall, Reed"
Now showing 1 - 6 of 6
Results Per Page
Sort Options
- ItemOpen AccessA multidisciplinary review of the policy, intellectual property rights, and international trade environment for access and affordability to essential cancer medications(2019-09-18) Baxi, Sangita M.; Beall, Reed; Yang, Joshua; Mackey, Tim KAbstract In 2015, the World Health Organization (WHO) Expert Committee approved the addition of 16 cancer medicines to the WHO Model List of Essential Medicines (EML), bringing the total number of cancer medicines on the list to 46. This change represented the first major revision to the EML oncology section in recent history and reinforces international recognition of the need to ensure access and affordability for cancer treatments. Importantly, many low and middle-income countries rely on the EML, as well as the children’s EML, as a guide to establish national formularies, and moreover use these lists as tools to negotiate medicine pricing. However, EML inclusion is only one component that impacts cancer treatment access. More specifically, factors such as intellectual property rights and international trade agreements can interact with EML inclusion, drug pricing, and accessibility. To better understand this dynamic, we conducted an interdisciplinary review of the patent status of EML cancer medicines compared to other EML noncommunicable disease medicines using the 17th, 18th, 19th, 20th, and 21st editions of the list. We also explored the interaction of intellectual property rights with the international trade regime and how trade agreements can and do impact cancer treatment access and affordability. Based on this analysis, we conclude that patent status is simply one factor in the complex international environment of health systems, IPR policies, and trade regimes and that aligning these oftentimes disparate interests will require shared global governance across the cancer care continuum.
- ItemOpen AccessEnhancing the Reproducibility of Health Technology Assessments(2021-12) Wagner, Daniel; Spackman, Eldon; Hazlewood, Glen; Beall, Reed; Bojke, LauraHealth systems around the world depend on Health Technology Assessment (HTA) programs to provide policy guidance on many factors, including value-for-money. To ensure decisions are made with current information, methods of evidence synthesis and economic evaluation are used to inform a continuous process of evidence gathering and decision making. While computers are used in almost every part of this process, the act of updating an existing HTA often involves a duplication of the original effort. The experience of other scientific fields suggests this is attributable to a lack of reproducibility. This refers to the ability to obtain consistent computational results, using the same set of files and processes. The objective of this thesis was to explore how an emphasis on reproducibility can support the effective development and maintenance of HTAs. Satisfaction of this objective required the identification and implementation of computing strategies to enhance the reproducibility of HTAs. A literature review was used to identify techniques for reproducibility which had proven successful in other fields. The identified strategies encouraged the creation of an accurate and complete record of the research process in human and machine-readable formats. These findings were subsequently applied to a case study which redeveloped an existing appraisal of biologic treatment for psoriatic arthritis. The first part of the case study summarized the development and execution of an automated workflow. The second part explored how the computing strategies affected the programming of the economic model. Outcomes from the case study included improved quality control, more efficient updating, and the elimination of barriers to the characterization of uncertainty. With enough investment, enhancing the reproducibility of HTAs will enable improved transparency, better decision making, and ultimately population health gains.
- ItemOpen AccessHealthcare utilization and adverse outcomes stratified by sex, age and long-term care residency using the Alberta COVID-19 Analytics and Research Database (ACARD): a population-based descriptive study(2023-05-19) Rennert-May, Elissa; Crocker, Alysha; D’Souza, Adam G.; Zhang, Zuying; Chew, Derek; Beall, Reed; Vickers, David M.; Leal, JenineAbstract Background Understanding the epidemiology of Coronavirus Disease of 2019 (COVID-19) in a local context is valuable for both future pandemic preparedness and potential increases in COVID-19 case volume, particularly due to variant strains. Methods Our work allowed us to complete a population-based study on patients who tested positive for COVID-19 in Alberta from March 1, 2020 to December 15, 2021. We completed a multi-centre, retrospective population-based descriptive study using secondary data sources in Alberta, Canada. We identified all adult patients (≥ 18 years of age) tested and subsequently positive for COVID-19 (including only the first incident case of COVID-19) on a laboratory test. We determined positive COVID-19 tests, gender, age, comorbidities, residency in a long-term care (LTC) facility, time to hospitalization, length of stay (LOS) in hospital, and mortality. Patients were followed for 60 days from a COVID-19 positive test. Results Between March 1, 2020 and December 15, 2021, 255,037 adults were identified with COVID-19 in Alberta. Most confirmed cases occurred among those less than 60 years of age (84.3%); however, most deaths (89.3%) occurred among those older than 60 years. Overall hospitalization rate among those who tested positive was 5.9%. Being a resident of LTC was associated with substantial mortality of 24.6% within 60 days of a positive COVID-19 test. The most common comorbidity among those with COVID-19 was depression. Across all patients 17.3% of males and 18.6% of females had an unplanned ambulatory visit subsequent to their positive COVID-19 test. Conclusions COVID-19 is associated with extensive healthcare utilization. Residents of LTC were substantially impacted during the COVID-19 pandemic with high associated mortality. Further work should be done to better understand the economic burden associated with related healthcare utilization following a COVID-19 infection to inform healthcare system resource allocation, planning, and forecasting.
- ItemOpen AccessThe Impact of Geographic Deprivation Levels on Acute Ischemic Stroke Care in Alberta(2022-06) Eagles, Matthew; Spackman, Eldon; Beall, Reed; Wong, John; Hill, MichaelIntroduction: Acute ischemic stroke is a neurological emergency that is associated with significant morbidity and mortality. Treatments for this condition aim to reperfuse the ischemic brain and are time sensitive in nature. To optimize patient outcome, strokes need to be recognized quickly, triaged appropriately, and started down the optimal treatment pathway. Unfortunately, previous works have suggested that there are inequalities in the provision of stroke care and outcomes based on patient socioeconomic status (SES). The objective of this thesis was to assess for disparities in the management and outcomes of patients who suffer ischemic stroke in Alberta, Canada based on a measure of neighbourhood SES. Methods: We performed three retrospective cohort studies using population level data from the Quality Improvement in Clinical Research Database. All patients were treated with IV Alteplase between January 1, 2017, and December 31, 2019. The outcomes of interest were treatment with endovascular thrombectomy (EVT), patient outcome (home-time), and treatment acuity (emergency room triage scores and stroke to needle time). Our independent variable of interest was an individual’s neighbourhood deprivation, as calculated by the Pampalon Index. We used regression modeling to assess for relationships between our outcomes and independent variable of interest. Results: Overall deprivation was significantly associated with the odds of being treated with EVT, yet this difference was no longer statistically significant after controlling for the distance an individual lives from the nearest comprehensive stroke centre. There was no significant association between deprivation level and home-time or stroke to needle time; however, being from the most deprived areas of Alberta was significantly associated with less acute emergency room triage scores being assigned. Conclusions: We identified potential areas of disparity in the treatment of acute ischemic stroke based on a measure of neighbourhood SES. However, these gaps did not lead to significantly worse patient outcomes in this study cohort. Future works should attempt to replicate these findings while including patients who were not treated with Alteplase.
- ItemEmbargoPublic Policy Analysis: Social Prescribing and Improving Older Adults' Access to Healthy Food(2023-05-29) Toth, Aidan; Beall, ReedWhile federal and provincial social security programs exist that provide general economic assistance, and social and welfare services exist for addressing emergent need for food, healthy food access remains suboptimal, affecting the physical and mental health of affected populations, and older adults are especially vulnerable. This policy analysis used a modified version of Patton's Rational Problem-Solving Process: problem identification, determining evaluation criteria, identifying and assessing policy options, selecting the preferred policy, and implementing, monitoring. The policy problem used is: Too many older adults cannot afford enough healthy food to follow the nutritional advice of their healthcare providers. Six policy options were identified in a previously conducted environmental scan that systematically scanned and identified literature on programs to reduce the cost of, and improve access to, healthy foods. These policy options were evaluated using decision criteria adapted from the National Collaborating Centre for Healthy Public Policy, effectiveness, unintended effects, equity, cost, feasibility, and acceptability. Stakeholders with expertise in health service and delivery, food insecurity and social prescribing were consulted. The top policy options identified were voucher prescriptions and income support with reimbursement. Following a fulsome analysis and stakeholder feedback, the highest scoring and recommended option was income support with reimbursement.
- ItemOpen AccessWhen the truth hurts: ordinary selling price regulation in a monopoly(2021-05-13) Sahragardjooneghani, Babak; Hollis, Aidan; Beall, Reed; Migrow, DimitriHow does restricting firms to communicate a truthful ordinary selling price affect pricing and profits when some consumers are uncertain about product quality? In this thesis we analyze a two-period monopoly model to study the welfare effect of ordinary selling price (OSP) regulation. In the model, quality is observed by informed consumers who buy in the first period. However, consumers who arrive in market in the second period are not able to discern quality, but must infer it indirectly through prices. We first characterize the necessary conditions for OSP regulation to make the first-period price informative for second-period consumers. We show that OSP regulation has no effect when the proportion of uninformed consumers is high. This means regulation is ineffective when it would be most useful. We then compare the equilibrium outcome when OSP is effective to the equilibrium outcome in an unregulated environment. A simple welfare measure indicates that restricting firms to communicate a truthful first-period price has no effect on the uninformed consumers' expected surplus, but does create a deadweight loss from deceptive pricing in the first period. This deceptive pricing occurs because OSP regulations provide incentives for a low-quality firm to charge a high initial price when doing so enables it to earn excess profits in the second period.