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Volume 18, Issue 1, Spring 2018

Me2

Sumit "Me2" Majumdar

January 11, 1966 - January 19, 2018

We were sad to say goodbye to a close friend within the ACHORD group, with the death of Dr. Sumit ‘Me2’ Majumdar on January 19, 2018.
Me2 was a long-time member of ACHORD, a successful and widely cited author and a sought-after speaker. As a mentor, he helped train future clinicians, researchers and clinician-scientists. His contributions to ACHORD and academic life at the University of Alberta influenced so many people. Most of all, he was a husband, a father, a son, a friend and a colleague to many. He will be greatly missed by our ACHORD group, by trainees, colleagues and collaborators throughout the University of Alberta and beyond. Our deepest sympathies are extended to his wife (Dr. Anisa Khaliq), children, and extended family.

UofA Tribute
BMJ Obituary

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Report from the Chair

Hello All! Spring is here, and while we have been enjoying some sunshine, we are still waiting for the snow to melt! Here is a quick update on our ACHORD Group's activities since our last newsletter.

Sadly, we lost a friend and colleague, Sumit “Me2” Majumdar, who passed away in January. There have been many tributes to Me2, including our own in this newsletter, but I don’t think words fully express the great loss the medical, academic and research community has experienced. He will be greatly missed.

At the end of March, we said goodbye to two staff members moving on to other opportunities. Mu Lin was a statistical analyst with the ACHORD Group for the last 4 years. Meghan was a Research Assistant with the ACHORD group for the last 15 months. I want to thank Mu and Meghan for their time with us and for all the work they have completed. We wish you both all the best.

The ACHORD Retreat was held on March 1 and 2 at Alumni House, U of A Campus; more information is reported below.

ACHORD Members are attending the following conferences in April and May: The 2018 Canadian Agency for Drugs and Technologies in Health (CADTH) Symposium in Halifax, Can-SOLVE CKD Annual Meeting in Vancouver, International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2018 in Baltimore, the Alberta SPOR Summer Institute in Calgary and the Canadian Public Health Association (CPHA) and Canadian Association for Health Services and Policy Research [CAHSPR] Annual Meetings in Montreal.

Following the relaunch of the ABCD survey this year, we are pleased that over 600 of our participants have completed the survey online, and data collection is on-going. We continue to learn about how people in the ABCD study are engaging with online content. This will certainly help with future surveys. Information about the ABCD survey is available at www.albertaABCD.com

The Alberta’s PROMs and EQ-5D Research and Support Unit (APERSU), based in the ACHORD offices, continues to grow as awareness of the EQ-5D tool increases and more people are asking for our support. Many APERSU Members attended the 3rd Annual EuroQol Academy meeting in Budapest, Hungary at the beginning of March. Plans are underway for the 4th Annual APERSU End-User Meeting, which will be held October 11 and 12, 2018 at the Varscona Hotel in Edmonton.

I hope the information in our newsletter is informative, and if you have any questions about our activities, please do not hesitate to contact us. I look forward to updating you later this summer on more of ACHORD’s activities.

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Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, February 6, 2018; Commentary by Nathan McClure)

Vallejo‐Torres L, García‐Lorenzo B, Serrano‐Aguilar P. Estimating a cost‐effectiveness threshold for the Spanish NHS. Health Economics. 2017 Dec 28. doi: 10.1002/hec.3633.

Background
The cost-effectiveness threshold is a decision-criterion used to evaluate the value of health that is generated from health spending. The threshold is often conceptualized in terms of a ratio of costs (numerator) to outcomes (denominator), which is most commonly given as the cost per quality adjusted life-year (QALY) in the health-utility context (i.e., health-utility threshold). This paper provides an estimate of the (supply side) cost-effectiveness threshold for the Spanish National Health Service based on variation in health service budgets and quality-adjusted life expectancy (QALE) over 5 years and among 17 different health service regions.

Summary
The authors used ordinary least squares regression using (region and year specific) QALEs and (one-year lagged) health expenditure as the outcome and explanatory variables, respectively. In this regard, the beta-coefficient estimates the health spending elasticity for health (adjusting for differences between regions and over time). Since differences in health spending may be determined by differences in need, which, in turn, is correlated with health outcomes, an instrumental variable approach was used to test for potential endogeneity. Age specific QALEs were calculated from EQ-5D data captured by the Spanish Health Survey (2011/12), as well as predicted EQ-5D values estimated from generalised linear models based on other health and socio-economic indicators from the European Health Interview Survey (2006/07 and 2009/10). Age specific cost per QALY estimates were estimated from the model and combined to give a (population) mean and overall cost per QALY. The estimated average health spending elasticity for health was 0.07, yielding a cost per QALY estimate between 22,000 – 25,000 Euros.

Discussion
The cost-effectiveness threshold estimated by this supply side approach is less than the 30,000 Euro figure commonly used for Spain in economic evaluations of health technologies. We discussed how the threshold is useful in interpreting the outputs of economic evaluations of health technologies, specifically incremental cost-effectiveness ratios, in that it divides the Northeast and Southwest quadrants of the cost-effectiveness plane into areas representing “good-value” (i.e., accept technology) and “poor-value” (i.e., reject technology). To this end, the challenge for health economists and decision-makers is the determination of a cost-effectiveness threshold that captures the opportunity cost or shadow price, namely the potential health gains that would be realized by investing in other alternatives that are given up to invest in the technology under consideration (i.e., the forgone benefits). We considered two conventional types of opportunity cost: demand side and supply side. In the former case, willingness-to-pay approaches are used to estimate the opportunity cost; however, this may not be appropriate in publically funded healthcare systems and social decision-making with the goal of making care available to all with scarce resources (and not based on one’s ability to pay). The supply side opportunity cost reflects allocation decisions under a constrained budget scenario wherein the cost-effectiveness threshold is the health (at a population level) that is displaced by an alternative use of the healthcare resources. We also noted how the estimated health spending elasticity for life expectancy was 0.01 to 0.02, which is similar to other estimates and recent Canadian estimates from Dutton DJ et al. (2018) (see CMAJ 2018;190:E66-71. doi: 10.1503/cmaj.170132). Journal Club members agreed that it would be useful to estimate a supply side cost-effectiveness threshold for QALEs in Canada, exploring regional differences (i.e., between provinces).

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15th Annual ACHORD Retreat

The 15th Annual ACHORD Retreat was held on March 1-2, 2018 at the Alumni House on University of Alberta campus. As in past years, this informal meeting provides an opportunity for ACHORD investigators, collaborators and trainees to share research activities, and plan for continued growth of the ACHORD group. Although the ACHORD Retreat was smaller than normal this year, it was still a huge success. Thank you to everyone that attended.

In particular, thank you to the following individuals who presented at the Retreat:

Welcome
• Jeff Johnson - Introductions, Welcome and Tribute to Me2 Majumdar

Student Project Presentations
• Ming Ye – Anthropometric Changes and Risk of Diabetes: Are There Sex Differences? A Longitudinal Study of Alberta’s Tomorrow Project cohort.
• Candace Necyk – Evaluation of Comprehensive Annual Care Plan for Complex Patients by Family Physicians and Pharmacists in Alberta.
• Ben Dubois – Time to Treatment Intensification in Newly Treated Type 2 Diabetes Patients.
• Arsene Zongo – Effect of 1) Alberta Health Comprehensive Annual Care Plan and 2) Acute coronary syndrome/stroke on adherence to lipid-lowering drugs.
• Hayford Avedzi – Healthy Eating and Active Living for Diabetes – Glycemic Index (HEALD-GI) Trial: An Update.
• Jennifer Jin – EQ-5D-3L vs EQ-5D-5L: a comparison of measurement properties among total hip and knee replacement patients.

Accolades
• Steve Johnson – ACHORD Accolades

Project Updates
• Cathy Chan – PRIHS Update
• Allison Soprovich – Community pharmacy-based foot care interventions: A systematic review.
• Nonsi Mathe – HEALD-GDM Update.
• Meghan Ingstrup – Women’s Experience with Peer Counselling and Social Support During a Lifestyle Intervention Among Women with a History of Gestational Diabetes Pregnancy.
• Scott Simpson – Can Adherence Bridge the Gap Between Clinical Trial Efficacy and the Real World?
• Hilary Short – The Relationship of Neighbourhood-level Material and Social Deprivation with Health-Related Quality of Life.

Thank you to everyone who attended the 15th Annual Retreat, we hope to see you all again next year!

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Meet the Staff - Melody Cesar

Project Support Coordinator, Alberta SPOR Support Unit

Melody was born and raised in Edmonton, Alberta. She is completing a Master of Health Studies degree at Athabasca University. She has worked as a Research Coordinator in the areas of pediatric weight management and adolescent mental health. Melody has also worked as a Medical Education Program Coordinator in Cardiology and a Research Administrator in Aboriginal Child Health. Prior to joining SPOR, Melody was with Alberta Health Services in Medical Affairs.

In her spare time, Melody enjoys travelling, long distance running and volunteering.

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ACHORD Seen and Heard

Recent Publications

Avedzi H, Mathe N, Storey K, Johnson JA, Johnson ST. Examining Sex Differences in Glycaemic Index Knowledge and Intake Among Individuals with Type 2 Diabetes. Primary Care Diabetes 2018;12(1)71-79. PMID: 28823516.

Beka Q, Bowker SL, Savu A, Kingston D, Johnson JA, Kaul P. History of mood or anxiety disorders and risk of gestational diabetes mellitus in a population-based cohort. Diabet Med 2018;35(1):147-151. PMID: 29120506.

Bharadia R, Lorenz K, Cor K, Simpson SH. Financial remuneration is positively correlated with the number of clinical activities: an example from diabetes management in Alberta community pharmacies. Int J Pharm Prac 2018;26(1):77-80. PMID: 28240395.

Butalia S, Donovan L, Savu A, Johnson J, Edwards A, Kaul P. Postpartum Diabetes testing rates after Gestational Diabetes Mellitus in Canadian women: A Population-based study. Can J Diabetes 2017;41(6):613-620. PMID: 28506815.

Chen CB, Eskin M, Eurich DT, Majumdar SR, Johnson JA. Metformin, Asian ethnicity and risk of prostate cancer in type 2 diabetes: a systematic review and meta-analysis. BMC Cancer 2018;18(1):65. PMID: 29320995.

Chen CB, Eurich DT, Majumdar SR, Johnson JA. Risk of prostate cancer across different racial/ethnic groups in men with diabetes: a retrospective cohort study. Diabet Med 2018;35(1):107-111. PMID: 29078006.

Donovan L, Edwards A, Savu A, Butalia S, Johnson JA, Kaul P. Population-level outcomes with a 2-step approach for gestational diabetes screening and diagnosis. Can J Diabetes 2017;41(6)596-602. PMID: 28454899.

Eurich, DT, Achtymichuk K, Johnson JA, Sandhu J, Lin M. Development and Validation of an Index Score to Adjust for Healthy User Bias in Observational Studies. J Popul Ther Clin Pharmacol 2017;24(3):e79-e89. PMID: 29432672.

Gamble JM, Donnan JR, Chibrikov E, Twells LK, Midodzi WK, Majumdar SR. The risk of fragility fractures in new users of dipeptidyl peptidase-4 inhibitors compared to sulfonylureas and other anti-diabetic drugs: A cohort study. Diabetes Res Clin Pract 2018;136:159-167. PMID 29258886.

Lix LM, Leslie WD, Majumdar SR. Measuring improvement in fracture risk prediction for a new risk factor: a simulation. BMC Res Notes 2018;11(1):62. PMID: 29357907.

Mathe N, Boyle T, Al Sayah F, Mundt C, Vallance JK, Johnson JA, Johnson ST. Correlates of Accelerometer-Assessed Physical Activity and Sedentary Time Among Adults With Type 2 Diabetes. Can J Pub Health 2017;108(4):e355-e361. PMID: 29120305.

Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Effect of Age on the Manifestations and Outcomes of Invasive Pneumococcal Disease in Adults. Am J Med 2018;131(1):100.e1-100.e7. PMID: 28803139.

Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ, Bruns A, Feldman BM, Eurich DT; Research in Arthritis in Canadian Children Emphasizing Outcomes Investigators. Arthritis Care Res (Hoboken). 2018;70(2):303-308. PMID: 28426894.

Schrijnders D, Hendriks SH, Kleefstra N, Vissers PAJ, Johnson JA, de Bock GH, Bilo HJG, Landman GWD. Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49). PLOS One 2018;13(1):e0190870. PMID: 29370205.

Simson SH, MacCallum L, Mansell K. Pharmacy Practice and Diabetes Care. Can J Diabetes 2018;41(6):549-550. PMID: 29224632.

Ye M, Robson PJ, Eurich DT, Vena JE, Xu JY, Johnson JA. Systemic Use of Antibiotics and Risk of Diabetes in Adults: A Nested Case-control Study of Alberta's Tomorrow Project. Diabetes Obes Metab. 2018;20(4):849-857. PMID: 29152889.

Ye M, Robson PJ, Eurich DT, Vena JE, Xu JY, Johnson JA. Changes in body mass index and incidence of diabetes: A longitudinal study of Alberta's Tomorrow Project Cohort. Prev Med. 2018;106:157-163. PMID: 29117506.

Zanders MM, Haak H, Van Herk-Sukel MP, Herings R, van de Poll-Franse LV, Johnson J. Changes in glucose-lowering drug use before and after cancer diagnosis among patients with diabetes. Diabetes & Metabolism 2018;44(1):22-29. PMID: 29066209.

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ACHORD Accolades

Congratulations to:

▪ Dean Eurich on receiving a 2018 Great Supervisor Award from the Faculty of Graduate Studies and Research
▪ Candace Necyk for successfully completing her PhD Candidacy Exam
Dean Eurich on receiving a 2018 Great Supervisor Award from the Faculty of Graduate Studies and Research
Candace Necyk for successfully completing her PhD Candidacy Exam

Other ACHORD News

Congratulations to:

▪ Nonsi Mathe on becoming a Canadian Citizen
▪ Ben Dubois on his engagement to Cerina Kim
▪ Arsene Zongo and Laure on the birth of their son, Nebsom Jordan Zongo
Nonsi Mathe on becoming a Canadian Citizen
Ben Dubois on his engagement to Cerina Kim
Arsene Zongo and Laure on the birth of their son, Nebsom Jordan Zongo
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Upcoming Events

4th Annual APERSU End-User Meeting

October 11 & 12, 2018

Varscona on Whyte

Edmonton, Alberta, Canada

16th Annual ACHORD Retreat

March, 2019

University of Alberta Campus

Edmonton, Alberta, Canada

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ACHORD
University of Alberta
2-040 Li Ka Shing CHRI
Edmonton, AB T6G 2E1
email: achord@ualberta.ca
Phone: 780-248-1010

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