Unchained melody: revisiting the estimation of SF-6D values

Factors influencing medical expenditures in patients with unresolved facial palsy and pharmacoeconomic analysis of upper eyelid lid loading with gold and platinum weights compared to tarsorrhaphy

There are no standards in diagnostic and therapeutic approaches to eye care in incomplete eyelid closure due to unresolved facial palsy (FP). Loading of the upper eyelid (UELL) with gold weights (GWs) or platinum chains (PCs) is a highly effective procedure for the correction of lagophthalmos. Despite this, the procedure is used infrequently in our country because of the relatively high price of the implant and the lack of reimbursement. The aim of this research was to assess the factors influencing medical expenditures in this group of patients and to analyze utility costs for the UELL procedure with the use of GW and PC compared to tarsorrhaphy.Material and methods The costs of 88 surgical procedures (40 GWs, 11 PCs and 37 tarsorrhaphies) and medical expenditures before and after surgery were calculated based on reporting of materials, staff salaries and the SF-36 questionnaire. Distribution quartiles of the cost per QALY measure (dependent variable) was assessed via an ordered logistic regression model with eight explanatory variables.Results The calculated total cost of the surgery was US$209 for tarsorrhaphy, US$758 for UELL with a GW and US$1,676 for UELL with a PC. Bootstrapped costs per QALY values (CUI) in 88% of cases were below the US$100,000 cutoff. Etiology and duration of facial palsy and presence of Bell's phenomenon were factors that significantly influenced the CUI. Patient gender and age, history of previous eyelid surgery, and presence of corneal sensation were found to be not significant (p > 0.1). Calculated ICER for GW was US$1,241.74/1QALY and ICER for PC was US$13,181.05/1QALY compared to tarsorrhaphy.Conclusions Eye protection in patients with FP should be a crucial element of health policy. Findings suggest UELL procedure with a GW or a PC to be a cost-effective procedure with GW being the most cost-effective.

Should the Preference-Based Index Set of Values Be Country or Disease Specific? An Analysis Using Data From Women With Symptoms of Overactive Bladder

OBJECTIVES

Overactive bladder (OAB) and urinary incontinence (UI) are common conditions among women. We aimed to verify the difference between the preference-based index extracted from short-form six-dimension version one (SF-6Dv1) in women with OAB using different country-specific value sets, translate and cross-culturally adapt the King's Health Questionnaire Five Dimension (KHQ-5D) into Brazilian Portuguese, and examine the association between preference-based index obtained by the SF-6Dv1 and KHQ-5D.

METHODS

This cross-sectional study included 387 women with OAB, divided into groups with and without UI. The participants answered the sociodemographic questionnaire, KHQ, KHQ-5D, and SF-6Dv1. A two-way mixed analysis of variance, with post hoc to multiple comparisons were applied and a Spearman's test was applied to verify the correlation between the preference-based index of SF-6Dv1 and KHQ-5D.

RESULTS

The main analysis showed a statistically significant interaction between the presence of UI and the value set obtained from the different countries (P = .005, Cohen's d = 0.02). The post hoc analyses showed that there was a statistically significant main effect of the value sets obtained from different countries (P < .001, d = 0.63) and in the presence of UI (P = .012, d = 0.02). The correlations between the preference-based index obtained from different countries using the SF-6Dv1 and KHQ-5D were significant.

CONCLUSIONS

Differences were observed between the preference-based index obtained in different countries and presence of UI, although positive and significant results were observed in the correlation between preference-based index from different countries. The correlation between general and specifics preference-based index was small; the SF-6Dv1 could be used in cost-utility studies for this population.

US valuation of the SF-6D

BACKGROUND

The original SF-6D valuation study collected 3503 standard gambled responses from 611 UK respondents to predict quality-adjusted life year (QALY) values.

METHODS

Using 19,980 paired comparison responses from 666 US respondents and a stacked probit model, the 25 coefficients of the original SF-6D multiattribute utility (MAU) regression were estimated, such that each coefficient represents a QALY decrement. The US QALY predictions were compared with UK predictions using 8428 SF-6D states in the US Medicare Health Outcomes Survey (MHOS), 1998 to 2003.

RESULTS

Twenty-two of the 25 decrements in the SF-6D MAU regression are statistically significant. The remaining decrements are insignificant based on US and UK results. The US and UK QALY predictions for the MHOS SF-6D states are remarkably similar given differences in experimental design, format, and sampling (Lin's coefficient of agreement, 0.941; absolute mean difference, 0.043). Limitations. The underlying theoretical framework for the

STUDY DESIGN

and econometric analysis builds from the episodic random utility model and the concept of QALYs and inherits their limitations.

CONCLUSIONS

This study enhances the potential for US comparative effectiveness research by translating SF-6D states into US QALYs as well as improves upon discrete choice experiment design and econometric methods for health valuation.