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Minnema J, Polinder-Bos HA, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Perez Bazan LM, Eruslanova K, Topinková E, Vassallo MA, Faes MC, van Tol LS, Caljouw MAA, Achterberg WP, Haaksma ML. The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection. J Am Med Dir Assoc 2024; 25:105002. [PMID: 38670170 DOI: 10.1016/j.jamda.2024.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Affiliation(s)
- J Minnema
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - H A Polinder-Bos
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - F Dockery
- Department of Geriatric Medicine, Beaumont Hospital, Dublin, Ireland
| | - I H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - B N Francis
- Fliman Geriatric Rehabilitation Centre, Haifa, Israel; Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - A L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, United Kingdom
| | - S Grund
- Centre for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the Heidelberg University, Heidelberg, Germany
| | - L M Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - K Eruslanova
- Russian Clinical and Research Centre of Gerontology, Moscow, Russia
| | - E Topinková
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | - M A Vassallo
- Geriatric Medicine Society of Malta & Telghet G'Mangia, Rehabilitation Hospital Karin Grech, Pietà, Malta
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - L S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - M A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - M L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
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Chang JYA, Hsu CN, Ramos-Goñi JM, Luo N, Lin HW, Lin FJ. Beyond 10-year lead-times in EQ-5D-5L: leveraging alternative lead-times in willingness-to-accept questions to capture preferences for worse-than-dead states and their implication. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1041-1055. [PMID: 38072877 DOI: 10.1007/s10198-023-01642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/18/2023] [Indexed: 07/28/2024]
Abstract
BACKGROUND A fixed 10-year lead-time in composite time-trade-off (C-TTO) tasks might compromise the precision of utility values below - 1. This study explored how alternative lead-times (ALTs) influence EQ-5D-5L value sets and their implications in economic evaluations. METHODS Leveraging data from Taiwan's EQ-5D-5L valuation and capitalizing on its exploratory willingness-to-accept question, we explored participants' quantification of "worse-than-dead (WTD)" health states with ALTs up to 50 years. We then derived alternative value sets incorporating these ALTs through interval regression and compared them against those from conventional models. To evaluate their impact on health change valuation, we simulated utility differences for all possible EQ-5D-5L health-state-pairs using each value set. RESULTS With a salient floor effect observed in the C-TTO values, the model with ALT led to a wider range of predicted utilities ( - 2.3897 ~ 1), compared with those of conventional models (generalized least squares (GLS): - 0.7773 ~ 1; Tobit-GLS: - 0.9583 ~ 1). Compared to the Tobit-GLS model, the model with ALT increased the numerical distance in 80% of health-state-pairs, with 11% decreasing and 9% altering direction (e.g., positive to negative) in utility differences. CONCLUSIONS While ALTs offer insights into patient preferences, their integration into economic evaluations might require rescaling. Future research should prioritize advanced rescaling methods or enhanced elicitation strategies for populations with substantial censoring. This is pivotal for improving the elicitation of extreme WTD states and accurately discerning the relative distances between health states. Countries developing EQ-5D-5L value sets should consider pilot studies and incorporating region-specific questions on social determinants, especially where pronounced floor effects are suspected.
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Grants
- EQ project 2016440 EuroQol Research Foundation
- 10542652 The Center for Drug Evaluation, Taiwan
- NSC102-2320-B-039-007 Ministry of Science and Technology, Taiwan
- MOST 109-2622-8-039-001-TB1; MOST 110-2622-8-039-004 -TB1 Ministry of Science and Technology, Taiwan
- NHRI-EX103-10318PC The National Health Research Institute, Taiwan
- NHRI-EX104-10318PC The National Health Research Institute, Taiwan
- NHRI-EX105-10318PC The National Health Research Institute, Taiwan
- NHRI-EX106-10318PC The National Health Research Institute, Taiwan
- CMU108-N-03 China Medical University, Taiwan
- CMU108-Z-7 China Medical University, Taiwan
- CMU109-Z-07 China Medical University, Taiwan
- CMU110-Z-07 China Medical University, Taiwan
- DMR-110-080 China Medical University Hospital, Taiwan
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Affiliation(s)
- Jen-Yu Amy Chang
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hsiang-Wen Lin
- School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Taichung, Taiwan.
- Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan.
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, USA.
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Joundi RA, Smith EE, Ganesh A, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Rempel JL, Field TS, Dowlatshahi D, Sahlas J, Swartz R, Shah R, Sauvageau E, Puetz V, Silver FL, Campbell B, Chapot R, Tymianski M, Goyal M, Hill MD. Time From Hospital Arrival Until Endovascular Thrombectomy and Patient-Reported Outcomes in Acute Ischemic Stroke. JAMA Neurol 2024; 81:752-761. [PMID: 38829660 PMCID: PMC11148789 DOI: 10.1001/jamaneurol.2024.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/29/2024] [Indexed: 06/05/2024]
Abstract
Importance The time-benefit association of endovascular thrombectomy (EVT) in ischemic stroke with patient-reported outcomes is unknown. Objective To assess the time-dependent association of EVT with self-reported quality of life in patients with acute ischemic stroke. Design, Setting, and Participants Data were used from the Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, which tested the effect of nerinetide on functional outcomes in patients with large vessel occlusion undergoing EVT and enrolled patients from March 1, 2017, to August 12, 2019. The ESCAPE-NA1 trial was an international randomized clinical trial that recruited patients from 7 countries. Patients with EuroQol 5-dimension 5-level (EQ-5D-5L) index values at 90 days and survivors with complete domain scores were included in the current study. Data were analyzed from July to September 2023. Exposure Hospital arrival to arterial puncture time and other time metrics. Main Outcomes and Measures EQ-5D-5L index scores were calculated at 90 days using country-specific value sets. The association between time from hospital arrival to EVT arterial-access (door-to-puncture) and EQ-5D-5L index score, quality-adjusted life years, and visual analog scale (EQ-VAS) were evaluated using quantile regression, adjusting for age, sex, stroke severity, stroke imaging, wake-up stroke, alteplase, and nerinetide treatment and accounting for clustering by site. Using logistic regression, the association between door-to-puncture time and reporting no or slight symptoms (compared with moderate, severe, or extreme problems) was determined in each domain (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression) or across all domains. Time from stroke onset was also evaluated, and missing data were imputed in sensitivity analyses. Results Among 1105 patients in the ESCAPE-NA1 trial, there were 1043 patients with EQ-5D-5L index values at 90 days, among whom 147 had died and were given a score of 0, and 1039 patients (mean [SD] age, 69.0 [13.7] years; 527 male [50.7%]) in the final analysis as 4 did not receive EVT. There were 896 survivors with complete domain scores at 90 days. There was a strong association between door-to-puncture time and EQ-5D-5L index score (increase of 0.03; 95% CI, 0.02-0.04 per 15 minutes of earlier treatment), quality-adjusted life years (increase of 0.29; 95% CI, 0.08-0.49 per 15 minutes of earlier treatment), and EQ-VAS (increase of 1.65; 95% CI, 0.56-2.72 per 15 minutes of earlier treatment). Each 15 minutes of faster door-to-puncture time was associated with higher probability of no or slight problems in each of 5 domains and all domains concurrently (range from 1.86%; 95% CI, 1.14-2.58 for pain or discomfort to 3.55%; 95% CI, 2.06-5.04 for all domains concurrently). Door-to-puncture time less than 60 minutes was associated higher odds of no or slight problems in each domain, ranging from odds ratios of 1.49 (95% CI, 1.13-1.95) for pain or discomfort to 2.59 (95% CI, 1.83-3.68) for mobility, with numbers needed to treat ranging from 7 to 17. Results were similar after multiple imputation of missing data and attenuated when evaluating time from stroke onset. Conclusions and Relevance Results suggest that faster door-to-puncture EVT time was strongly associated with better health-related quality of life across all domains. These results support the beneficial impact of door-to-treatment speed on patient-reported outcomes and should encourage efforts to improve patient-centered care in acute stroke by optimizing in-hospital processes and workflows.
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Affiliation(s)
- Raed A. Joundi
- Division of Neurology, Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raul G. Nogueira
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ryan A. McTaggart
- Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andrew M. Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
| | - Alexandre Y. Poppe
- Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Jeremy L. Rempel
- Department of Radiology, University of Alberta Hospital, Edmonton, Canada
| | - Thalia S. Field
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dar Dowlatshahi
- Department of Neurology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jim Sahlas
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Swartz
- Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ruchir Shah
- Department of Neurology, Erlanger Hospital, Chattanooga, Tennessee
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Frank L. Silver
- University Health Network, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Campbell
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - René Chapot
- Department of Neuroradiology, Alfred Krupp Krankenhaus Essen, Essen, Germany
| | | | - Mayank Goyal
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada
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Kiely B, Hobbins A, Boland F, Clyne B, Galvin E, Byers V, Loomba S, O'Donnell P, Connolly D, Shea EO', Smith SM. An exploratory randomised trial investigating feasibility, potential impact and cost effectiveness of link workers for people living with multimorbidity attending general practices in deprived urban communities. BMC PRIMARY CARE 2024; 25:233. [PMID: 38943076 PMCID: PMC11212363 DOI: 10.1186/s12875-024-02482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Social prescribing link workers are non-health or social care professionals who connect people with psychosocial needs to non-clinical community supports. They are being implemented widely, but there is limited evidence for appropriate target populations or cost effectiveness. This study aimed to explore the feasibility, potential impact on health outcomes and cost effectiveness of practice-based link workers for people with multimorbidity living in deprived urban communities. METHODS A pragmatic exploratory randomised trial with wait-list usual care control and blinding at analysis was conducted during the COVID 19 pandemic (July 2020 to January 2021). Participants had two or more ongoing health conditions, attended a general practitioner (GP) serving a deprived urban community who felt they may benefit from a one-month practice-based social prescribing link worker intervention.. Feasibility measures were recruitment and retention of participants, practices and link workers, and completion of outcome data. Primary outcomes at one month were health-related quality of life (EQ-5D-5L) and mental health (HADS). Potential cost effectiveness from the health service perspective was evaluated using quality adjusted life years (QALYs), based on conversion of the EQ-5D-5L and ICECAP-A capability index to utility scoring. RESULTS From a target of 600, 251 patients were recruited across 13 general practices. Randomisation to intervention (n = 123) and control (n = 117) was after baseline data collection. Participant retention at one month was 80%. All practices and link workers (n = 10) were retained for the trial period. Data completion for primary outcomes was 75%. There were no significant differences identified using mixed effects regression analysis in EQ-5D-5L (MD 0.01, 95% CI -0.07 to 0.09) or HADS (MD 0.05, 95% CI -0.63 to 0.73), and no cost effectiveness advantages. A sensitivity analysis that considered link workers operating at full capacity in a non-pandemic setting, indicated the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability index. CONCLUSIONS While the trial under-recruited participants mainly due to COVID-19 restrictions, it demonstrates that robust evaluations and cost utility analyses are possible. Further evaluations are required to establish cost effectiveness and should consider using the ICE-CAP-A wellbeing measure for cost utility analysis. REGISTRATION This trial is registered on ISRCTN. TITLE Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas. TRIAL ID ISRCTN10287737. Date registered 10/12/2019. Link: https://www.isrctn.com/ISRCTN10287737.
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Affiliation(s)
- Bridget Kiely
- Department of General Practice, Clinical Research Fellow, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Dublin, Ireland.
| | - Anna Hobbins
- Centre for Research in Medical Devices (CÚRAM, RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, SFI 13, Galway, Ireland
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Dublin, Ireland
| | - Barbara Clyne
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Dublin, Ireland
| | - Emer Galvin
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Dublin, Ireland
| | - Vivienne Byers
- Environment Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Sonali Loomba
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, 123 St Stephens Green, Dublin 2, Dublin, Ireland
| | - Patrick O'Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
| | - Eamon O ' Shea
- School of Business and Economics, University of Galway, Galway, Ireland
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Trinity College, Dublin, Ireland
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Trépel D, Ruiz-Adame M, Cassarino M, Ahern E, Devlin C, Robinson K, O’Shaughnessy Í, McCarthy G, Corcoran C, Galvin R. The cost effectiveness of early assessment and intervention by a dedicated health and social care professional team for older adults in the emergency department compared to treatment-as-usual: Economic evaluation of the OPTI-MEND trial. PLoS One 2024; 19:e0298162. [PMID: 38917081 PMCID: PMC11198796 DOI: 10.1371/journal.pone.0298162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Over 65s are frequent attenders to the Emergency Department (ED) and more than half are admitted for overnight stays. Early assessment and intervention by a dedicated ED-based Health and Social Care Professionals (HSCP) team reduces ED length of stay and the risk of hospital admissions among older adults while improving patient health-related quality-of-life and satisfaction with care. This study aims to evaluate whether augmenting the treatment as usual for older adults admitted to ED is cost-effective. METHODS AND FINDINGS Cost-effectiveness analysis (CEA), conducted alongside the OPTI-MEND randomised controlled trial of 353 patients aged ≥65 with lower urgency complaints compared the effectiveness of early assessment and intervention by a dedicated HSCP team in the ED to treatment as usual (TAU). An economic analysis estimated the average cost per older adults randomised to the HSCP team, and compared to TAU, how contact with HSCP team changed health care use, and associated total costs, and estimated the effect of HSCP on Quality-Adjusted Life Years (QALYs). Within the OPTI-MEND trial, the average cost of a contact with the HSCP team during ED attendance is estimated to be €801 per patient. Compared to TAU, the incremental QALY of intervention is 0.053 (95% CI: 0.023 to 0.0826, p<0.0001). Accounting for cost savings because of contact with HSCP team, the average incremental saving in the total cost, compared to TAU, is -€6,128 (95% CI: -€9,217 to -€3,038, p<0.0001). Given the incremental health gains and significant cost savings, bootstrapped cost CEA suggests that dedicated HSCP care dominates over TAU for low urgency older adults attending the ED. CONCLUSIONS A dedicated HSCP team in the ED significantly improves overall health for lower acuity older adults and, by reducing inpatient length of stay, results in staggering cost savings. This economic evaluation conducted on the OPTI-MEND trial provides convincing evidence that HSCP should be adopted as part of treatment as usual in Irish EDs. TRIAL REGISTRATION ClinicalTrials.gov, NCT03739515; registered on 12th November 2018. https://classic.clinicaltrials.gov/ct2/show/NCT03739515.
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Affiliation(s)
- Dominic Trépel
- Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- University California San Francisco, San Francisco, California, United States of America
| | - Manuel Ruiz-Adame
- Trinity College Dublin, Dublin, Ireland
- Applied Economics Department, Department Campus of Melilla, University of Granada, Melilla, Spain
| | - Marica Cassarino
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Elayne Ahern
- Trinity College Dublin, Dublin, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Collette Devlin
- Health Research Institute, School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Health Research Institute, School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Íde O’Shaughnessy
- Health Research Institute, School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Gerard McCarthy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | | | - Rose Galvin
- Health Research Institute, School of Allied Health, Ageing Research Centre, University of Limerick, Limerick, Ireland
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Nørmark LP, McAuliffe F, Maindal HT, O'Reilly S, Davies A, Burden C, Skinner TC, Vrangbæk K, Callander E. Protocol for cost-effectiveness analysis of a randomised trial of mHealth coaching (Bump2Baby and Me) compared with usual care for healthy gestational weight gain and postnatal outcomes in at-risk women and their offspring in the UK, Australia, Ireland and Spain. BMJ Open 2024; 14:e080823. [PMID: 38772891 PMCID: PMC11110546 DOI: 10.1136/bmjopen-2023-080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Gestational diabetes mellitus and overweight are associated with an increased likelihood of complications during birth and for the newborn baby. These complications lead to increased immediate and long-term healthcare costs as well as reduced health and well-being in women and infants. This protocol presents the health economic evaluation to investigate the cost-effectiveness of Bump2Baby and Me (B2B&Me), which is a health coaching intervention delivered via smartphone to women at risk of gestational diabetes. METHODS AND ANALYSIS Using data from the B2B&Me randomised controlled trial, this economic evaluation compares costs and health effects between the intervention and control group as an incremental cost-effectiveness ratio. Direct healthcare costs, costs of pharmaceuticals and intervention costs will be included in the analysis, body weight and quality-adjusted life-years for the mother will serve as the effect outcomes. To investigate the long-term cost-effectiveness of the trial, a Markov model will be employed. Deterministic and probabilistic sensitivity analysis will be employed. ETHICS AND DISSEMINATION The National Maternity Hospital Human Research and Ethics Committee was the primary approval site (EC18.2020) with approvals from University College Dublin HREC-Sciences (LS-E-20-150-OReilly), Junta de Andalucia CEIM/CEI Provincial de Granada (2087-M1-22), Monash Health HREC (RES-20-0000-892A) and National Health Service Health Research Authority and Health and Care Research Wales (HCRW) (21/WA/0022). The results from the analysis will be disseminated in scientific papers, through conference presentations and through different channels for communication within the project. TRIAL REGISTRATION NUMBER ACTRN12620001240932.
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Affiliation(s)
- Laura Pirhonen Nørmark
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, University College Dublin, Dublin, Ireland
- Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland
| | | | - Sharleen O'Reilly
- Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Christy Burden
- University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Timothy C Skinner
- Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
| | - Emily Callander
- School of Public Health, University of Technology Sydney, Sydney, UK
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Al-Jedai A, Almudaiheem H, Al-Salamah T, Aldosari M, Almutairi AR, Almogbel Y, AlRuthia Y, Althemery AU, Alluhidan M, Roudijk B, Purba FD, Awad N, O'jeil R. Valuation of EQ-5D-5L in the Kingdom of Saudi Arabia: A National Representative Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:552-561. [PMID: 38342365 DOI: 10.1016/j.jval.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES To estimate a Saudi-specific value set for the EQ-5D-5L questionnaire using the EuroQol Valuation Technology program and the EuroQol Group's standard protocol. METHODS Participants were quota-sampled from the Saudi adult population based on residency location, age group, gender, education level, and employment status. The participants were guided through the completion of composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks by trained interviewers using EuroQol Valuation Technology software. Quality control (QC) measures were used to ensure good data quality. Random intercept and Tobit models analyzed the cTTO data, as well as models correcting for heteroskedasticity. DCE data were analyzed using conditional logit models, whereas hybrid models were used to analyze the cTTO and DCE data jointly. To evaluate model performance, prediction accuracy, logical consistency, significance level, and goodness of fit were used. RESULTS The valuation study included a representative sample of the Saudi population (N = 1000). The hybrid heteroskedastic model without a constant was chosen as the preferred model for generating the value set. The predicted values ranged from -0.683 for the worst health state ("55555") to 1 for the full health state ("11111"). Pain and discomfort had the largest impact on health-state preference values, whereas usual activities had the least. CONCLUSION The value set for the Kingdom of Saudi Arabia is the first value set for the EQ-5D-5L for any country in the Middle East. The value set can be used in Saudi health system economic evaluations and decision making.
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Affiliation(s)
- Ahmed Al-Jedai
- Alfaisal University Alfaisal University, Colleges of Medicine and Pharmacy, Riyadh, Saudi Arabia; Therapeutics Affairs, Ministry of Health, Riyadh, Saudi Arabia.
| | - Hajer Almudaiheem
- Drug Policy and Regulation Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Tareq Al-Salamah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Emergency Medicine, University of Maryland Medical Centre, Baltimore, MD, USA
| | - Muath Aldosari
- King Saud University College of Dentistry, Riyadh, Saudi Arabia; Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Yasser Almogbel
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah U Althemery
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | - Bram Roudijk
- EuroQol Research Foundation, Marten Meesweg 107, Rotterdam, The Netherlands
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van Tol LS, Haaksma ML, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Matchekhina L, Bazan LMP, Schols JMGA, Topinková E, Vassallo MA, Caljouw MAA, Achterberg WP. Post-COVID-19 patients in geriatric rehabilitation substantially recover in daily functioning and quality of life. Age Ageing 2024; 53:afae084. [PMID: 38725361 PMCID: PMC11082471 DOI: 10.1093/ageing/afae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND After an acute infection, older persons may benefit from geriatric rehabilitation (GR). OBJECTIVES This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. DESIGN Multicentre prospective cohort study. SETTING 59 GR facilities in 10 European countries. PARTICIPANTS Post-COVID-19 patients admitted to GR between October 2020 and October 2021. METHODS Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. RESULTS 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. CONCLUSIONS Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.
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Affiliation(s)
- Lisa S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Matteo Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - Frances Dockery
- Beaumont Hospital & Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Bahaa N Francis
- Fliman Geriatric Rehabilitation Hospital, Zalman Shneur Street, Haifa, 31021, Israel
- Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2UH, UK
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Luba Matchekhina
- Russian Gerontology Research and Clinical Centre, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Laura Monica Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Eva Topinková
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | | | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
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9
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Richmond JP, Kelly MG, Johnston A, Murphy PJ, O'Connor L, Gillespie P, Hobbins A, Alvarez-Iglesias A, Murphy AW. A community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anticancer medication: a pilot study. Pilot Feasibility Stud 2024; 10:46. [PMID: 38424625 PMCID: PMC10902979 DOI: 10.1186/s40814-024-01461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
Oral anti-cancer medications (OAMs) are being used increasingly within cancer care. OAMs offer the potential to improve patient convenience and increase hospital capacity. The clinical assessment for each cycle of OAMs requires specialist patient review often performed in hospital-based oncology units. Consequently, any potential improvement in patient expediency or increased hospital capacity that OAMs can offer is not realised. This study aimed to develop and pilot the specialist assessment of patients receiving OAMs by an Advanced Nurse Practitioner (ANP) in a community-based location.The primary aim of this pilot study was to assess the feasibility of a community-based ANP-led integrated oncology care model for adults receiving OAMs in Ireland who met the pre-specified eligibility criteria. The objectives were to determine the feasibility of a definitive trial of this intervention by measuring patient safety, acceptability to patients and staff and cost of the new model of care.This single-centre pilot study provided patient care (n = 37) to those receiving OAM therapies within a community setting for a 4-month period. Consent rate was high with no attrition other than for clinical reasons. There were 151 contacts with the sample during that time.Results demonstrated that the ANP-led intervention and new model for OAM care was safe, highly acceptable to patients and staff and that related healthcare costs could be captured. Based on the success of this pilot study, the authors conclude that a community-based ANP-led integrated oncology care model for adults receiving OAMs is feasible, and a definitive trial is warranted.Trial registration ISRCTN, ISRCTN10401455 . Registered 30 November 2020.
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Affiliation(s)
| | | | | | - Patrick J Murphy
- Discipline of General Practice, HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Laura O'Connor
- Discipline of General Practice, HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Paddy Gillespie
- Centre for Research in Medical Devices (CÚRAM, RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, SFI 13, Galway, Ireland
| | - Anna Hobbins
- Centre for Research in Medical Devices (CÚRAM, RC/2073_P2) and Health Economics and Policy Analysis Centre, University of Galway, SFI 13, Galway, Ireland
| | | | - Andrew W Murphy
- Discipline of General Practice, HRB Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
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10
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O’Shaughnessy Í, Robinson K, Whiston A, Barry L, Corey G, Devlin C, Hartigan D, Synnott A, McCarthy A, Moriarty E, Jones B, Carroll I, Shchetkovsky D, O’Connor M, Steed F, Carey L, Conneely M, Leahy A, Quinn C, Shanahan E, Ryan D, Galvin R. Comprehensive Geriatric Assessment in the Emergency Department: A Prospective Cohort Study of Process, Clinical, and Patient-Reported Outcomes. Clin Interv Aging 2024; 19:189-201. [PMID: 38343726 PMCID: PMC10859053 DOI: 10.2147/cia.s434641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024] Open
Abstract
Background This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance. Patients and Methods A prospective cohort study recruited older adults aged ≥65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance. Telephone interviews were completed with participants at 30- and 180-day follow-up. The primary outcome was incidence of hospital admission following the index ED attendance. Secondary outcomes included participant satisfaction, incidence of functional decline, health-related quality of life, incidence of unscheduled ED re-attendance(s), hospital (re)admission(s), nursing home admission, and death. Results A total of 133 participants (mean age 82.43 years, standard deviation = 6.89 years; 71.4% female) were recruited; 21.8% of the cohort were admitted to hospital following the index ED attendance with a significant decline in function reported at hospital discharge (Z = 2.97, p = 0.003). Incidence of 30- and 180-day unscheduled ED re-attendance was 10.5% and 24.8%, respectively. The outcome at the index ED attendance was a significant predictor of adverse outcomes whereby those who were discharged home had significantly lower odds of multiple adverse process outcomes at 30- and 180-day follow-up, and significantly higher function and health-related quality of life at 30-day follow-up. Conclusion While this study was observational in nature, findings suggest CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on a longitudinal approach to healthcare delivery at the primary-secondary care interface. Future research should be underpinned by an experimental study design to address key limitations in this study.
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Affiliation(s)
- Íde O’Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Whiston
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Gillian Corey
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Collette Devlin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Deirdre Hartigan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Physiotherapy, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Eoin Moriarty
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Bryan Jones
- Department of Medical Social Work, University Hospital Limerick, Limerick, Ireland
| | - Ida Carroll
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Denys Shchetkovsky
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fiona Steed
- Department of Health, Government of Ireland, Dublin, Ireland
| | - Leonora Carey
- Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland
| | - Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Colin Quinn
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Damien Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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11
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Yang Z, Devlin NJ, Rand K, Luo N. Testing 2 Alternative Time Trade-Off Methods for Valuation of Children's Health States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:43-50. [PMID: 37813195 DOI: 10.1016/j.jval.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Composite time trade-off (cTTO) values for EQ-5D-Y-3L health states tend to be high, raising concerns about sensitivity particularly for mild or moderate health states. We conceptualized and pilot tested 2 alternative time trade-off (TTO) variants: the caregiver TTO (CGTTO) and lag-time TTO (LTTO). METHODS We collected CGTTO and LTTO data in China for 10 EQ-5D-Y-3L health states and compared the resulting values, respondent feedback, and task completion times with those from an EQ-5D-Y-3L valuation study using cTTO. We also examined how age and parental status of respondents could affect TTO values. RESULTS A total of 304 participants were included in this study. Overall, cTTO showed statistically better results in all feedback questions. On a 5-point Likert scale where lower score means greater agreement, the mean (SD) feedback scores for cTTO, LTTO, and CGTTO were 1.18 (0.58), 1.45 (0.91), and 1.65 (1.02) for "easy to understand"; 1.45 (0.91), 1.94 (1.08), and 1.86 (1.24) for "easy to differentiate"; and 3.61 (1.29), 2.97 (1.33), and 3.02 (1.50) for "difficult to decide," respectively. The mean (SD) TTO values of all 10 states were 0.463 (0.494), 0.387 (0.555), and 0.123 (0.710) for cTTO, LTTO, and CGTTO, respectively. The effects of age and parental status on TTO values differed by the 3 methods. CONCLUSIONS LTTO and CGTTO produce values with good characteristics and merit further investigation. Researchers need to be aware of the differences in design and values when using the TTO method to value children's health states.
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Affiliation(s)
- Zhihao Yang
- Department of Health Services Management, Guizhou Medical University, Guiyang, China; Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Nancy J Devlin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Rand
- Health Services Research Centre, Akershus University Hospital, Oslo, Norway; Maths in Health B.V., Rotterdam, The Netherlands
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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12
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Jelovac A, McCaffrey C, Terao M, Shanahan E, Mohamed E, Whooley E, McDonagh K, McDonogh S, Igoe A, Loughran O, Shackleton E, O'Neill C, McLoughlin DM. Study protocol for Ketamine as an adjunctive therapy for major depression (2): a randomised controlled trial (KARMA-Dep [2]). BMC Psychiatry 2023; 23:850. [PMID: 37974160 PMCID: PMC10655414 DOI: 10.1186/s12888-023-05365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Depression is a common psychiatric disorder and a leading cause of disability worldwide. Conventional monoaminergic antidepressants have limited efficacy and take weeks to exert a therapeutic effect. Single infusions of subanaesthetic doses of ketamine exhibit rapid antidepressant action but effects are transient and relapse is common. One potential strategy for increasing ketamine's antidepressant efficacy and/or prolonging its therapeutic benefit may be serial infusions. There is limited evidence on the efficacy and safety of repeated ketamine infusions against an active comparator. METHODS This protocol describes an ongoing pragmatic, randomised, controlled, parallel-group, patient- and rater-blind, superiority trial. Eligible adult inpatients with a confirmed DSM-5 diagnosis of a major depressive episode (unipolar or bipolar) are randomly allocated in a 1:1 ratio to a course of up to eight infusions of ketamine or midazolam twice-weekly over four weeks. The primary objective is to assess the efficacy of serial adjunctive ketamine infusions versus active comparator midazolam by measuring Montgomery-Åsberg Depression Rating Scale score difference between arms from before the first infusion to 24 h after the final infusion, supplemented by a 95% confidence interval. To facilitate generalisability of results, the trial takes place under "real world" conditions with both groups continuing to receive regular inpatient care including treatment-as-usual pharmacotherapy, nursing care, and psychological and other therapies during the randomised treatment phase and regular outpatient care thereafter. Participants are monitored for relapse during a 24-week follow-up after the end of the randomised phase. Secondary objectives of the trial are to assess: response and remission rates at the end of randomised phase; relapse status during the 24-week follow-up after the end of the randomised phase; the safety and tolerability of repeated ketamine infusions regarding psychotomimetic and other psychiatric side effects, cognitive side effects, as well as withdrawal symptoms, haemodynamic stability, neurological, urological, and other physical side effects; and quality of life and cost-effectiveness. DISCUSSION There is an unmet clinical need for rapidly-acting novel antidepressants. This trial will provide efficacy, safety and health economic data on serial ketamine infusions and thus help inform clinical practice on the potential role of this treatment in the management of depression. TRIAL REGISTRATION EudraCT 2019-003109-92. Registered 2 October 2019. CLINICALTRIALS gov NCT04939649. Registered 25 June 2021.
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Affiliation(s)
- Ana Jelovac
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Cathal McCaffrey
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Masashi Terao
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Enda Shanahan
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Enas Mohamed
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Emma Whooley
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Kelly McDonagh
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Sarah McDonogh
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Anna Igoe
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Orlaith Loughran
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Ellie Shackleton
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, Global Research Institute for Health Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, James Street, Dublin, D08 K7YW, Ireland.
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
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13
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Prevolnik Rupel V, Ogorevc M. EQ-5D-5L Value Set for Slovenia. PHARMACOECONOMICS 2023; 41:1515-1524. [PMID: 37341959 PMCID: PMC10570207 DOI: 10.1007/s40273-023-01280-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES The aim of this valuation study was to produce a value set to support the use of EQ-5D-5L data in decision making in Slovenia. METHODS The study design followed the published EuroQol research protocol, and a quota sample was defined according to age, sex, and region. Overall, 1012 adult respondents completed 10 time trade-off and seven discrete choice experiment tasks in face-to-face interviews. The Tobit model was used to analyse the composite time trade-off (cTTO) data in order to generate values for the 3125 EQ-5D-5L health states. RESULTS The data showed logical consistency, with more severe states being given lower values. The greatest disutility was shown in the pain/discomfort and anxiety/depression dimensions. In the EQ-5D-5L value set, the values range from -1.09 to 1. With the exception of UA5 (unable to perform usual activities), all other levels on all health dimensions were statistically different from 0 and from each other. Compared with the existing EQ-5D-3L value set, there is a slightly lower share of 'worse than dead' states (32.1% compared with 33.7%) and the minimum value is lower. CONCLUSIONS Results have important implications for users of the EQ-5D-5L in Slovenia and regions. It is a robust and up-to-date value set and should be the preferred value set used in adults in Slovenia and in neighbouring countries without their own value set.
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Affiliation(s)
- Valentina Prevolnik Rupel
- Institute for Economic Research, Kardeljeva ploščad 17, Ljubljana, Slovenia.
- DOBA Faculty, Prešernova cesta 1, 2000, Maribor, Slovenia.
| | - Marko Ogorevc
- Institute for Economic Research, Kardeljeva ploščad 17, Ljubljana, Slovenia
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14
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Conneely M, Leahy S, O’Connor M, Corey G, Gabr A, Saleh A, Okpaje B, O’ Shaughnessy Í, Synnott A, McCarthy A, Holmes A, Robinson K, Ryan L, Griffin A, Barry L, Trépel D, Ryan D, Galvin R. A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS). Clin Interv Aging 2023; 18:1769-1788. [PMID: 37901478 PMCID: PMC10612516 DOI: 10.2147/cia.s413961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.
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Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Gillian Corey
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Anastasia Saleh
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Blessing Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Íde O’ Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Alison Holmes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lorna Ryan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Damian Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
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Zhu W, Zhang M, Pan J, Shi L, Gao H, Xie S. Valuing Chinese medicine quality of life-11 dimensions (CQ-11D) health states using a discrete choice experiment with survival duration (DCE TTO). Health Qual Life Outcomes 2023; 21:99. [PMID: 37612664 PMCID: PMC10463386 DOI: 10.1186/s12955-023-02180-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To explore generating a health utility value set for the Chinese medicine Quality of life-11 Dimensions (CQ-11D), a utility instrument designed to assess patients' health status while receiving TCM treatment, among the Chinese population. METHODS The study was designed to recruit at least 2400 respondents across mainland China to complete one-to-one, face-to-face interviews. Respondents completed ten discrete choice experiment with survival duration (DCETTO) tasks during interviews. The conditional logit models were used to generate the health utility value set for the CQ-11D using the DCETTO data. RESULTS A total of 2,586 respondents were invited to participate in the survey and 2498 valid interviews were completed (a completion rate of 96.60%). The modified conditional logit model with combing logically inconsistent levels was ultimately selected to construct the health utility value set for the CQ-11D instrument. The range of the measurable health utility value was -0.868 ~ 1. CONCLUSION The study provides the first utility value set for the CQ-11D among the Chinese population. The CQ-11D and corresponding utility value set can be used to measure the health utility values of patients undergoing traditional Chinese medicine interventions, and further facilitate relevant cost-utility analyses. The application of the CQ-11D can support TCM resource allocation in China.
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Affiliation(s)
- Wentao Zhu
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China.
| | - Mengpei Zhang
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Jie Pan
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Lizheng Shi
- Tulane University, 1440 Canal Street Suite 1900, New Orleans, LA, 70112, USA
| | - Hailiang Gao
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
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16
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Maione R, Formica C, Quartarone A, Lo Buono V. The Impact of Non-Motor Symptoms on Quality of Life in Cervical Dystonia. J Clin Med 2023; 12:4663. [PMID: 37510780 PMCID: PMC10380526 DOI: 10.3390/jcm12144663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Cervical dystonia (CD) is characterized by cranial muscle overactivity leading to abnormal intermittent or continuous posturing of the head. Nowadays, the treatment of patients suffering from this condition focuses principally on the motor component of the disorder, certainly the invaliding part; however, it leaves out the non-motor one that has a similarly invalidated effect on the quality of the subject's life. This review was conducted on studies investigating the impact of non-motor symptoms on levels of quality of life. We searched on the PubMed, EMBASE and Web of Science databases and screening references of included studies and review articles for additional citations. From an initial 150 publications, we included only five studies that met the search criteria. The results showed that anxiety, depression, pain and sleep quality have a great influence on patients' health and on the outcome of the disease. Future studies should focus more on investigating the non-motor components of CD as an integral part of the clinical management of dystonic patients in order to improve their well-being.
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Affiliation(s)
- Raffaela Maione
- IRCCS Centro Neurolesi "Bonino-Pulejo", 98124 Messina, Italy
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17
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Olariu E, Mohammed W, Oluboyede Y, Caplescu R, Niculescu-Aron IG, Paveliu MS, Vale L. EQ-5D-5L: a value set for Romania. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:399-412. [PMID: 35688994 PMCID: PMC10060331 DOI: 10.1007/s10198-022-01481-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/12/2022] [Indexed: 05/16/2023]
Abstract
OBJECTIVE We aimed to develop an EQ-5D-5L value set for Romania. METHODS In line with the EuroQoL standardized valuation protocol, computer-assisted interviews were conducted face-to-face in a representative sample in Romania (November 2018-November 2019). Valuation methods included composite time trade-off and discrete choice experiment tasks. Several models were tested, including models that accounted for data censoring, panel structure of the data, heteroscedasticity, conditional logit, and hybrid models. The final model was selected based on logical consistency, theoretical considerations, and use of all available data. We compared our value set with other value sets from Central and Eastern Europe region. RESULTS Data from 1493 respondents was used to estimate the value set. A censored hybrid model corrected for heteroscedasticity was selected to represent the value set. The highest decrements in utility were observed for the pain/discomfort dimension (0.375), followed by the mobility dimension (0.293). Health utilities ranged from 1.000 to - 0.323 and 1.3% of the values were negative. The model was corrected with survey weights to better reflect the representativeness of the sample, but the first two coefficients of the self-care dimension stopped being logically consistent. Differences were found between the Romanian, Hungarian and Polish EQ-5D-5L value sets. Good agreement was noted with the Romanian EQ-5D-3L value set, with a swap between pain/discomfort and mobility in ranking of dimensions. CONCLUSION A value set for EQ-5D-5L is now available for Romania. This will push one-step further the development of health technology assessment and encourage more health-related quality-of-life research to be conducted locally.
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Affiliation(s)
- Elena Olariu
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - Wael Mohammed
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Yemi Oluboyede
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Raluca Caplescu
- Department of Statistics and Econometrics, Faculty of Economic Cybernetics, Statistics and Informatics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Ileana Gabriela Niculescu-Aron
- Department of Statistics and Econometrics, Faculty of Economic Cybernetics, Statistics and Informatics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Marian Sorin Paveliu
- Department of Pharmacology and Pharmaeconomics, Faculty of General Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Corcoran C, Ruiz-Adame M, Trépel D. Early assessment and intervention by a dedicated health and social care professional team in the emergency department in older adults compared to treatment-as-usual: Health Economic Analysis Plan for within-trial cost effectiveness analysis. HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13693.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Older adults (aged over 65 years) experience high rates of adverse outcomes after presenting to emergency departments (EDs). The OPTI-MEND trial aimed to examine what impact intervention and early assessment by a dedicated health and social care professional (HSCP) team can have on quality of care for older adults in EDs. This paper presents the finalized Health Economic Analysis Plan (HEAP) specifying how the within-trial cost effectiveness analysis (CEA) will be conducted. Methods: This HEAP was developed retrospectively in collaboration with the OPTI-MEND team and the trial health economist to provide a plan to conduct the CEA. The HEAP aimed to fulfil international recommendations from a consensus of the required items for inclusion in HEAPs. In line with best practice guidelines, and to ensure full visibility in the scientific process, this paper makes the HEAP available in the public domain. Results: This HEAP illustrates the plan we followed when conducting our CEA. As this paper is a protocol it has no concrete results. A detailed list of all items in the HEAP are provided as Extended data on Open Science Framework at https://doi.org/10.17605/OSF.IO/YVG2P. Conclusions: Cost effectiveness analysis is an opportunity to extend beyond the primary clinical analysis of a trial. Congruent to a trial’s statistical analysis plan (SAP), a HEAP outlines the plan for estimating cost effectiveness and avoiding potentially spurious post-hoc analysis and questionable policy recommendations.
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Jensen MB, Jensen CE, Gudex C, Pedersen KM, Sørensen SS, Ehlers LH. Danish population health measured by the EQ-5D-5L. Scand J Public Health 2023; 51:241-249. [PMID: 34847818 PMCID: PMC9969307 DOI: 10.1177/14034948211058060] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aims of this study were to provide Danish population norms for the EQ-5D-5L and to assess the measurement properties of the instrument in a Danish population setting. METHODS We used data from the Danish 5L valuation study in which a representative sample of the Danish population completed the EQ-5D-5L and answered socio-demographic questions. We generated population norms for the five EQ-5D-5L dimensions, corresponding utility scores and the EQ-5D visual analogue scale (EQ VAS) according to age and sex. Measurement properties of ceiling effects, known-group construct validity and convergent validity were assessed. RESULTS The mean EQ-5D-5L utility score for the 1014 respondents completing the EQ-5D-5L was 0.90 (standard deviation (SD)=0.16). No significant differences emerged across age groups (minimum mean utility score=0.88 (SD=0.19); maximum mean utility score=0.93 (SD=0.11)) or sex (mean utility score for women=0.89 (SD=0.17); mean utility score for men=0.91 (SD=0.15)). Statistical differences were found across educational level, occupational status, income and living situation. Similar patterns were observed for the EQ VAS. Generally, respondents most often reported problems with pain and discomfort, but young women most often reported problems with anxiety/depression. There was a significant strong correlation between EQ-5D-5L utility and the EQ VAS and a significant correlation between overall health and each of the five EQ-5D-5L dimensions. The overall ceiling effect for the EQ-5D-5L was 39% (compared to 56% for the EQ-5D-3L). CONCLUSIONS
Danish population norms for the EQ-5D-5L are now available. We found fewer ceiling effects for the EQ-5D-5L compared to the EQ-5D-3L, and we provide evidence for convergent and known-group validity of the EQ-5D-5L.
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Affiliation(s)
- Morten B. Jensen
- Danish Center for Healthcare
Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg
University, Denmark,Department of Economics and Business
Economics, Aarhus University, Denmark,Morten B. Jensen, Aarhus University,
Fuglesangs Alle 4, DK8210 Aarhus V, Denmark. E-mail:
| | - Cathrine E. Jensen
- Danish Center for Healthcare
Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg
University, Denmark
| | - Claire Gudex
- Department of Clinical Research,
University of Southern Denmark and OPEN, Open Patient data Explorative Network,
Odense University Hospital, Denmark
| | - Kjeld M. Pedersen
- Danish Center for Healthcare
Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg
University, Denmark,Department of Economics, University of
Southern Denmark, Denmark
| | - Sabrina S. Sørensen
- Danish Center for Healthcare
Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg
University, Denmark
| | - Lars H. Ehlers
- Danish Center for Healthcare
Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg
University, Denmark
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20
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Sun S, Chuang LH, Sahlén KG, Lindholm L, Norström F. Estimating a social value set for EQ-5D-5L in Sweden. Health Qual Life Outcomes 2022; 20:167. [PMID: 36564844 PMCID: PMC9780618 DOI: 10.1186/s12955-022-02083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The study aims to elicit a value set based on the EQ-VT for the EQ-5D-5L that can be used to support decision-making in Sweden. METHODS Participants were recruited from the general population based on age, sex and urban/rural area quota sampling from five regions across Sweden. In total, 785 interviews were conducted from February 2020 to April 2021 using the EQVT 2.1 protocol, and both composite time trade-off (c-TTO) and discrete choice experiments (DCE) were used to elicit health preferences. A variety of models have been tested for the c-TTO data (generalized least square, Tobit, heteroskedastic models) and DCE data (conditional logit model), as well as the combined c-TTO and DCE data (hybrid modelling). Model selection was based on theoretical considerations, logical consistency of the parameter estimates, and significance of the parameters (p = 0.05). Model goodness-of-fit was assessed by AIC and BIC, and prediction accuracy was assessed in terms of mean absolute error. The predictions for the EQ-5D-5L health states between models were compared using scatterplots. RESULTS The preferred model for generating the value set was the heteroskedastic model based on the c-TTO data, with the health utilities ranging from -0.31 for the worst (55,555) to 1 for the best (11111) EQ-5D-5L states. CONCLUSION This is the first c-TTO-based social value set for the EQ-5D-5L in Sweden. It can be used to support the health utility estimation in economic evaluations for reimbursement decision making in Sweden.
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Affiliation(s)
- Sun Sun
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden. .,Research Group Health Outcomes and Economic Evaluation, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Ling-Hsiang Chuang
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden
| | - Klas-Göran Sahlén
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 90185, Umeå, Sweden
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Łaszewska A, Sajjad A, Busschbach J, Simon J, Hakkaart-van Roijen L. Conceptual Framework for Optimised Proxy Value Set Selection Through Supra-National Value Set Development for the EQ-5D Instruments. PHARMACOECONOMICS 2022; 40:1221-1234. [PMID: 36201130 PMCID: PMC9534733 DOI: 10.1007/s40273-022-01194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Preference differences between countries and populations justify the use of country-specific value sets for the EQ-5D instruments. There are no clear criteria based on which the selection of value sets for countries without a national value set should be made. As part of the European PECUNIA project, this study aimed to identify factors contributing to differences in preference-based valuations and develop supra-national value sets for homogenous country clusters in Europe. METHODS A literature review was conducted to identify factors relevant to variations in the EQ-5D-3L/5L health state valuations across countries. Factors fulfilling the pre-specified criteria of validity, reliability, international feasibility and comparability were used to group 27 European Union member states, the European Free Trade Association countries and the UK. Clusters of countries were developed based on the frequency of their appearance in the same grouping. The supra-national value sets were estimated for these clusters from the coefficients of existing published valuation studies using the ordinary least-squares model. RESULTS Ten factors were identified from 69 studies. From these, five grouping variables: (1) culture and religion; (2) linguistics; (3) healthcare system typology; (4) healthcare system financing; and (5) sociodemographic aspects were derived to define the groups of homogenous countries. Frequency-based grouping revealed five cohesive clusters: English-speaking, Nordic, Central-Western, Southern and Eastern European. CONCLUSIONS European countries were clustered considering variables that may relate to differences in health state valuations. Supra-national value sets provide optimised proxy value set selection in the lack of a national value set and/or for regional decision making.
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Affiliation(s)
- Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
| | - Ayesha Sajjad
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan Busschbach
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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22
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Carty PG, Teljeur C, De Gascun CF, Gillespie P, Harrington P, McCormick A, O'Neill M, Smith SM, Ryan M. Another Step Toward Hepatitis C Elimination: An Economic Evaluation of an Irish National Birth Cohort Testing Program. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1947-1957. [PMID: 35778325 DOI: 10.1016/j.jval.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/14/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to evaluate the cost-effectiveness of offering once-off birth cohort testing for hepatitis C virus (HCV) to people in Ireland born between 1965 and 1985, the cohort with the highest reported prevalence of undiagnosed chronic HCV infection. METHODS Systematic and opportunistic HCV birth cohort testing programs, implemented over a 4-year timeframe, were compared with the current practice of population risk-based testing only in a closed-cohort decision tree and Markov model hybrid over a lifetime time horizon. Outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented from the health system's perspective in 2020 euro (€). Uncertainty was assessed via deterministic, probabilistic, scenario, and threshold analyses. RESULTS In the base case, systematic testing yielded the largest cost and health benefits, followed by opportunistic testing and risk-based testing. Compared with risk-based testing, the incremental cost-effectiveness ratio for opportunistic testing was €14 586 (95% confidence interval €4185-€33 527) per QALY gained. Compared with opportunistic testing, the incremental cost-effectiveness ratio for systematic testing was €16 827 (95% confidence interval €5106-€38 843) per QALY gained. These findings were robust across a range of sensitivity analyses. CONCLUSIONS Both systematic and opportunistic birth cohort testing would be considered an efficient use of resources, but systematic testing was the optimal strategy at willingness-to-pay threshold values typically used in Ireland. Although cost-effective, any decision to introduce birth cohort testing for HCV (in Ireland or elsewhere) must be balanced with considerations regarding the feasibility and budget impact of implementing a national testing program given high initial costs and resource use.
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Affiliation(s)
- Paul G Carty
- RCSI University of Medicine and Health Sciences, Dublin, Ireland; Health Information and Quality Authority, Dublin, Ireland.
| | - Conor Teljeur
- Health Information and Quality Authority, Dublin, Ireland
| | - Cillian F De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Paddy Gillespie
- Health Economics & Policy Analysis Centre, National University of Ireland Galway, Galway, Ireland; CÚRAM, The SFI Research Centre for Medical Devices (12/RC/2073_2), National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Susan M Smith
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Ireland
| | - Mairin Ryan
- Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin, Ireland
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23
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Kearns N, Raigal-Aran L, O’Connell K, Davis A, Bermingham K, O’Reilly S, Collins DC, Corrigan M, Coulter J, Cleary V, Cushen S, Flavin A, Byrne F, O’Grady A, O’Neill D, Murphy A, Dahly D, Palmer B, Connolly RM, Hegarty J. The Women's Health Initiative cancer survivorship clinic incorporating electronic patient-reported outcomes: a study protocol for the Linking You to Support and Advice (LYSA) randomized controlled trial. Pilot Feasibility Stud 2022; 8:238. [PMID: 36357934 PMCID: PMC9648029 DOI: 10.1186/s40814-022-01186-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Women's Health Initiative cancer survivorship clinic in Ireland. METHODS The trial https://spcare.bmj.com/content/9/2/209.short comprises an intervention and control arm. Two hundred participants will be recruited. Key eligibility (1) women with early-stage hormone receptor-positive breast or gynecologic cancer (cervix or endometrial), within 12 months of completion of primary curative therapy, and (2) access to the Internet. The complex intervention comprises a nurse-led clinic targeting symptom management through a trigger alert system, utilizing electronic patient-reported outcome (ePRO) assessments at baseline, and 2, 4, 6, 8, 10, and 12 months. It also includes input from a dietitian monitoring diet and nutritional status. The control group will receive their usual care pathway standard of care and attend the cancer survivorship clinic and complete ePRO assessments at the start and end of the study. The primary endpoint (feasibility) includes the proportion of enrolled participants who complete baseline and follow-up ePRO surveys and partake in health professional consultations after ePRO data triggers. Secondary endpoints include changes in cancer-related symptom scores assessed by ePROs, health-related Quality of Life Questionnaire (QLQ) scores, Appraisal Self-Care Agency-R scores, and adjuvant endocrine therapy medication adherence. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in December 2020, with accrual commencing in March 2021. DISCUSSION This protocol describes the implementation of a parallel arm randomized controlled trial (RCT) which examines the feasibility of delivering a Cancer Survivorship Clinic. The ePRO is an innovative symptom monitoring system which detects the treatment-related effects and provides individualized support for cancer survivors. The findings will provide direction for the implementation of future survivorship care. TRIAL REGISTRATION ClinicalTrials.gov , NCT05035173 . Retrospectively registered on September 5, 2021.
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Affiliation(s)
- Noreen Kearns
- grid.7872.a0000000123318773Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laia Raigal-Aran
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Kate O’Connell
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Andrea Davis
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Katie Bermingham
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Seamus O’Reilly
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.412702.20000 0004 0617 8029Department of Medical Oncology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Dearbhaile C. Collins
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Mark Corrigan
- grid.411916.a0000 0004 0617 6269Department of Academic Surgery, Cork University Hospital, Cork, Ireland
| | - John Coulter
- grid.411916.a0000 0004 0617 6269Department of Gynaecology Oncology, Cork University Maternity Hospital, Cork, Ireland
| | - Vicki Cleary
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Gynaecology Oncology, Cork University Maternity Hospital, Cork, Ireland
| | - Samantha Cushen
- grid.7872.a0000000123318773School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Aileen Flavin
- grid.411916.a0000 0004 0617 6269Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Fiona Byrne
- grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Aisling O’Grady
- grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Deirdre O’Neill
- grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland
| | - Aileen Murphy
- grid.7872.a0000000123318773Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Darren Dahly
- grid.7872.a0000000123318773HRB Clinical Research Facility, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773School of Public Health, University College Cork, Cork, Ireland
| | - Brendan Palmer
- grid.7872.a0000000123318773HRB Clinical Research Facility, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773School of Public Health, University College Cork, Cork, Ireland
| | - Roisin M. Connolly
- grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland ,grid.411916.a0000 0004 0617 6269Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Josephine Hegarty
- grid.7872.a0000000123318773Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Cancer Research @UCC, College of Medicine and Health, University College Cork, Cork, Ireland
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Bouckaert N, Cleemput I, Devriese S, Gerkens S. An EQ-5D-5L Value Set for Belgium. PHARMACOECONOMICS - OPEN 2022; 6:823-836. [PMID: 35927410 PMCID: PMC9362639 DOI: 10.1007/s41669-022-00353-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE This study aimed to establish a Belgian EQ-5D-5L value set based on the preferences of the adult Belgian general population. METHODS The most recent EuroQol Valuation Technology (EQ-VT 2.1) protocol for EQ-5D-5L valuation studies was followed. Computer-assisted personal interviews were carried out in a representative sample of the adult Belgian population. Potential respondents were randomly selected from the National Register using a multistage, stratified, cluster sampling with unequal probability design. Each respondent valued 10 or 11 health states using composite time trade-off (cTTO) and 14 health states in seven paired choice tasks using a discrete choice experiment (DCE). Different model specifications were explored and assessed based on logical consistency, goodness of fit, predictive accuracy and theoretical considerations. RESULTS A total of 892 respondents were included in the analyses. The sample was representative of the Belgian adult population in terms of age, sex, region of residence, educational attainment, labour market status, self-assessed health status and health-related quality of life (HRQoL). The preferred model specification was a hybrid (DCE and cTTO data combined) multiplicative eight-coefficient model with intercept random effects and correction for heteroskedasticity. Values range from - 0.532 to 1. Loss of HRQoL is highest in the dimension pain/discomfort, closely followed by anxiety/depression. CONCLUSIONS This study developed a Belgian EQ-5D-5L value set, based on the preferences of the Belgian adult general population. It provides opportunities for future clinical and economic evaluations in healthcare, for the measurement of patient-reported outcomes and for population health assessments.
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Affiliation(s)
- Nicolas Bouckaert
- Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, 1000, Bruxelles, Belgium.
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, 1000, Bruxelles, Belgium
| | - Stephan Devriese
- Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, 1000, Bruxelles, Belgium
| | - Sophie Gerkens
- Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, 1000, Bruxelles, Belgium
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Rowen D, Mukuria C, McDool E. A Systematic Review of the Methodologies and Modelling Approaches Used to Generate International EQ-5D-5L Value Sets. PHARMACOECONOMICS 2022; 40:863-882. [PMID: 35829931 DOI: 10.1007/s40273-022-01159-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The international protocol for valuing EQ-5D-5L focuses upon prescribed preference elicitation methods and design. However, there are no recommendations around sampling, recruitment, data analysis or modelling to generate the EQ-5D-5L value set. This review examines methods used to generate international EQ-5D-5L values sets, across sampling, recruitment, data analysis, modelling, assessing model performance and selection of the recommended value set. METHODS All published EQ-5D-5L value sets were identified by a systematic search and confirmed by the EuroQol Group. Data were extracted to assess sampling, recruitment, preference elicitation techniques and design, data analysis, modelling, assessing model performance, and vale set selection. These are summarised in tables. RESULTS The review included 29 studies with 27 value sets generated using time-trade-off (TTO) data (n = 10) only or using a hybrid model that combines TTO and discrete choice experiment data (n = 17). TTO data were most commonly estimated using a heteroscedastic Tobit model with censoring at - 1, and the hybrid model using a specially created program. Model performance was generally assessed using goodness of fit, logical consistency and significance of coefficients, suitability of the model for the data characteristics and parsimony, though not all selected models account for the specific characteristics of the data. DISCUSSION Different assessments of model performance and reasoning are provided for the selection of the recommended value set for a country. This raises the question of valid criteria for selecting a recommended value set and whether this should rely upon researchers' recommendations when value sets are often used to inform public policy.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Emily McDool
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Jyani G, Sharma A, Prinja S, Kar SS, Trivedi M, Patro BK, Goyal A, Purba FD, Finch AP, Rajsekar K, Raman S, Stolk E, Kaur M. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1218-1226. [PMID: 35779943 DOI: 10.1016/j.jval.2021.11.1370] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare. METHODS A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set. RESULTS A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension. CONCLUSIONS This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare.
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Affiliation(s)
- Gaurav Jyani
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sitanshu Sekhar Kar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mayur Trivedi
- Indian Institute of Public Health, Gandhinagar, India
| | | | - Aarti Goyal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fredrick Dermawan Purba
- Department of Developmental Psychology, Faculty of Psychology, Universitas Padjadjaran, Indonesia
| | | | - Kavitha Rajsekar
- Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Swati Raman
- Academy of Management Studies, Lucknow, India
| | - Elly Stolk
- EuroQol Research Foundation, Rotterdam, The Netherlands
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kharroubi SA, Kelleher D. Use of a Non-parametric Bayesian Method to Model Health State Preferences: An Application to Polish and Irish EQ-5D-5L Valuations. Front Public Health 2022; 10:917728. [PMID: 35812518 PMCID: PMC9260504 DOI: 10.3389/fpubh.2022.917728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Valuations of preference-based measures for health are conducted in different countries. There is scope to use results from existing countries' valuations to generate better valuation estimates than analyzing the data from each country separately. We analyse data from two smaller design EQ-5D-5L valuation studies where a sample of 119 Polish migrants and 123 native Irish valued 30 common health states using similar composite time trade-off protocols. We apply a non-parametric Bayesian method to provide better predictions of the Polish (Irish) population utility function when the existing Irish (Polish) results were used as informative priors. The resultant new estimates were then compared to those obtained by analyzing the data from each country by itself via different prediction criterions. The results suggest that existing countries' valuations could be used as potential informative priors to produce better valuation estimates under all prediction criterions used. The implications of these results will be hugely important in countries where valuation studies are expensive and hard to conduct. Future application to other countries and to other preference-based health measures are encouraged.
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Affiliation(s)
- Samer A. Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, United Kingdom
| | - Dan Kelleher
- Yale School of Public Health, Yale University, New Haven, CT, United States
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Brazil K, Cardwell C, Carter G, Clarke M, Corry DAS, Fahey T, Gillespie P, Hobbins A, McGlade K, O'Halloran P, O'Neill N, Wallace E, Doyle F. Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial. BMC Geriatr 2022; 22:452. [PMID: 35610581 PMCID: PMC9131621 DOI: 10.1186/s12877-022-03128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To determine the feasibility, implementation and outcomes of an Anticipatory Care Planning (ACP) intervention in primary care to assist older adults at risk of functional decline by developing a personalized support plan. Design Feasibility cluster randomized control trial. Setting and participants Eight primary care practices (four in Northern Ireland, United Kingdom and four in the Republic of Ireland) were randomly assigned to either intervention or control arm. Eligible patients were those identified in each practice as 70 years of age or older and assessed as at risk of functional decline. Study participants (intervention n = 34, control n = 31) and research staff were not blinded to group assignment. Anticipatory care intervention The intervention delivered by a registered nurse including: a) a home-based patient assessment; b) care planning on the basis of a holistic patient assessment, and c) documentation of a support plan. Outcome measures A conceptual framework (RE-AIM) guided the assessment on the potential impact of the ACP intervention on patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and reduction of potentially inappropriate prescribing. Data were collected at baseline and at 10 weeks and six months following delivery of the intervention. Results All pre-specified feasibility indicators were met. Patients were unanimous in the acceptance of the ACP intervention. Health care providers viewed the ACP intervention as feasible to implement in routine clinical practice with attending community supports. While there were no significant differences on the primary outcomes (EQ-5D-5L: -0.07 (-0.17, 0.04) p = .180; CES-D: 1.2 (-2.5, 4.8) p = .468) and most secondary measures, ancillary analysis on social support showed responsiveness to the intervention. Incremental cost analysis revealed a mean reduction in costs of €320 per patient (95% CI -31 to 25; p = 0.82) for intervention relative to the control. Conclusions We successfully tested the ACP intervention in primary care settings and have shown that it is feasible to implement. The ACP intervention deserves further testing in a definitive trial to determine whether its implementation would lead to better outcomes or reduced costs. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03128-x.
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Affiliation(s)
- Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Christopher Cardwell
- Centre for Public Health, ICSB, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Mike Clarke
- Centre for Public Health, ICSB, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Dagmar Anna S Corry
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Patrick Gillespie
- Health Economics and Policy Analysis Centre, Institute for Lifecourse and Society, National University of Ireland, Galway (NUI Galway), Republic of Ireland
| | - Anna Hobbins
- Health Economics and Policy Analysis Centre, Institute for Lifecourse and Society, National University of Ireland, Galway (NUI Galway), Republic of Ireland
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Dunluce Health Centre, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nina O'Neill
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland.,Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
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Kelleher D, Kharroubi S, Doherty E, Baio G, O’Neill C. Examining the Association between Polish Migrant Status and Health Preferences Using a Novel Application of a Smaller Design EQ-5D-5L Valuation Study. PHARMACOECONOMICS - OPEN 2022; 6:425-435. [PMID: 35080756 PMCID: PMC9043148 DOI: 10.1007/s41669-021-00314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Migrants have different utilisation of healthcare services and health-related behaviours than host populations. A potential factor that may contribute to the notable differences in healthcare use and health-related behaviours between migrants and host populations is how these groups value health. Those who place a high value on health have greater healthcare-seeking practices than those who do not. OBJECTIVE The aim of this study was to examine how Polish migrants and native Irish differ in health state utility valuations using a novel application of a smaller design EQ-5D-5L valuation study. METHODS This study uses health preferences as a predictor of how one values health. We examined the EQ-5D-5L health preferences of 119 Polish migrants and 123 native Irish, both residing full-time in Ireland. To do so, we used a novel application of a smaller design EQ-5D-5L valuation study that consisted of 30 health states and a targeted sampling strategy coupled with a Bayesian statistical nonparametric model. We collected data from June 2018 to September 2019. RESULTS Our results highlight that Polish migrants and native Irish differ in their health preferences for and valuation of severe health states. Polish migrants place meaningfully higher utility valuations of 0.1 or more on the three most severe health states compared with the native Irish. CONCLUSION This study can provide an understanding of a potential new factor underpinning some of the disparities in healthcare utilisation and health-related behaviours among migrants and host populations in Europe. This study also provides proof of principle for using a smaller design EQ-5D-5L valuation study to explore differences in health preferences among other minority subgroups, which can otherwise be hard to uncover when using the secondary analysis of national EQ-5D-5L valuation studies.
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Affiliation(s)
- Dan Kelleher
- The Institute for Lifecourse and Society, NUI Galway, Room 2007, Upper Newcastle, Galway, H91C7DK Ireland
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, PO Box 11-0236, Beirut, Lebanon
| | - Edel Doherty
- Health Economics and Policy Analysis Centre, The Institute for Lifecourse and Society, Upper Newcastle, NUI Galway, National University of Ireland, Galway, H91C7DK Ireland
| | - Gianluca Baio
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Ciaran O’Neill
- Institute of Clinical Sciences, Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital, Block B, Belfast, BT12 6BA Northern Ireland, UK
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Al Shabasy S, Abbassi M, Finch A, Roudijk B, Baines D, Farid S. The EQ-5D-5L Valuation Study in Egypt. PHARMACOECONOMICS 2022; 40:433-447. [PMID: 34786590 PMCID: PMC8595057 DOI: 10.1007/s40273-021-01100-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 05/19/2023]
Abstract
INTRODUCTION No value sets exist for either the EQ-5D-3L or the EQ-5D-5L in Egypt, despite local pharmacoeconomic guidelines recommending the use of the EQ-5D to derive utility. Most published Egyptian economic evaluation studies have used utility values from other published studies and systematic reviews. OBJECTIVE Our objective was to develop an Egyptian EQ-5D-5L value set using the international EuroQol standardized protocol (EQ-VT-2.1). This study is a revision of a previous EQ-5D-5L value set for Egypt retracted by the authors. METHODS Adult Egyptian participants were recruited from public places using multi-stratified quota sampling based on age, sex, and geographical distribution. Two elicitation techniques were applied: the composite time trade-off (cTTO) and discrete-choice experiments (DCEs). Before actual data collection, interviewers' performance was assessed in a pilot phase. Data were modelled using generalized least squares, Tobit, heteroskedastic, logit, and hybrid models, and the best fitting model was selected based on logical consistency of the parameters, significance level, prediction accuracy, and model parsimony. RESULTS A total of 1378 interviews were conducted, of which 188 were excluded because they were incomplete and did not comply with the protocol, 216 were pilot interviews, and 974 were included in the final analysis. The heteroskedastic model with constraints (model 4) based on the cTTO data was selected as the preferred model to generate the value set. Values ranged from - 0.964 for the worst health state (55555) to 1 for full health (11111) and 0.948 for 11211, with 1123 of all predicted health states (35.94%) being worse than dead. Mobility had the largest impact on health state preference values. CONCLUSION This is the first value set for the EQ-5D-5L based on social preferences obtained from a nationally representative sample in Egypt or any Arabic-speaking country. The value set can be used as a scoring system for economic evaluation and to improve the quality of health technology assessment in the Egyptian healthcare system.
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Affiliation(s)
- Sahar Al Shabasy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt
| | - Maggie Abbassi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt
| | | | - Bram Roudijk
- EuroQol Group Office, Rotterdam, The Netherlands
| | | | - Samar Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt.
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Morrissey EC, Byrne M, Casey B, Casey D, Gillespie P, Hobbins A, Lowry M, McCarthy E, Newell J, Roshan D, Sharma S, Dinneen SF. Improving outcomes among young adults with type 1 diabetes: the D1 Now pilot cluster randomised controlled trial. Pilot Feasibility Stud 2022; 8:56. [PMID: 35260182 PMCID: PMC8902268 DOI: 10.1186/s40814-022-00986-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The D1 Now intervention is designed to improve outcomes in young adults living with type 1 diabetes. It consists of three components: an agenda-setting tool, an interactive messaging system and a support worker. The aim of the D1 Now pilot cluster randomised controlled trial (RCT) was to gather and analyse acceptability and feasibility data to allow (1) further refinement of the D1 Now intervention, and (2) determination of the feasibility of evaluating the D1 Now intervention in a future definitive RCT. METHODS A pilot cluster RCT with two intervention arms and a control arm was conducted over 12 months. Quantitative data collection was based on a core outcome set and took place at baseline and 12 months. Semi-structured interviews with participants took place at 6, 9 and 12 months. Fidelity and health economic costings were also assessed. RESULTS Four diabetes centres and 57 young adults living with type 1 diabetes took part. 50% of eligible young adults were recruited and total loss to follow-up was 12%. Fidelity, as measured on a study delivery checklist, was good but there were three minor processes that were not delivered as intended in the protocol. Overall, the qualitative data demonstrated that the intervention was considered acceptable and feasible, though this differed across intervention components. The agenda-setting tool and support worker intervention components were acceptable to both young adults and staff, but views on the interactive messaging system were mixed. CONCLUSIONS Some modifications are required to the D1 Now intervention components and research processes but with these in place progression to a definitive RCT is considered feasible. TRIAL REGISTRATION ISRCTN (ref: ISRCTN74114336 ).
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Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Bláthín Casey
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Paddy Gillespie
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
- CURAM, Science Foundation Ireland (SFI) Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
| | - Anna Hobbins
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
- CURAM, Science Foundation Ireland (SFI) Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
| | - Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Elizabeth McCarthy
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Davood Roshan
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Shikha Sharma
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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Sandmann FG, Tessier E, Lacy J, Kall M, Van Leeuwen E, Charlett A, Eggo RM, Dabrera G, Edmunds WJ, Ramsay M, Campbell H, Amirthalingam G, Jit M. Long-Term Health-Related Quality of Life in Non-Hospitalized Coronavirus Disease 2019 (COVID-19) Cases With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in England: Longitudinal Analysis and Cross-Sectional Comparison With Controls. Clin Infect Dis 2022; 75:e962-e973. [PMID: 35245941 PMCID: PMC8903473 DOI: 10.1093/cid/ciac151] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to quantify the unknown losses in health-related quality of life of coronavirus disease 2019 (COVID-19) cases using quality-adjusted lifedays (QALDs) and the recommended EQ-5D instrument in England. METHODS Prospective cohort study of nonhospitalized, polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2-positive (SARS-CoV-2-positive) cases aged 12-85 years and followed up for 6 months from 1 December 2020, with cross-sectional comparison to SARS-CoV-2-negative controls. Main outcomes were QALD losses; physical symptoms; and COVID-19-related private expenditures. We analyzed results using multivariable regressions with post hoc weighting by age and sex, and conditional logistic regressions for the association of each symptom and EQ-5D limitation on cases and controls. RESULTS Of 548 cases (mean age 41.1 years; 61.5% female), 16.8% reported physical symptoms at month 6 (most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath). Cases reported more limitations with doing usual activities than controls. Almost half of cases spent a mean of £18.1 on nonprescription drugs (median: £10.0), and 52.7% missed work or school for a mean of 12 days (median: 10). On average, all cases lost 13.7 (95% confidence interval [CI]: 9.7, 17.7) QALDs, whereas those reporting symptoms at month 6 lost 32.9 (95% CI: 24.5, 37.6) QALDs. Losses also increased with older age. Cumulatively, the health loss from morbidity contributes at least 18% of the total COVID-19-related disease burden in the England. CONCLUSIONS One in 6 cases report ongoing symptoms at 6 months, and 10% report prolonged loss of function compared to pre-COVID-19 baselines. A marked health burden was observed among older COVID-19 cases and those with persistent physical symptoms.
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Affiliation(s)
- Frank G Sandmann
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Corresponding author: Frank G. Sandmann Infectious Disease Modeller / Health Economist
| | - Elise Tessier
- Immunisation Division, UK Health Security Agency, London, UK,COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - Joanne Lacy
- Immunisation Division, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - Edwin Van Leeuwen
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andre Charlett
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Ramsay
- Immunisation Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- Immunisation Division, UK Health Security Agency, London, UK
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Bruyndonckx R, Bilcke J, van der Velden AW, Li X, Hens N, Coenen S, Butler CC, Beutels P. Impact of Adding Oseltamivir to Usual Care on Quality-Adjusted Life-Years During Influenza-Like Illness. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:178-184. [PMID: 35094790 DOI: 10.1016/j.jval.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The ALIC4E trial has shown that oseltamivir reduces recovery time while increasing the risk of nausea. This secondary analysis of the ALIC4E trial aimed to determine the gain in quality-adjusted life-years (QALYs) associated with adding oseltamivir to usual primary care in patients presenting with influenza-like illness (ILI). METHODS Patients with ILI were recruited during the influenza season (2015-2018) in 15 European countries. Patients were assigned to usual care with or without oseltamivir through stratified randomization (age, severity, comorbidities, and symptom onset). Patients' health status was valued with the EQ-5D and visual analog scale (VAS) for up to 28 days. Average EQ-5D and VAS scores over time were estimated for both treatment groups using one-inflated beta regression in children (<13 years old) and adults (≥13 years old). QALY gain was calculated as the difference between the groups. Sensitivity analysis considered the value set to convert EQ-5D answers to summary scores and the follow-up period. RESULTS In adults, oseltamivir gained 0.0006 (95% confidence interval 0.0002-0.0010) QALYs, whereas no statistically significant gain was found in children (14-day follow-up, EQ-5D). QALY gains were statistically significant in patients aged ≥65 years, patients without relevant comorbidities, or patients experiencing symptoms for ≤48 hours. Using VAS and accounting for 28-day follow-up resulted in higher QALY gain. CONCLUSIONS QALY gain owing to oseltamivir is limited compared with other diseases, and its clinical meaningfulness remains to be determined. Further analysis is needed to evaluate whether QALY gain and its impact on ILI treatment cost render oseltamivir cost-effective.
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Affiliation(s)
- Robin Bruyndonckx
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Joke Bilcke
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - Alike W van der Velden
- Julius Centre for Health, Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Xiao Li
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium; Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Department of Family Medicine and Population Health, Centre for General Practice, University of Antwerp, Antwerp, Belgium
| | - Christopher C Butler
- Institute for Primary Care and Public Health, Cardiff University, Cardiff, England, UK
| | - Philippe Beutels
- Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Poudel N, Fahim SM, Qian J, Garza K, Chaiyakunapruk N, Ngorsuraches S. Methodological similarities and variations among EQ-5D-5L value set studies: a systematic review. J Med Econ 2022; 25:571-582. [PMID: 35416095 DOI: 10.1080/13696998.2022.2066441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES (1) To descriptively compare the selected elements of valuation methods for EQ-5D-5L value set studies, (2) to compare the characteristics of the value sets, and (3) to examine the associations between the selected elements of valuation methods and the EQ-5D-5L value sets. METHODS A systematic literature search of EQ-5D-5L valuation studies from 1 January 2009 to 22 April 2021 was conducted in selected databases. Following the initial search, we also explored additional studies published during the completion of the final version of the manuscript. Similarities and variations for selected elements of valuation methods were descriptively compared. The relative importance of dimensions, utility decrements between the levels, and distribution of the utility scores were used to compare value sets. A meta-regression analysis examined the associations between the selected methodological elements and the utility scores and dimension levels of EQ-5D-5L. RESULTS A total of 31 studies were included in this review. Methodological similarities centered around data collection and preference elicitation method. On the other hand, variations include sampling technique, sample size, and value set modeling. The variations in value sets based on the relative importance of dimension, decrement in utility score, and distribution of utility score across countries were observed. Although the distribution of the utility scores differed across countries, higher levels of each dimension tended to have a larger decrement in the utility scores. Mean utility scores for the experience-based value sets were higher than those estimated using stated choice methods. The selected methodological elements were not significantly associated with the mean predicted utility scores or most dimension-level coefficients. CONCLUSIONS EQ-5D-5L health state valuation methods and characteristics of value sets differed across studies. The impact of the variation of methodological elements on the value sets should be further investigated.
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Affiliation(s)
- N Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
| | - S M Fahim
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
| | - J Qian
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
| | - K Garza
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
| | - N Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - S Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
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O’Donovan M, Quinn E, Johnston K, Singleton E, Benson J, O'Mahony B, Noone D, Duggan C, Gilmore R, Ryan K, O'Donnell JS, O’Connell NM. Recombinant factor IX-Fc fusion protein in severe hemophilia B: Patient-reported outcomes and health-related quality of life. Res Pract Thromb Haemost 2021; 5:e12602. [PMID: 34667923 PMCID: PMC8505226 DOI: 10.1002/rth2.12602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION In 2017, all people with severe hemophilia B in Ireland switched to recombinant factor IX Fc fusion protein concentrate (rFIXFc) prophylaxis. Patient-reported outcomes (PROs) and health-related quality of life (HRQoL) are important to evaluate with new treatments. AIMS To assess HRQoL in people with severe hemophilia B and their experience after switching to rFIXFc prophylaxis. METHODS Participants completed a Patient Reported Outcomes Burden and Experience (PROBE) questionnaire on initiation and following two years of rFIXFc prophylaxis. The PROBE questionnaire has four domains: demographics, general health, haemophilia-specific, and European Quality of Life 5-Dimensions (EQ-5D-5L) questionnaire. RESULTS Twenty-three participants completed the questionnaire at both time points. The number of activities where chronic pain occurred and interfered with the activity was reduced by 25% and 33%, respectively (P < .001), following two years of rFIXFc prophylaxis. There was a 9% decrease in chronic pain during the second year of rFIXFc prophylaxis compared to baseline, but the rate remained high, at 74%. A 25% reduction in the number of affected activities of daily living (ADLs) was reported following 2 years of rFIXFc prophylaxis (P = .007). The most common health problems were arthritis, hypertension, anxiety/depression, and gingivitis. The median EQ-5D-5L score was similar following two years of rFIXFc prophylaxis, 0.76 (range, -0.01 to 0.95), compared to 0.77 (range, 0.36-1) at baseline. CONCLUSION This study of real-world patient experience using PROs demonstrates a reduction in chronic pain and improvement in ADLs in participants after switching to rFIXFc prophylaxis. It provides important insights into patient-identified health care needs and living with severe hemophilia B.
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Affiliation(s)
- Mairead O’Donovan
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
| | - Eimear Quinn
- National Coagulation CentreSt James’s HospitalDublinIreland
| | - Kate Johnston
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
| | | | - Julie Benson
- National Coagulation CentreSt James’s HospitalDublinIreland
| | - Brian O'Mahony
- School of MedicineTrinity College DublinDublinIreland
- Irish Haemophilia SocietyDublinIreland
| | | | | | | | - Kevin Ryan
- National Coagulation CentreSt James’s HospitalDublinIreland
| | | | - Niamh M. O’Connell
- National Coagulation CentreSt James’s HospitalDublinIreland
- School of MedicineTrinity College DublinDublinIreland
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Li P, Lin Z, Du H, Feng T, Zuo J. Do environmental taxes reduce air pollution? Evidence from fossil-fuel power plants in China. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 295:113112. [PMID: 34174685 DOI: 10.1016/j.jenvman.2021.113112] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/25/2021] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
Taking environmental protection into consideration, China introduced the new Environmental Protection Tax Law in 2018, which levies taxes for pollutants with higher standards. The vast majority of existing studies have investigated the impacts of environmental taxes (ETs) at the city level or province level. In contrast, we estimate their effects on pollutant reductions for fossil-fuel power plants in 30 provinces in China. Our results show that ETs have positive effects on pollutant emission reductions compared with the pollution discharge fee policy. We provide empirical evidence that sulfur dioxide (SO2), nitrogen oxide (NOx), and dust from fossil fuel power plants significantly decreased by 2.186 (7.7%), 1.550 (6.84%), and 1.064 (16.1%) tons, respectively, after the implementation of the policy. Moreover, there is an inverted U-shape relationship between pollutant emission reductions and tax rates. We offer further evidence that they play a limited role in high environmental regulation regions. Finally, we compare how different types of firms responded to ETs. The results show that ETs have limited effects on pollutant reductions for large state-owned coal power plants, which may have achieved environmental transformation to a certain extent. Therefore, policymakers could consider promoting tax rates in areas with low tax rates and strengthening tax breaks to stimulate firms to achieve pollutant reduction. In addition, local governments should set tax rates taking regional environmental regulation levels and firm heterogeneity into account.
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Affiliation(s)
- Panni Li
- College of Management and Economics, Tianjin University, Tianjin, 300072, China
| | - Zhongguo Lin
- College of Management and Economics, Tianjin University, Tianjin, 300072, China.
| | - Huibin Du
- College of Management and Economics, Tianjin University, Tianjin, 300072, China
| | - Tong Feng
- College of Management and Economics, Tianjin University, Tianjin, 300072, China
| | - Jian Zuo
- School of Architecture & Built Environment, Entrepreneurship, Commercialization, And Innovation Centre (ECIC), The University of Adelaide, SA, 5005, Australia
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Joelson A, Wildeman P, Sigmundsson FG, Rolfson O, Karlsson J. Properties of the EQ-5D-5L when prospective longitudinal data from 28,902 total hip arthroplasty procedures are applied to different European EQ-5D-5L value sets. LANCET REGIONAL HEALTH-EUROPE 2021; 8:100165. [PMID: 34557854 PMCID: PMC8454852 DOI: 10.1016/j.lanepe.2021.100165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The purpose of this study was to evaluate the impact of using different country-specific value sets in EQ-5D-5L based outcome analyses. Methods We obtained data on patients surgically treated with total hip arthroplasty (THA) between 2017 and 2019 from the national Swedish Hip Arthroplasty Register. Preoperative and one-year postoperative data on a total of 28,902 procedures were available for analysis. The EQ-5D-5L health states were coded to the EQ-5D-5L preference indices using 13 European value sets. The EQ-5D-5L index distributions were then estimated with kernel density estimation. The change in EQ-5D-5L index before and one year after treatment was evaluated with the standardized response mean (SRM). The lifetime gain in quality-adjusted life years (QALYs) was estimated with a 3.5% annual QALY discount rate. Findings There was a marked variability in means and shapes of the resulting EQ-5D-5L index distributions. There were also considerable differences in the EQ-5D-5L index distribution shape before and after the treatment using the same value set. The effect sizes of one-year change (SRM) were similar for all value sets. However, the differences in estimated QALY gains were substantial. Interpretation The EQ-5D-5L index distributions varied considerably when a single large data set was applied to different European EQ-5D-5L value sets. The most pronounced differences were between the value sets based on experience-based valuation and the value sets based on hypothetical valuation. This illustrates that experience-based and hypothetical value sets are inherently different and also that QALY gains derived with different value sets are not comparable. Our findings are of importance in study planning since the results and conclusions of a study depend on the choice of value set. Funding None.
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Affiliation(s)
- Anders Joelson
- Orebro University School of Medical Sciences, Orebro, Sweden.,Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Peter Wildeman
- Orebro University School of Medical Sciences, Orebro, Sweden.,Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Freyr Gauti Sigmundsson
- Orebro University School of Medical Sciences, Orebro, Sweden.,Department of Orthopedics, Orebro University Hospital, Orebro, Sweden
| | - Ola Rolfson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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Health preferences and preventive care utilisation: How EQ-5D-5L health preferences may affect uptake. Prev Med Rep 2021; 24:101514. [PMID: 34401223 PMCID: PMC8358689 DOI: 10.1016/j.pmedr.2021.101514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Despite the economic and health benefits of preventive care being well established, the uptake of many cost-effective preventive services remains lower than desired in many cases, especially among specific sub-populations. The value an individual places on health can influence their uptake of preventive care. One way to capture the value an individual places on health and future health status is to examine their health preferences. This study used a novel use of EQ-5D-5L health preferences to determine if health preferences are associated with the uptake of a range of preventive care services, including a cancer screening, blood pressure check, cholesterol check, blood test and urine test. We collected EQ-5D-5L composite time trade-off data in 2018/2019 on 242 respondents residing in Ireland. We estimated an initial tobit model to predict an individual’s health preference to capture health preferences as a regressor. We then estimated a bivariate probit model to examine the uptake of each preventive service and GP use. Each model controlled for health preferences, education, sex, type of health coverage, self-reported health, employment status, age and marital status. Health preferences are a significant determinant of all five preventive services while controlling for other covariates. The results shows that the higher an individual values good health, the more likely they are to avail of preventive care. Health preferences can be noted as a potential determinant of preventive care use that could guide policy responses seeking to increase demand-side factors for preventive care uptake.
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Ageing, Health-Related Quality of Life and Physical Activity – Evidence Based on the EQ-5D-5L. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Jensen CE, Sørensen SS, Gudex C, Jensen MB, Pedersen KM, Ehlers LH. The Danish EQ-5D-5L Value Set: A Hybrid Model Using cTTO and DCE Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:579-591. [PMID: 33527304 PMCID: PMC8270796 DOI: 10.1007/s40258-021-00639-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Quality-adjusted life-years (QALYs) are expected to be used for priority setting of hospital-dispensed medicines in Denmark from 2021. The aim of this study was to develop the first Danish value set for the EQ-5D-5L based on interviews with a representative sample of the Danish adult population. METHODS A nationally representative sample based on age (> 18 years), gender, education, and geographical region was recruited using data provided by Statistics Denmark. Computer-assisted personal interviews were carried out using the EQ-VT 2.1. Respondents each valued ten health states using composite time trade-off (cTTO) and seven health states using discrete-choice experiment (DCE). Different predictive models were explored using cTTO and DCE data alone or in combination as hybrid models. Model performance was assessed using logical consistency. RESULTS A total of 1014 interviews were included in the analyses. The sample was representative of the Danish adult population, though the sample contained slightly more respondents with higher education than in the general population. Only the heteroscedastic censored hybrid model combining cTTO and DCE data yielded consistent results, and hence was chosen for modelling the final Danish value set. The predicted values ranged from - 0.757 to 1, and anxiety/depression was the dimension assigned most value by respondents. CONCLUSIONS This study established the Danish EQ-5D-5L value set, which represents the preferences of the Danish general population, and is expected to provide key input for healthcare decision-making in a Danish context.
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Affiliation(s)
- Cathrine Elgaard Jensen
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark.
| | - Sabrina Storgaard Sørensen
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark and OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Morten Berg Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Kjeld Møller Pedersen
- Department of Management and Economics, University of Southern Denmark, Odense, Denmark
| | - Lars Holger Ehlers
- Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark
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Henry E, Cullinan J. Mental health spillovers from serious family illness: Doubly robust estimation using EQ-5D-5L population normative data. Soc Sci Med 2021; 279:113996. [PMID: 33993007 DOI: 10.1016/j.socscimed.2021.113996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
People are interconnected and ill-health is rarely experienced in isolation. However, while there has been extensive research on health spillovers related to informal caregiving, there is comparatively little evidence on how ill-health may impact upon non-caregiving family members. This paper analyses EQ-5D-5L normative data from a nationally representative sample of adult residents of Ireland to estimate the independent relationship between serious family illness and five distinct dimensions of health. The empirical strategy combines inverse probability weighting and multivariate ordered probit regression in a doubly robust estimation. We find that experience of serious family illness is associated with large mental health decrements that are independent of caring responsibilities, while similar results are not evident for the four other health dimensions. Furthermore, stratified sub-sample analyses indicate considerable heterogeneity by sex and by income. In particular, we find evidence consistent with larger mental health spillovers for females than for males, as well as for low- and medium-income households relative to high-income households. The latter suggests that such spillovers may be substantially worse for those with fewer resources. Overall, the findings have a range of potential implications, including for the provision of mental health supports and services, for equity of health outcomes, as well as for health economic evaluation. For example, we calculate that our estimates of health spillovers are consistent with a 1.3% reduction in health utility for non-caregiving family members.
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Affiliation(s)
- Edward Henry
- Discipline of Economics, National University of Ireland Galway, Ireland.
| | - John Cullinan
- Discipline of Economics, National University of Ireland Galway, Ireland.
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Doherty E, Hobbins A, Whitehurst DGT, O'Neill C. An Exploration on Attribute Non-attendance Using Discrete Choice Experiment Data from the Irish EQ-5D-5L National Valuation Study. PHARMACOECONOMICS - OPEN 2021; 5:237-244. [PMID: 33481204 PMCID: PMC8160058 DOI: 10.1007/s41669-020-00244-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND Generic measures of health-related quality of life (HRQoL) permit comparisons of competing demands for healthcare resources using outcomes that reflect the preferences of tax payers. EQ-5D instruments are the most commonly used generic, preference-based measures of HRQoL. The EQ-5D-5L enables respondents to describe their health state using five dimensions of health, each with five response levels. The standardised protocol for the valuation of EQ-5D-5L health states comprises use of the composite time trade-off valuation technique, supplemented by a discrete choice experiment (DCE). OBJECTIVE This paper presents the first exploration on attribute non-attendance (ANA) to the dimensions of the EQ-5D-5L using DCE data collected following the standardised protocol. METHOD This paper uses the equality constrained latent class model and the endogenous attribute attendance model to examine ANA to the dimensions of the EQ-5D-5L. RESULTS The results suggest that respondents are less likely to consider the physical dimensions of the EQ-5D-5L (such as self-care and usual activities) when evaluating the health states. The effects of ANA on utility scores depends on the interpretation of the underlying reasons for ANA. CONCLUSIONS We recommend that future value sets based in whole or in part on DCE data examine the impact of and reasons for non-attendance in national valuation studies.
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Affiliation(s)
- Edel Doherty
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Anna Hobbins
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
- Centre for Research in Medical Devices (Cúram) and Health Economics and Policy Analysis Centre (HEPAC), National University of Ireland, Galway, Ireland
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Ciaran O'Neill
- School of Medicine, Dentistry and Biomedical Sciences and Centre for Public Health, Queen's University Belfast, Belfast, UK
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Erim DO, Bennett AV, Gaynes BN, Basak RS, Usinger D, Chen RC. Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D. Qual Life Res 2021; 30:2919-2928. [PMID: 33993437 DOI: 10.1007/s11136-021-02871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To create a crosswalk that predicts Short Form 6D (SF-6D) utilities from Memorial Anxiety Scale for Prostate Cancer (MAX-PC) scores. METHODS The data come from prostate cancer patients enrolled in the North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS, N = 1016). Cross-sectional data from 12- to 24-month follow-up were used as estimation and validation datasets, respectively. Participants' SF-12 scores were used to generate SF-6D utilities in both datasets. Beta regression mixture models were used to evaluate SF-6D utilities as a function of MAX-PC scores, race, education, marital status, income, employment status, having health insurance, year of cancer diagnosis and clinically significant prostate cancer-related anxiety (PCRA) status in the estimation dataset. Models' predictive accuracies (using mean absolute error [MAE], root mean squared error [RMSE], Akaike information criterion [AIC] and Bayesian information criterion [BIC]) were examined in both datasets. The model with the highest prediction accuracy and the lowest prediction errors was selected as the crosswalk. RESULTS The crosswalk had modest prediction accuracy (MAE = 0.092, RMSE = 0.114, AIC = - 2708 and BIC = - 2595.6), which are comparable to prediction accuracies of other SF-6D crosswalks in the literature. About 24% and 52% of predictions fell within ± 5% and ± 10% of observed SF-6D, respectively. The observed mean disutility associated with acquiring clinically significant PCRA is 0.168 (standard deviation = 0.179). CONCLUSION This study provides a crosswalk that converts MAX-PC scores to SF-6D utilities for economic evaluation of clinically significant PCRA treatment options for prostate cancer survivors.
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Affiliation(s)
- Daniel O Erim
- Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina, Chapel Hill, NC, USA.
| | - Antonia V Bennett
- Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina, Chapel Hill, NC, USA.,Department of Health Policy and Management, The University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Bradley N Gaynes
- Department of Psychiatry, The University of North Carolina, Chapel Hill, NC, USA
| | - Ram Sankar Basak
- Department of Radiation Oncology, The University of North Carolina, Chapel Hill, NC, USA
| | - Deborah Usinger
- Lineberger Comprehensive Cancer Center, School of Medicine, The University of North Carolina, Chapel Hill, NC, USA
| | - Ronald C Chen
- Department of Radiation Oncology, The University of Kansas Cancer Center, Kansas City, KS, USA
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Zhang R, Fu B, Wang K, Zhao W. Objective indicators contribute more than subjective beliefs to resident willingness to pay for ecosystem services on the Tibetan Plateau. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 285:112048. [PMID: 33578209 DOI: 10.1016/j.jenvman.2021.112048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
Effective ecosystem management on the Tibetan Plateau will contribute to regional environmental sustainability, and these efforts need broad public support, especially that of residents, over the long run. Although residents' subjective perceptions often directly influence practices, the interactive effects of subjective and objective indicators at the individual level often interfere with resident participation in ecosystem management. With the objective of decoupling the effects of multiple variables on resident participation in environmental sustainability, we launched a questionnaire survey on the topic of willingness to pay (WTP) on the Tibetan Plateau, and explored the effects of single variables and pairwise variables on WTP via dummy regression and proposed specific management suggestions. The results showed that objective indicators were the key drivers of WTP. First, it not only had strong direct effects on WTP (2770.32 CNY/year) but also interacted with subjective beliefs (3805.92 CNY/year); second, it had indirect effects on participation attitudes (R = 0.79) through subjective beliefs (R = 0.38). Put differently, the challenge of achieving sustainable management in the TP is how to enhance and satisfy the sociodemographic and socio-economic attributes of indigenous residents.
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Affiliation(s)
- Rui Zhang
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Faculty of Geographical Science, Beijing Normal University, No. 19, XinJieKouWai St., HaiDian District, Beijing, 100875, PR China
| | - Bojie Fu
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Faculty of Geographical Science, Beijing Normal University, No. 19, XinJieKouWai St., HaiDian District, Beijing, 100875, PR China.
| | - Kevin Wang
- Centre on Migration, Policy and Society (COMPAS), University of Oxford, 58 Banbury Road, Oxford, OX2 6QS, United Kingdom
| | - Wenwu Zhao
- State Key Laboratory of Earth Surface Processes and Resource Ecology, Faculty of Geographical Science, Beijing Normal University, No. 19, XinJieKouWai St., HaiDian District, Beijing, 100875, PR China
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Al Shabasy SA, Abbassi MM, Finch AP, Baines D, Farid SF. The EQ-5D-5L Valuation Study in Egypt. PHARMACOECONOMICS 2021; 39:549-561. [PMID: 33709283 PMCID: PMC7952144 DOI: 10.1007/s40273-021-01002-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION No value sets exist for either the EQ-5D-3L or the EQ-5D-5L in Egypt, despite local pharmacoeconomic guidelines recommending the use of the EQ-5D to derive utility. Most published Egyptian economic evaluation studies have used utility values from other published studies and systematic reviews. OBJECTIVE Our objective was to develop an Egyptian EQ-5D-5L value set using the international EuroQol standardized protocol (EQ-VT-2.1). METHODS Adult Egyptian participants were recruited from public places using multi-stratified quota sampling based on age, sex, and geographical distribution. Two elicitation techniques were applied: the composite time trade-off (cTTO) and discrete-choice experiments (DCEs). Before actual data collection, interviewers' performance was assessed in a pilot phase. Data were modelled using generalized least square, Tobit, heteroskedastic, logit, and hybrid models, and the best fitting model was selected based on the value range between observed and predicted values, logical consistency of the parameters, significance level, and prediction accuracy. RESULTS A total of 1378 interviews were conducted, of which 188 were excluded because they were incomplete or did not comply with protocol, 216 were pilot interviews, and 974 were included in the final analysis. The heteroskedastic model (model 4) based on the cTTO data was selected as the preferred model to generate the value set. Values ranged from - 0.93 for the worst health state (55555) to 1 for full health (11111), with 1136 (36.3%) of all predicted health states being worse than dead. Mobility had the largest impact on health state preference values. CONCLUSION This is the first value set for the EQ-5D-5L based on social preferences obtained from a nationally representative sample in Egypt or any Arabic-speaking country. The value set can be used as a scoring system for economic evaluations and to improve the quality of health technology assessment in the Egyptian healthcare system.
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Affiliation(s)
- Sahar A Al Shabasy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt
| | - Maggie M Abbassi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt
| | | | - Darrin Baines
- Business School, Dorset House Talbot Campus, Bournemouth University, Fern Barrow, Poole, UK
| | - Samar F Farid
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Kasr El-Aini St., Cairo, 11562, Egypt.
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Monaghan R, Cogley C, Burke T, McCormack D, O'Riordan S, Ndukwe I, Hutchinson M, Pender N, O'Keeffe F. Non-motor features of cervical dystonia: Cognition, social cognition, psychological distress and quality of life. Clin Park Relat Disord 2020; 4:100084. [PMID: 34316662 PMCID: PMC8299967 DOI: 10.1016/j.prdoa.2020.100084] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/29/2020] [Accepted: 11/26/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Non-motor features of cervical dystonia (CD) have been identified, including depression, anxiety, and neuropsychological deficits. The aims were: to provide a clinical neuropsychological profile of CD patients with specific focus on social cognition; assess levels of psychological distress; and investigate the relationship between non-motor features of CD, including cognitive functioning, psychological distress, CD severity, pain, and health-related quality of life (HR-QoL). METHODS A multi-domain neuropsychological assessment battery was administered to 46 participants with CD, examining cognitive and social cognitive domains. Clinical data on dystonia severity, pain, psychological distress and HR-QoL were collected. RESULTS The majority of participants with CD performed within the average range across most tests of cognition. Scores were significantly lower than standardized norms in social cognition, processing speed, and aspects of memory. High levels of anxiety (Hospital Anxiety and Depression Scale [HADS-A] ≥ 11, 30%) and depression (HADS-D ≥ 11; 29%) were observed. Psychological distress, CD severity, pain and HR-QoL were not significantly associated with neuropsychological functioning after controlling for multiple comparisons. Low HR-QoL was associated with higher levels of pain and psychological distress, but not severity of motor symptoms. CONCLUSION Results indicate that psychological distress and deficits in cognitive and social cognitive functioning are likely distinct features of CD. While motor symptoms do not appear to impact HR-QoL, pain and psychological distress were associated with low HR-QoL. Findings highlight the importance of addressing non-motor symptoms in the treatment of CD.
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Affiliation(s)
| | - Clodagh Cogley
- St Vincent’s University Hospital, Dublin, Ireland
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Sean O'Riordan
- St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Ihedinachi Ndukwe
- St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Michael Hutchinson
- St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine & Health Science, University College Dublin, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- St Vincent’s University Hospital, Dublin, Ireland
- School of Psychology, University College Dublin, Dublin, Ireland
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Jyani G, Prinja S, Kar SS, Trivedi M, Patro B, Purba F, Pala S, Raman S, Sharma A, Jain S, Kaur M. Valuing health-related quality of life among the Indian population: a protocol for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study. BMJ Open 2020; 10:e039517. [PMID: 33444194 PMCID: PMC7682473 DOI: 10.1136/bmjopen-2020-039517] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Quality-adjusted life year (QALY) has been recommended by the government as preferred outcome measure for Health Technology Assessment (HTA) in India. As country-specific health-related quality of life tariff values are essential for accurate measurement of QALYs, the government of India has commissioned the present study. The aim of this paper is to describe the methods for the Development of an EQ-5D Value set for India using an Extended design (DEVINE) Study. Additionally, this study aspires to establish if the design of 10-time trade-off (TTO) blocks is enough to generate valid value sets. METHODS AND ANALYSIS A cross-sectional survey using the EuroQol Group's Valuation Technology (EQ-VT) will be undertaken in a sample of 2700 respondents selected from six different states of India using a multistage stratified random sampling technique. The participants will be interviewed using computer-assisted personal interviewing technique. The TTO valuation will be done using 10 composite TTO (c-TTO) tasks and 7 discrete choice experiment (DCE) tasks. Hybrid modelling approach using both c-TTO and DCE data to estimate the potential value set will be applied. Values of all 3125 health states will be predicted using both the conventional EQ-VT design of 10 blocks of 10 TTO tasks, and an extended design of 18 blocks of 10 TTO tasks. The potential added value of the eight additional blocks in overall validity will be tested. The study will deliver value set for India and assess the adequacy of existing 10-blocks design to be able to correctly predict the values of all 3125 health states. ETHICS AND DISSEMINATION The ethical approval has been obtained from Institutional Ethics Committee of PGIMER, Chandigarh, India. The anonymised EQ-5D-5L value set will be available for general use and in the HTAs commissioned by India's central HTA Agency.
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Affiliation(s)
- Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - Mayur Trivedi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Binod Patro
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Fredrick Purba
- Department of Developmental Psychology, Universitas Padjadjaran, Jatinangor, West Jawa, Indonesia
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Swati Raman
- Academy of Management Sciences, Lucknow, Uttar Pradesh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalu Jain
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ndukwe I, O'Riordan S, Walsh CB, Hutchinson M. Trust the Patient Not the Doctor: The Determinants of Quality of Life in Cervical Dystonia. Front Neurol 2020; 11:991. [PMID: 33013654 PMCID: PMC7499056 DOI: 10.3389/fneur.2020.00991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Mood disorder is common in cervical dystonia and can impact on quality of life. It often precedes the onset of cervical dystonia and does not improve with botulinum toxin therapy. Objective: To assess health-related quality of life in relation to mood disorder and measures of severity, disability and pain, in cervical dystonia patients receiving botulinum toxin therapy. Methods: In a single-center, University Hospital movement disorders clinic, we conducted a comprehensive, cross-sectional study of disease severity, non-motor symptoms, mood and health-related quality of life in patients with cervical dystonia receiving botulinum toxin therapy using TWSTRS-2 for pain, severity and disability; Beck Anxiety Inventory and Beck Depression Inventory. We assessed all variables in relation to health-related quality of life assessed by Cervical Dystonia Impact Profile-58 and the Euro-QoL Utility Index. Results: In 201 patients (136 women), mean age 61.5 years, significant determinants of impaired health related quality of life were: being a woman, reporting a history of anxiety or depression, prevalent pain, disability, anxiety and/or depression but not physician-assessed disease severity. Conclusion: Patient-reported measures of pain, disability and, most markedly, mood disorder, are significant factors affecting quality of life; these were totally unrelated to the neurologist-rated measure of disease severity. Mood disorders, the predominant predictor of quality of life, were not addressed in the botulinum toxin clinic.
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Affiliation(s)
- Ihedinachi Ndukwe
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Sean O'Riordan
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Cathal B Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Michael Hutchinson
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
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Rencz F, Brodszky V, Gulácsi L, Golicki D, Ruzsa G, Pickard AS, Law EH, Péntek M. Parallel Valuation of the EQ-5D-3L and EQ-5D-5L by Time Trade-Off in Hungary. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1235-1245. [PMID: 32940242 DOI: 10.1016/j.jval.2020.03.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The wording of the Hungarian EQ-5D-3L and EQ-5D-5L descriptive systems differ a great deal. This study aimed to (1) develop EQ-5D-3L and EQ-5D-5L value sets for Hungary from a common sample, and (2) compare how level wording affected valuations. METHODS In 2018 to 2019, 1000 respondents, representative of the Hungarian general population, completed composite time trade-off tasks. Pooled heteroscedastic Tobit models were used to estimate value sets. Value set characteristics, single-level transition utilities from adjacent corner health states, and mean transition utilities for all possible health states were compared between the EQ-5D-3L and EQ-5D-5L. RESULTS Health utilities ranged from -0.865 to 1 for the EQ-5D-3L and -0.848 to 1 for the EQ-5D-5L. The relative importance of the 5 EQ-5D-5L dimensions was as follows: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. A similar preference ranking was observed for the EQ-5D-3L with self-care being more important than pain/discomfort. The EQ-5D-5L demonstrated lower ceiling effects (range of utilities for the mildest states: 0.900-0.958 [3L] vs 0.955-0.965 [5L]) and better consistency of mean transition utilities across the range of scale. Changing "confined to bed" (3L) to "unable to walk" (5L) had a large positive impact on utilities. Smaller changes with more negative wording in the other dimensions (eg, "very much anxious/feeling down a lot" [3L] vs "extremely anxious/depressed" [5L]) had a modest negative impact on utilities. CONCLUSION This study developed value sets of the EQ-5D-3L and EQ-5D-5L for Hungary. Our findings contribute to the understanding of how the wording of descriptive systems affects the estimates of utilities.
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Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary; Hungarian Academy of Sciences, Premium Postdoctoral Research Programme, Budapest, Hungary.
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Gábor Ruzsa
- Institute of Psychology, Doctoral School of Psychology, Eötvös Loránd University of Sciences, Budapest, Hungary; Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Ernest H Law
- Patient & Health Impact, Pfizer Inc, New York, NY, USA
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
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Yusransyah, Halimah E, Suwantika AA. Measurement of the Quality of Life of Prolanis Hypertension Patients in Sixteen Primary Healthcare Centers in Pandeglang District, Banten Province, Indonesia, Using EQ-5D-5L Instrument. Patient Prefer Adherence 2020; 14:1103-1109. [PMID: 32753850 PMCID: PMC7352006 DOI: 10.2147/ppa.s249085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction The prevalence of hypertension in Indonesia is increasing, not least in some peripheral areas, including in Pandeglang District, Banten Province. The government of Indonesia, through the Social Health Insurance Administration Body (BPJS Kesehatan) has launched a chronic disease management program (Prolanis) to achieve more optimal results in treating patients with chronic diseases, including hypertension. Objective This study aimed to measure the quality of life of Prolanis hypertension patients at the primary healthcare centers (PHCs) using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) instrument and taking pharmacists' counseling intervention into account. This study was conducted in 96 Prolanis patients, consisting of 48 patients from 8 PHCs who did not receive pharmacists' counseling intervention (control group) and 48 other patients from 8 different PHCs who received 4 times intervention (intervention group). This study was conducted in a period of 3 months (June–August 2019) in 16 sub-districts of Pandeglang District. Methods An experimental study design was applied by considering a purposive sampling method. Patients' quality of life were measured by using EQ-5D-5L instrument and its Indonesian value set. For data analysis, we applied the Kruskal–Wallis, Mann–Whitney, Wilcoxon, and Binomial tests to investigate the differences of patients' quality of life in both groups of control and intervention. Results and Conclusions The results showed that the average utility value of the intervention group experienced an improvement at each meeting (m1 = 51.25%; m2 = 66.25%; m3 = 84.17%; and m4 = 91.67%), while the control group experienced a lower and more fluctuative improvement than the intervention group (m1 = 65.42%; m2 = 70.42%; m3 = 80.42%; and m4 = 76.67%). The same results also occurred in the average value of visual analogue scale (VAS). There was a better improvement in the intervention group than in the control group. Clinical Trial Registration Number 62/UN6.KEP/EC/2019. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/e0ehLVzB4Ig
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Affiliation(s)
- Yusransyah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia.,STIKes Salsabila Serang, Pharmacy Study Program, Banten, Indonesia
| | - Eli Halimah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Auliya A Suwantika
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
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