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Nielsen US, Rasmussen ER, Rosenørn MR, Schjellerup Jørkov AP, Homøe P. Recurrent Laryngeal Papillomatosis in Denmark from 1994 to 2021: A Nationwide Register Study. Laryngoscope 2024. [PMID: 39157968 DOI: 10.1002/lary.31678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES The aim of this study is to describe the incidence and demographics of laryngeal papillomatosis (LP) in Denmark, including sex and age distribution, recurrence rates, and HPV subtypes, using a new method of register identification. METHODS The data were extracted from the Danish Pathology Data Bank using SNOMED codes instead of the usual method using ICD codes from the Danish National Health Register. The derived pathology records were manually verified by three medical doctors. The study period was 1994-2021. Patients were categorized according to age as either juvenile-onset RRP (JoRRP) if <18 years or adult-onset RRP (AoRRP) if 18 years or older. RESULTS We identified 1819 RRP patients (JoRRP: 56; AoRRP:1763). The overall incidence per 100,000 inhabitants were 0.17 for JoRRP and 1.45 for AoRRP. The vast majority (72%) of the patients were male, but there was no significant difference in age at onset of RRP or recurrence rates between the sexes. Children below 3 years of age had the highest recurrence probability. Extracting data using SNOMED codes resulted in a positive predictive value of 99% regarding total number of biopsies and 98% regarding individuals. The incidence decreased throughout the study period. CONCLUSION Comparable incidence and recurrence rates of RRP were found between Denmark and Norway. In this study, the Danish Pathology Register was found to be a highly valuable method for identifying LP patients. The effect of the nationwide HPV vaccination program can be evaluated using this method as the vaccinated cohort is starting to grow older and reproduce. LEVEL OF EVIDENCE Retrospective registry-based national cohort study, level of evidence 3 Laryngoscope, 2024.
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Affiliation(s)
- Ulrik Steen Nielsen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
| | | | - Marie R Rosenørn
- Department of Pathology, Zealand University Hospital, Koege, Denmark
| | | | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Koege, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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So RJ, McClellan K, Best SR. Recurrent Respiratory Papillomatosis: Quality of Life Data from an International Patient Registry. Laryngoscope 2022. [PMID: 36177852 DOI: 10.1002/lary.30401] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Quality of life studies in recurrent respiratory papillomatosis (RRP) have traditionally relied upon clinician-designed survey instruments. This study's objective is to report quality of life outcomes from a patient-designed questionnaire. METHODS Patients who provided health information and completed a quality of life questionnaire were identified from the RRPF-CoRDS patient registry. Demographic, clinical, and quality of life measures were collected. Means and standard deviations were calculated for continuous data, and frequencies and percentages were calculated for categorical data. Outcomes for patients with juvenile-onset RRP (JORRP) and adult-onset RRP (AORRP) were compared using Student's t-tests for continuous data and χ2 analyses for categorical data. RESULTS Seventy-three patients with RRP were identified (JORRP: 32; AORRP: 41). Common clinical symptoms included raspy voice (78.1%) and dyspnea (61.6%). The majority (97.3%) of patients reported feeling debilitated by their diagnosis, and 94.5% of patients reported avoiding participation in career and/or social activities due to their voice quality. Due to their RRP, 65.7% reported missing at least five work days each month. Social anxiety was reported in 79.5% of patients, though only 28.8% of the cohort reported utilizing mental health services. The median (range) lifetime number of surgeries received was 20 (1 - 3). Most patients (57.5%) reported paying at least 5% of their annual income towards RRP-related medical care. CONCLUSION RRP presents high mental and fiscal burden. Our results highlight data from a quality of life questionnaire designed by RRP patients, and may help to elucidate potential disconnects between what clinicians and RRP patients consider most impactful. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kim McClellan
- Recurrent Respiratory Papillomatosis Foundation, Lawrenceville, New Jersey, USA
| | - Simon R Best
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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A Novel In Vivo Model of Laryngeal Papillomavirus-Associated Disease Using Mus musculus Papillomavirus. Viruses 2022; 14:v14051000. [PMID: 35632742 PMCID: PMC9147793 DOI: 10.3390/v14051000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
Recurrent respiratory papillomatosis (RRP), caused by laryngeal infection with low-risk human papillomaviruses, has devastating effects on vocal communication and quality of life. Factors in RRP onset, other than viral presence in the airway, are poorly understood. RRP research has been stalled by limited preclinical models. The only known papillomavirus able to infect laboratory mice, Mus musculus papillomavirus (MmuPV1), induces disease in a variety of tissues. We hypothesized that MmuPV1 could infect the larynx as a foundation for a preclinical model of RRP. We further hypothesized that epithelial injury would enhance the ability of MmuPV1 to cause laryngeal disease, because injury is a potential factor in RRP and promotes MmuPV1 infection in other tissues. In this report, we infected larynges of NOD scid gamma mice with MmuPV1 with and without vocal fold abrasion and measured infection and disease pathogenesis over 12 weeks. Laryngeal disease incidence and severity increased earlier in mice that underwent injury in addition to infection. However, laryngeal disease emerged in all infected mice by week 12, with or without injury. Secondary laryngeal infections and disease arose in nude mice after MmuPV1 skin infections, confirming that experimentally induced injury is dispensable for laryngeal MmuPV1 infection and disease in immunocompromised mice. Unlike RRP, lesions were relatively flat dysplasias and they could progress to cancer. Similar to RRP, MmuPV1 transcript was detected in all laryngeal disease and in clinically normal larynges. MmuPV1 capsid protein was largely absent from the larynx, but productive infection arose in a case of squamous metaplasia at the level of the cricoid cartilage. Similar to RRP, disease spread beyond the larynx to the trachea and bronchi. This first report of laryngeal MmuPV1 infection provides a foundation for a preclinical model of RRP.
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High recurrence rate in patients with juvenile-onset respiratory papillomatosis and its risk factors. Eur Arch Otorhinolaryngol 2022; 279:4061-4068. [PMID: 35441895 DOI: 10.1007/s00405-022-07390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify the recurrence rate and risk factors for recurrence in patients with juvenile-onset recurrent respiratory papillomatosis (JORRP). METHODS A retrospective review was performed for all JORRP patients who underwent surgery between 2002 and 2019 at our institution. The demographic characteristics and clinical parameters were recorded. Kaplan-Meier estimates and Cox proportional hazards models were used to analyze the rate of recurrence and its risk factors. RESULTS Our study included 721 patients. The cumulative recurrence rates at 1, 5, and 10 postoperative years following initial surgery were 74.2%, 90.0%, and 94.3%, respectively. Age at diagnosis younger than 4.5 years (HR = 2.380, 95% CI [1.169-4.846], P = 0.017), high Derkay anatomical score (HR = 1.136, 95% CI [1.043-1.236], P = 0.003) and HPV type 11 infection (HR = 2.947, 95% CI [1.326-6.551], P = 0.008) were independent risk factors for recurrence. Adjuvant therapy with interferon was less likely to recur (HR = 0.237, 95% CI [0.091-0.616], P = 0.003). Additionally, gender, tracheotomy, mode of delivery, parity, expression of Ki-67, HPV vaccination, and surgical treatment method were not independently associated with recurrence (P > 0.05). CONCLUSION Age at diagnosis younger than 4.5 years, high Derkay anatomical score and HPV type 11 infection were associated with an increased risk for recurrence in patients with JORRP. Adjuvant therapy with interferon may reduce the risk of recurrence.
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Simoens S, Bento-Abreu A, Merckx B, Joubert S, Vermeersch S, Pavelyev A, Varga S, Morais E. Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium. Front Pharmacol 2021; 12:628434. [PMID: 33912045 PMCID: PMC8072375 DOI: 10.3389/fphar.2021.628434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11-12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12-13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12-18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | | | | | | | - Andrew Pavelyev
- Merck & Co., Inc., Kenilworth, NJ, United States
- HCL America, Inc., Sunnyvale, CA, United States
| | - Stefan Varga
- Merck & Co., Inc., Kenilworth, NJ, United States
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Naunheim MR, Goldberg L, Dai JB, Rubinstein BJ, Courey MS. Measuring the impact of dysphonia on quality of life using health state preferences. Laryngoscope 2020; 130:E177-E182. [DOI: 10.1002/lary.28148] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Harvard Medical School Boston Massachusetts U.S.A
| | - Leanne Goldberg
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | - Jennifer B. Dai
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | | | - Mark S. Courey
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
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Seedat RY. Juvenile-Onset Recurrent Respiratory Papillomatosis Diagnosis and Management - A Developing Country Review. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:39-46. [PMID: 32099513 PMCID: PMC7007786 DOI: 10.2147/phmt.s200186] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/14/2020] [Indexed: 01/04/2023]
Abstract
Recurrent respiratory papillomatosis (RRP) is a condition caused by human papillomavirus (HPV), usually HPV types 6 and 11, which is characterized by recurrent papillomas of the respiratory tract, mainly the larynx. Patients usually present between the ages of 2 and 6 years. The initial presenting symptom is progressive dysphonia, followed by stridor and respiratory distress. Treatment consists of repeated microlaryngoscopic procedures to remove the papillomas as there is no cure. The poor availability and accessibility of appropriate healthcare services in developing countries are barriers to the early diagnosis and appropriate management of patients with juvenile-onset recurrent respiratory papillomatosis (JoRRP), requiring many patients to have a tracheostomy. The introduction of prophylactic vaccines that include HPV6 and HPV11 is necessary in order to reduce the incidence of JoRRP.
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Affiliation(s)
- R Y Seedat
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Khadka J, Kwon J, Petrou S, Lancsar E, Ratcliffe J. Mind the (inter-rater) gap. An investigation of self-reported versus proxy-reported assessments in the derivation of childhood utility values for economic evaluation: A systematic review. Soc Sci Med 2019; 240:112543. [PMID: 31586777 DOI: 10.1016/j.socscimed.2019.112543] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/24/2019] [Accepted: 09/07/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Evidence surrounding utilities for health states, derived either directly from the application of preference-based valuation methods or indirectly from the application of preference-based quality of life instruments, is increasingly being utilised to inform the cost-effectiveness of child health interventions. Proxy (parent or health professional) assessments are common in this area. This study sought to investigate the degree of convergence in childhood utilities generated directly or indirectly within dyad child and proxy assessments. METHODS A systematic literature review was conducted following PRISMA guidelines. A comprehensive literature search strategy conducted across six search engines (PubMed, Embase, Web of Science, PsychoINFO, EconLit, CINAHL and Cochrane Library). Original peer-reviewed articles that reported utilities derived directly or indirectly using simultaneous dyad child and proxy assessments were extracted. Mean and median utilities, correlation coefficients and levels of agreement were extracted, catalogued and assessed. RESULTS A total of 35 studies that reported utilities for two or more respondent types were identified. Of these, 29 studies reported dyad childhood self-report and proxy utilities whilst six studies reported levels of agreement and/or correlations only without documenting overall utilities. Proxy assessment was most often conducted by parents with the HUI3 representing the most commonly applied instrument across a range of health conditions. The utilities derived from child and parent proxy assessment were bidirectional with parental proxies tending to underestimate and health professional proxies tending to overestimate relative to child self-reports. Inter-rater agreement between child self-reports and parent-proxy reports were poorer for more subjective attributes (cognition, emotion and pain), relative to physical attributes (mobility, self-care, speech, vision) of health-related quality of life. CONCLUSIONS Childhood utilities derived from children or proxies are not interchangeable. The choice of self or proxy assessor may have potentially significant implications for economic evaluations of child health interventions.
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Affiliation(s)
- Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Science, Flinders University, Bedford Park, South Australia, Australia; Institute for Choice, Business School, University of South Australia, South Australia, Australia; Registry of Senior Australians, Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Joseph Kwon
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Emily Lancsar
- Department of Health Services Research and Policy, School of Population Health, The Australian National University, Canberra, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Science, Flinders University, Bedford Park, South Australia, Australia
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9
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Mpundu-Kaambwa C, Chen G, Huynh E, Russo R, Ratcliffe J. Mapping the PedsQL™ onto the CHU9D: An Assessment of External Validity in a Large Community-Based Sample. PHARMACOECONOMICS 2019; 37:1139-1153. [PMID: 31161585 DOI: 10.1007/s40273-019-00808-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Mapping algorithms have been indicated as a second-best solution for estimating health state utilities for the calculation of quality-adjusted life-years within cost-utility analysis when no generic preference-based measure is incorporated into the study. However, the predictive performance of these algorithms may be variable and hence it is important to assess their external validity before application in different settings. OBJECTIVE The aim of this study was to assess the external validity and generalisability of existing mapping algorithms for predicting preference-based Child Health Utility 9D (CHU9D) utilities from non-preference-based Pediatric Quality of Life Inventory (PedsQL) scores among children and adolescents living with or without disabilities or health conditions. METHODS Five existing mapping algorithms, three developed using data from an Australian community population and two using data from a UK population with one or more self-reported health conditions, were externally validated on data from the Longitudinal Study of Australian Children (n = 6623). The predictive accuracy of each mapping algorithm was assessed using the mean absolute error (MAE) and the mean squared error (MSE). RESULTS Values for the MAE (0.0741-0.2302) for all validations were within the range of published estimates. In general, across all ages, the algorithms amongst children and adolescents with disabilities/health conditions (Australia MAE: 0.2085-0.2302; UK MAE: 0.0854-0.1162) performed worse relative to those amongst children and adolescents without disabilities/health conditions (Australia MAE: 0.1424-0.1645; UK MAE: 0.0741-0.0931). CONCLUSIONS The published mapping algorithms have acceptable predictive accuracy as measured by MAE and MSE. The findings of this study indicate that the choice of the most appropriate mapping algorithm to apply may vary according to the population under consideration.
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Affiliation(s)
- Christine Mpundu-Kaambwa
- Institute for Choice, University of South Australia Business School, Level 3 Way Lee Building, North Terrace, Adelaide, SA, 5001, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Elisabeth Huynh
- Department of Health Services Research and Policy, The Australian National University, Canberra, Australia
| | - Remo Russo
- Faculty of Health Sciences, School of Medicine, Flinders University, Adelaide, Australia
- Department of Paediatric Rehabilitation, Women's and Children's Hospital, Adelaide, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia Business School, Level 3 Way Lee Building, North Terrace, Adelaide, SA, 5001, Australia
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Tam S, Wu CF, Peng HL, Dahlstrom KR, Sturgis EM, Lairson DR. Cost of treating recurrent respiratory papillomavirus in commercially insured and medicaid patients. Laryngoscope 2019; 130:1186-1194. [PMID: 31194270 DOI: 10.1002/lary.28139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/09/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The study objective was to estimate the first 2 years' direct costs of treating new cases of juvenile-onset and adult-onset recurrent respiratory papillomatosis (RRP) and determine the predictors of treatment costs. METHODS Cases were patients diagnosed with RRP in commercial insurance claims in 2011-2014 and Texas Medicaid in 2008-2012 for treatment of RRP. Controls were patients without a diagnosis of HPV-related cancer or RRP, matched with cases by age, sex, geographic area, date of diagnosis of RRP, and propensity score. Total health care costs in the first 2 years after diagnosis were obtained from cases and matched controls. A generalized linear model was created to identify predictors of monthly costs. RESULTS In commercially insured patients, a total of 122 cases of juvenile-onset (<18 years old) and 1824 cases of adult-onset (≥18 years old) RRP were identified. The mean first 2 years' cost difference between cases and controls was $58,733 for juvenile-onset disease and $11,185 for adult-onset disease after model adjustments. In the Texas Medicaid population, 73 cases of juvenile-onset and 96 cases of adult-onset RRP were identified. The mean first 2 years' cost difference between cases and controls was $76,115 for juvenile-onset disease and $4,633 for adult-onset disease after model adjustments. CONCLUSION The first 2 years' medical costs difference of juvenile-onset and adult-onset RRP among commercially insured and Medicaid population were approximately $60,000 to $70,000 and $5,000 to $11,000, respectively, and should be considered in HPV vaccination promotion investment decisions. LEVEL OF EVIDENCE N/A Laryngoscope, 130:1186-1194, 2020.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chi-Fang Wu
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Ho-Lan Peng
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erich M Sturgis
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - David R Lairson
- Department of Management, Policy, and Community Health the University of Texas Health Science Center, Houston, TX
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Reyes LM, Aguilar JL, Villamor P, De La Torre C, Álvarez A, Mantilla E, Álvarez-Neri H. Clinical and sociodemographic characteristics associated with disease severity in juvenile recurrent respiratory papillomatosis: A study of 104 patients in a tertiary care pediatric hospital. Int J Pediatr Otorhinolaryngol 2018; 108:63-66. [PMID: 29605367 DOI: 10.1016/j.ijporl.2018.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Juvenile recurrent respiratory papillomatosis (JRRP) is generally aggressive and with a high recurrence rate. Currently, there is no definite curative treatment for JRRP. Therefore, a greater understanding of the aspects that influence the severity and prognosis of the disease is required. OBJECTIVE The aim of this study was to establish the clinical and socioeconomic characteristics of pediatric patients with JRRP and its relationship with the severity of the disease in a tertiary care pediatric hospital. RESULTS A strong relationship was observed between the severity of the disease and the age at the time of diagnosis, and having a tracheostomy. A moderate association was found between the severity of the disease and the age at the time of the study, the area of origin and the recurrence rate. None of the socioeconomic statuses had a correlation with the severity of the JRRP. CONCLUSIONS JRRP is associated with multiple surgeries due to the recurrence and aggressiveness of the disease. The socioeconomic status does not seem to influence the severity of the disease, whereas younger patients and users of tracheostomy should receive a more strict follow-up given the increased risk of severe disease.
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Affiliation(s)
- Lee Marvin Reyes
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Juan León Aguilar
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Perla Villamor
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico.
| | - Carlos De La Torre
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Alicia Álvarez
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Edgar Mantilla
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
| | - Hiram Álvarez-Neri
- Department of Pediatric Otolaryngology, Hospital Infantil de México, Federico Gómez, Mexico
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12
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Quality of life of young patients with recurrent respiratory papillomatosis. The Journal of Laryngology & Otology 2017; 131:425-428. [PMID: 28193306 DOI: 10.1017/s0022215117000354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess quality of life of children and teenagers with recurrent respiratory papillomatosis, according to the evidence of infection by human papillomavirus types 6 and 11, compared with healthy volunteers and patients with chronic otitis media. METHOD Participants and their parents completed the Pediatric Quality of Life Inventory 4.0. RESULTS Patients with recurrent respiratory papillomatosis and their parents reported lower quality of life than healthy subjects (p < 0.01), but similar quality of life to patients with chronic otitis media. Those with human papillomavirus type 11 showed the lowest scores among all participants (p < 0.05). CONCLUSION Young Mexican patients with recurrent respiratory papillomatosis and their parents perceive a poor quality of life, and they may experience limitations in interactions with their peers. Infection by human papillomavirus type 11 may increase the impact of the disease on quality of life.
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13
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San Giorgi MRM, Aaltonen LM, Rihkanen H, Tjon Pian Gi REA, van der Laan BFAM, Hoekstra-Weebers JEHM, Dikkers FG. Validation of the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis. Otolaryngol Head Neck Surg 2016; 156:180-188. [DOI: 10.1177/0194599816668307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective There is no specific clinical tool for physicians to detect psychosocial and physical distress or health care need in patients with recurrent respiratory papillomatosis (RRP). The main aim of this study is to validate the RRP-adapted Distress Thermometer and Problem List (DT&PL). Study Design Prospective cross-sectional questionnaire research. Setting Academic tertiary care medical centers in Groningen, Netherlands, and Helsinki, Finland. Subjects and Methods Ninety-one juvenile- and adult-onset RRP patients participated from the departments of otorhinolaryngology–head and neck surgery of the University Medical Center Groningen, Netherlands, and Helsinki University Hospital, Finland. The Hospital Anxiety and Depression Scale was used as the gold standard. Results A DT cutoff score ≥4 gave the best sensitivity and specificity. Thirty-one percent of patients had significant distress according to the DT cutoff. Significantly more patients with a score above than under the cutoff had a referral wish. The PL appeared to be reliable. Patients’ opinions on the DT&PL were largely favorable. Conclusion The Dutch and Finnish versions of the DT&PL are valid, reliable screening tools for distress in RRP patients.
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Affiliation(s)
- Michel R. M. San Giorgi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Cancer Research Center Groningen, University of Groningen, Groningen, Netherlands
- Groningen Papilloma Studies, University Medical Center Groningen, Groningen, Netherlands
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Rihkanen
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Robin E. A. Tjon Pian Gi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Cancer Research Center Groningen, University of Groningen, Groningen, Netherlands
- Groningen Papilloma Studies, University Medical Center Groningen, Groningen, Netherlands
| | - Bernard F. A. M. van der Laan
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Cancer Research Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Frederik G. Dikkers
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Cancer Research Center Groningen, University of Groningen, Groningen, Netherlands
- Groningen Papilloma Studies, University Medical Center Groningen, Groningen, Netherlands
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14
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Novakovic D, Cheng ATL, Baguley K, Walker P, Harrison H, Soma M, Malloy M, Brotherton JML. Juvenile recurrent respiratory papillomatosis: 10-year audit and Australian prevalence estimates. Laryngoscope 2016; 126:2827-2832. [PMID: 27074766 DOI: 10.1002/lary.26005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/25/2016] [Accepted: 03/07/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To estimate the prevalence of juvenile onset recurrent respiratory papillomatosis (RRP) in Australia, describe its epidemiological profile, and assess the positive predictive value of International Classification of Disease, 10th revision (ICD-10) code D14.1 (benign neoplasm of larynx) in children for hospitalization due to RRP. STUDY DESIGN Retrospective case series. METHODS Retrospective case review undertaken at the three tertiary pediatric hospitals in New South Wales (Australia's largest state), by reviewing medical records of patients aged 0 to 16 years admitted during 2000-2009 containing the ICD-10 Australian modification code D14.1 or other possible disease (D14.2-4, D14.3, D14.4) and RRP-related procedure codes. For RRP diagnoses, we recorded treatment dates, length of stay, extent of disease, and surgical and adjuvant treatments. The positive predictive value (PPV) of code D14.1 and median number of hospitalizations per year were applied to national hospital separations data from 2000/2001 to 2012/2013 to estimate disease prevalence. RESULTS We identified 30 cases of RRP using code D14.1, which had a PPV of 98.1%, with no further cases identified using other codes. Fifty-seven percent of cases were female, median age of onset was 36 months, and median treatment duration was 36 months (mean = 40 months, range = 1-118). There was one patient death. Between 2000 and 2013, the estimated national prevalence rate was 0.81 per 100,000 aged < 15 years, peaking at age 5 to 9 years (1.1 per 100,000). CONCLUSIONS RRP prevalence can be monitored after human papillomavirus vaccination programs using routine hospital data. LEVEL OF EVIDENCE 4 Laryngoscope, 126:2827-2832, 2016.
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Affiliation(s)
- Daniel Novakovic
- University of Sydney Medical School, Canterbury Hospital, St. Leonards, New South Wales, Australia
| | - Alan T L Cheng
- Department of Paediatric Otolaryngology, Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia
| | | | - Paul Walker
- Departments of Surgery and Paediatrics, University of Newcastle, New Lambton, New South Wales, Australia
| | - Henley Harrison
- Head, Ear, Nose, and Throat Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Marlene Soma
- Head, Ear, Nose, and Throat Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Michael Malloy
- National HPV Vaccination Program Register, East Melbourne, Victoria, Australia
| | - Julia M L Brotherton
- National HPV Vaccination Program Register, East Melbourne, Victoria, Australia.,School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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15
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Motz KM, Hillel AT. Office-based Management of Recurrent Respiratory Papilloma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016; 4:90-98. [PMID: 27242951 DOI: 10.1007/s40136-016-0118-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review will highlight the indications and benefits of office-based therapy for recurrent respiratory papillomatosis (RRP) and discuss the utilization of photo-dynamic lasers and adjuvant medical therapy in office-based settings. Office-based management of RRP allows for more timely interventions, is preferred by the majority of patients, and negates the risk of general anesthesia. Current literature argues for the utilization of KTP laser over CO2 laser for office-based treatment of RRP. Medical therapies for RRP are limited, but agents such as bevacizumab are promising and have been shown to reduce disease burden. Medical therapies that can induce disease remission are still needed. Office-based procedures save time and healthcare expenses compared to like procedures in the operating room. However, the increased frequency for office-based procedures predicts similar overall healthcare costs for office-based and OR laser excision of RRP. Office-based management of RRP is a feasible and well-tolerated strategy in appropriately selected patients with adequate local anesthesia.
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Affiliation(s)
- Kevin M Motz
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N. Caroline Street, JHOC 6th Floor, Baltimore, MD 21287, USA
| | - Alexander T Hillel
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N. Caroline Street, JHOC 6th Floor, Baltimore, MD 21287, USA
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16
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Gruber M, Mills N, Blair D, Van Der Meer G, Mahadevan M. Safety of paediatric day-stay laryngeal surgery for recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2016; 82:116-9. [PMID: 26857327 DOI: 10.1016/j.ijporl.2016.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Safety assessment of day-stay laryngeal surgery in a cohort of children with recurrent respiratory papillomatosis (RRP). Recurrent respiratory papillomatosis is a chronic debilitating disease which usually requires multiple recurrent interventions under general anaesthesia. Day-stay surgery is an attractive option as it allows avoiding the inconvenience and costs of routine overnight admissions while recovering in the safe environment of the family home. This is the first study to assess the safety of day-stay laryngeal surgery in this cohort of patients. METHODS Retrospective cohort study of all consecutive RRP procedures performed between December 1998 and May 2015 in a single paediatric tertiary-level hospital. RESULTS A total of 465 surgical procedures were performed in 20 patients. Average age on diagnosis was 4.5 years. 415 (89.25%) of the procedures were done as day cases without overnight admission. Average number of procedures per patient was 20 and 25 for Children positive to HPV6 and HPV11, respectively. Only one patient after one single procedure (presenting 0.21% of total procedures, 0.24% of day-stay procedures) represented after discharge. CONCLUSIONS Day-stay surgery for children with RRP has a favourable safety profile in selected cases.
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Affiliation(s)
- Maayan Gruber
- Starship Children's Hospital, Auckland, New Zealand.
| | - Nicola Mills
- Starship Children's Hospital, Auckland, New Zealand
| | - Dora Blair
- Starship Children's Hospital, Auckland, New Zealand
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17
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Thorrington D, Eames K. Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature. PLoS One 2015; 10:e0135672. [PMID: 26275302 PMCID: PMC4537138 DOI: 10.1371/journal.pone.0135672] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/24/2015] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities. Objective We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults. Methods and Findings We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities. Conclusions Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with respect to the patients’ ages.
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Affiliation(s)
- Dominic Thorrington
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Ken Eames
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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18
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Estimating the incidence and prevalence of juvenile-onset recurrent respiratory papillomatosis in publicly and privately insured claims databases in the United States. Sex Transm Dis 2014; 41:300-5. [PMID: 24722383 DOI: 10.1097/olq.0000000000000115] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a chronic disease caused by human papillomavirus types 6 and 11. It is associated with significant morbidity that places intense physical, psychological, and financial strain on patients and their families. Few studies have assessed the incidence and prevalence of JORRP in the United States. METHODS This retrospective, longitudinal cohort study was performed using data from a pair of large insurance claims databases in the United States. The Optum Clinformatics and Truven MarketScan Medicaid databases represent a sample of privately and publicly insured children, respectively. Cohorts of children aged 0 to 17 years were created within each database to estimate the incidence and prevalence of JORRP in 2006. Claims-based algorithms were designed to capture as many potential cases as possible. To improve the accuracy of the incidence and prevalence estimates, chart validation was performed to estimate the positive predictive value (PPV) of the claims-based algorithms. RESULTS The overall PPV-adjusted incidence of JORRP in 2006 was 0.51 per 100,000 in Optum and 1.03 per 100,000 in the MarketScan Medicaid population. Peak incidence was observed among 0- to 4-year-olds in both databases. The PPV-adjusted prevalence of JORRP in 2006 was 1.45 and 2.93 per 100,000 in the Optum and MarketScan Medicaid cohorts, respectively. CONCLUSIONS Although relatively uncommon, JORRP represents a disease with significant morbidity. The incidence and prevalence of JORRP in publicly insured children were consistently higher than those covered by private insurance plans, suggesting an increased burden of illness among those with lower socioeconomic status.
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19
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Seedat RY, Combrinck CE, Burt FJ. HPV associated with recurrent respiratory papillomatosis. Future Virol 2013. [DOI: 10.2217/fvl.13.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Papillomaviruses are members of the Papillomaviridae family. Over 150 HPV types have been identified. Recurrent respiratory papillomatosis (RRP) is a chronic condition caused by HPV characterized by recurrent papillomas of the respiratory tract, mainly the larynx. During the early stages, the condition presents with hoarseness, while more advanced disease presents with stridor and respiratory distress. There is no specific cure and treatment consists of repeated surgical procedures to remove the papillomas. Most patients eventually go into remission, but some suffer for many years with this condition, which may be fatal. HPV-6 and HPV-11 are the HPV types most commonly associated with RRP. Although most studies have found RRP due to HPV-11 to be more aggressive than disease due to HPV-6, the variability in disease aggressiveness is probably multifactorial. Information regarding the current epidemiology, molecular diversity and host immune responses is important for strategizing ways to reduce disease. Data on HPV genotypes associated with RRP would provide valuable information for vaccination programs to reduce the incidence of these genotypes in mothers and, in the long term, reduce the incidence of RRP in children. This review focuses on HPV-6 and HPV-11 as the HPV types that cause RRP, and discusses the viral genome and replication, clinical presentation of RRP, current techniques of diagnosis and genotyping, and the molecular diversity of HPV-6 and HPV-11.
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Affiliation(s)
- Riaz Y Seedat
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Catharina E Combrinck
- Department of Medical Microbiology & Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Felicity J Burt
- Department of Medical Microbiology & Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Medical Microbiology & Virology, National Health Laboratory Service Universitas, Bloemfontein, South Africa
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20
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Dennett KV, Tracy S, Zurakowski D, Calvert CE, Chen C. Impact on family of management strategies for perforated appendicitis in children. J Pediatr Surg 2012; 47:1900-6. [PMID: 23084204 DOI: 10.1016/j.jpedsurg.2012.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/04/2012] [Accepted: 06/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to examine the impact on the family of immediate appendectomy compared with initial nonoperative management for perforated appendicitis in children. METHODS Sixty-six prospectively identified families of children with perforated appendicitis completed a daily activity journal and the Impact on Family Scale at presentation and at completion of therapy. RESULTS There were no significant differences in postoperative surgical site infections or number of missed school or employment days between the immediate appendectomy group (n = 40) and the initial nonoperative management group (n = 26). Impact on Family Scale total scores decreased over time for both groups, but this improvement over time was significant only in the initial nonoperative management group (P < .01). CONCLUSIONS Immediate appendectomy or initial nonoperative management can effectively manage perforated appendicitis in children with no statistically significant differences in the number of missed school or employment days. Greater improvements in family impact are associated with initial nonoperative management as measured by the Impact on Family Scale at completion of therapy.
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Affiliation(s)
- Kate V Dennett
- Department of Surgery, Children's Hospital Boston, Boston, MA 02115, USA
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21
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Jit M, Chapman R, Hughes O, Choi YH. Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model. BMJ 2011; 343:d5775. [PMID: 21951758 PMCID: PMC3181234 DOI: 10.1136/bmj.d5775] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To compare the effect and cost effectiveness of bivalent and quadrivalent human papillomavirus (HPV) vaccination, taking into account differences in licensure indications, protection against non-vaccine type disease, protection against disease related to HPV types 6 and 11, and reported long term immunogenicity. DESIGN A model of HPV transmission and disease previously used to inform UK vaccination policy, updated with recent evidence and expanded to include scenarios where the two vaccines differ in duration of protection, cross protection, and end points prevented. SETTING United Kingdom. Population Males and females aged 12-75 years. MAIN OUTCOME MEASURE Incremental cost effectiveness ratios for both vaccines and additional cost per dose for the quadrivalent vaccine to be equally cost effective as the bivalent vaccine. RESULTS The bivalent vaccine needs to be cheaper than the quadrivalent vaccine to be equally cost effective, mainly because of its lack of protection against anogenital warts. The price difference per dose ranges from a median of £19 (interquartile range £12-£27) to £35 (£27-£44) across scenarios about vaccine duration, cross protection, and end points prevented (assuming one quality adjusted life year (QALY) is valued at £30,000 and both vaccines can prevent all types of HPV related cancers). CONCLUSIONS The quadrivalent vaccine may have an advantage over the bivalent vaccine in reducing healthcare costs and QALYs lost. The bivalent vaccine may have an advantage in preventing death due to cancer. However, considerable uncertainty remains about the differential benefit of the two vaccines.
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Affiliation(s)
- Mark Jit
- Health Protection Agency, London NW9 6BT, UK.
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22
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Tirado Y, Chadha NK, Allegro J, Forte V, Campisi P. Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children. Otolaryngol Head Neck Surg 2011; 144:770-7. [DOI: 10.1177/0194599810391198] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. (1) To assess the long-term impact of thyroid ala cartilage laryngotracheal reconstruction (TAC-LTR) on health-related quality of life (QOL) in infants using 4 validated instruments: Health Utility Index version 3 (HUI3), Pediatric Voice-Related QOL (PVRQOL), Impact on Family Questionnaire, and a visual analog scale and (2) to perform acoustic and perceptual voice assessments to evaluate long-term voice quality outcomes. Study Design. Prospective study. Setting. Tertiary academic pediatric hospital. Subjects. Eligible children who received TAC-LTR before the age of 24 months between 1995 and 2007. Methods. Interviews with parents and children using 4 validated instruments, voice analyses, and endoscopic evaluation were performed. Results. Twelve patients (7 male, 5 female, median age 10 years) were enrolled over a 6-month period. The mean age at LTR was 5 months (range, 1-20 months), and the mean study follow-up period was 9 years (range, 2-14 years). The average speech HUI3, PVRQOL, and Impact on Family scores were 0.83 (95% confidence interval = 0.74, 0.92), 0.93 (interquartile range [IQR] = 0.81, 1.00), and 0.65 (IQR = 0.54, 0.92), respectively. All acoustic scores were either normal or mildly abnormal for the variables jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation, and fundamental frequency. The Consensus Auditory-Perceptual Evaluation of Voice overall severity score was in the normal to mildly abnormal range for 8 of 9 patients. Conclusion. This is the first study to explore and quantify long-term QOL and voice quality in children following LTR with thyroid ala graft at a very young age. Most patients had very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.
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Affiliation(s)
- Yamilet Tirado
- Department of Otolaryngology–Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Neil K. Chadha
- Department of Otolaryngology–Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Jennifer Allegro
- Division of Speech and Language Pathology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Vito Forte
- Department of Otolaryngology–Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Paolo Campisi
- Department of Otolaryngology–Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
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