Investigation of Evidence Sources for Health-Related Quality of Life in Cost-Utility Analysis of Pharmaceuticals in Japan

Burden of typical diseases attributed to the sources of PM2.5-bound toxic metals in Beijing: An integrated approach to source apportionment and QALYs

PM_2.5-bound toxic metals (TMs) are derived from various sources, and they can cause many adverse health effects on the human body. To effectively reduce the disease burden of TMs by controlling the relative sources, an integrated approach of quality-adjusted life years (QALYs) and source-apportionment (positive matrix factorization, PMF) was proposed and applied to some typical diseases induced by TMs in 2017 in Beijing. The estimation included two parts; first, the number of potentially affected people was calculated based on the source mass contribution from PMF and the inhalation unit risk of TMs; second, the QALYs lost per affected person was calculated based on the disease duration, expected years of life lost (EYLL) and quality of life (QoL) for both affected people and the general population. The results showed that QALYs lost per person for renal cancer (17.3 QALYs), pneumonia (14.4 QALYs), lung cancer (14.2 QALYs), skin cancer (12.7 QALYs) and diabetes mellitus (12.6 QALYs) were higher than those for other diseases. Combined with PMF, the source contributions to the overall burden of typical diseases from the TMs followed the order of coal combustion (50.2%) > vehicle emissions (24.4%) > fuel oil combustion (11.4%) > Cr-related industry (10.9%) > resuspended dust (3.0%). The rank was further compared with that assessed for noncancer and cancer risks, and we verified the reasonability of the QALYs method. For seasonal contributions to coal combustion, winter and spring had the highest contributions, which coincided with the fact that coal was the main fuel for heating in Beijing. The QALYs lost attributed to TMs for coal combustion decreased by 49.1% from 2016 to 2017, which may indicate an effective policy associated with coal control. Overall, the integrated approach was successfully employed for estimating the disease burden induced by TMs from each source and was an effective solution to identify the control rank of sources for TM reduction.

The EQ-5D-5L in patients admitted to a hospital in Japan with recent spinal cord injury: a descriptive study

STUDY DESIGN

Descriptive study.

OBJECTIVE

To demonstrate Euro Quality of Life 5-dimensional 5-level (EQ-5D-5L) by severity level at the acute stage and discharge in patients with traumatic spinal cord injury (SCI).

SETTING

Spinal Injuries Center, Fukuoka, Japan.

METHODS

Patients with traumatic SCI who completed the EQ-5D-5L instrument at the acute stage and discharge were divided into four groups according to severity (severity group G1; C1-C4 ASIA Impairment Scale (AIS) A, B, and C, G2; C5-C8 AIS A, B, and C, G3; T1-S5 AIS A, B, and C, G4; all AIS D). All data were extracted from the Japan single-center study for spinal cord injury database (JSSCI-DB).

RESULTS

Data were collected from 139 individuals at the acute stage and 164 individuals at discharge. In the comparison of utility score by severity in acute stage and discharge, G3 was significantly higher in discharge (0.325 versus 0.580). Utility scores by degree of severity were significantly higher in group G4 than those of G1, G2, and G3 at the acute stage. Utility scores at discharge were significantly higher in groups G3 and G4 than in G1, and there was a significant difference between groups G4 and G2.

CONCLUSIONS

At each stage, the utility scores of group G4 were significantly higher than those of groups G1 and G2. Altogether, the utility scores for hospitalized patients with traumatic SCI that were indicated in this study will serve as basic data that can be used while performing spinal regeneration medical procedures in the future.

Cost-effectiveness analyses of anti-hepatitis C virus treatments using quality of life scoring among patients with chronic liver disease in Hiroshima prefecture, Japan

AIM

We estimated the cost-effectiveness of direct-acting antiviral treatment (DAA) compared to triple therapy (simeprevir, pegylated interferon-α [Peg-IFN], and ribavirin [RBV]) (scenario 1), Peg-IFN + RBV (scenario 2), and non-antiviral therapy (scenario 3).

METHODS

Cost-effectiveness was evaluated as incremental cost-effectiveness ratios (ICERs) using direct costs and indirect costs, which included loss of wages during the patient's lifetime due to early death caused by viral hepatitis infection. Quality of life (QOL) scores were determined by EQ-5D-3L questionnaire survey on 200 HCV patients in Hiroshima.

RESULTS

The QOL scores for chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma were estimated as 0.871, 0.774, and 0.780, respectively. The follow-up period that the ICER of scenario 1 becomes shortest (cost <¥6 million) was 25 years after treatment in men and women who started treatment at the age of 20-60. In contrast, those of scenarios 2 and 3 was 10 years after treatment in patients who started treatment at age <80 years. Based on the sensitivity analysis in scenario 1, the most significant factor affecting the value of ICER is the QOL score after sustained virologic response (SVR), followed by the SVR rate of DAA or follow-up period.

CONCLUSIONS

Direct-acting antiviral treatment was estimated to be cost-effective from 10 to 25 years after treatment, depending on the SVR rate of the drugs and the age of onset of treatment. In order to increase the cost-effectiveness of DAA treatment, measures or effort to improve the QOL score of patients after SVR are necessary.