Implications of True and Perceived Treatment Burden on Cardiovascular Medication Use

Quantifying the impact of taking medicines for primary prevention: a time-trade off study to elicit direct treatment disutility in the UK

BACKGROUND

Direct treatment disutility (DTD) represents an individual's disutility associated with the inconvenience of taking medicine over a long period of time.

OBJECTIVES

The main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence DTD values.

METHODS

Design: We used a cross-sectional study consisting of time-trade off exercises embedded within online surveys. Respondents were asked to compare a one-off pill ('Medicine A') assumed to have no inconvenience and a daily pill ('Medicine B') over 10 years (statins) or 5 years (bisphosphonates).Setting: Individuals from National Health Service (NHS) primary care and the general population were surveyed using an online panel company.Participants: Two types of participants were recruited. First, a purposive sample of patients with experience of taking a statin (n=260) or bisphosphonate (n=100) were recruited from an NHS sampling frame. Patients needed to be aged over 30, have experience of taking the medicine of interest and have no diagnosis of dementia or of using dementia drugs. Second, a demographically balanced sample of members of the public were recruited for statins (n=376) and bisphosphonates (n=359).Primary and secondary outcome measures: Primary outcome was mean DTD. Regression analysis explored factors which could influence DTD values.

RESULTS

A total of 879 respondents were included for analysis (514 for statins and 365 for bisphosphonates). The majority of respondents reported a disutility associated with medicine use. Mean DTD for statins was 0.034 and for bisphosphonates 0.067, respectively. Respondent characteristics including age and sex did not influence DTD. Experience of bisphosphonate-use reduced reported disutilities.

CONCLUSIONS

Statins and bisphosphonates have a quantifiable DTD. The size of estimated disutilities suggest they are likely to be important for cost-effectiveness, particularly in individuals at low-risk when treated for primary prevention.

Associations between treatment burden, self-reported treatment qualities, antiretroviral therapy obtainment, and health-related quality of life among Ugandan PLWH

BACKGROUND

Understanding related risk factors of health-related quality of life (HRQoL) could avoid treatment failure and provide an insight of personalized treatment approach among people living with HIV/AIDS (PLWH). The objective of this study was to identify factors associated with self-reported treatment qualities and domains of health-related quality of life (HRQoL) among PLWH in Uganda.

METHOD

Data were from "Life on antiretroviral therapy: People's adaptive coping and adjustment to living with HIV as a chronic condition in Wakiso District, Uganda" in English. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess the HRQoL of 263 PLWH in the sample. Considering variance inflation factors, multiple regression analyses were performed to assess the associations between demographic factors, ART obtainment, treatment burden, and self-reported treatment qualities, associations between demographic factors, self-reported treatment qualities, and HRQoL, and association between ART obtainment and HRQoL. Controlling for the confounding effects, several regression anatomies were employed to explore the associations between self-reported treatment qualities and six domains of HRQoL.

RESULTS

In the sample, the geographical distribution were urban (5.70%), semi-urban (37.26%), and rural (57.03%). 67.30% of the participants were females. The mean age of the sample was 39.82 years (standard deviation = 9.76) ranging from 22 to 81 years. Multiple logistic regressions reported statistically significant associations of distance to ART facility with self-reported quality of services, advice, manners, and counseling, statistically significant association between self-reported manners quality and four domains of HRQoL, and statistically significant association between TASO membership and domains of HRQoL. Plots from regression anatomies reported that self-reported treatment qualities had statistically significant associations with six domains of HRQoL.

CONCLUSIONS

Treatment burden, self-reported treatment qualities, ART obtainment, and TASO were possible determinants of individual domains of HRQoL among PLWH in Uganda. PLWH's HRQoL might be improved by promoting medical quality and optimizing ART obtainment in the healthcare providers' practice. Findings in this study had important implications for the redesign of clinical guidelines, healthcare delivery, and health care co-ordination among PLWH globally.

The assessment and management of quality of life of older adults with diabetes mellitus

Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.