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Kouis P, Kakkoura MG, Elia SA, Ioannou P, Anagnostopoulou P, Potamiti L, Loizidou MA, Panayiotidis MI, Kyriacou K, Hadjisavvas A, Yiallouros PK. Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures. Multidiscip Respir Med 2022; 17:881. [PMID: 36636646 PMCID: PMC9830407 DOI: 10.4081/mrm.2022.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) is a congenital disorder characterized by chronic respiratory morbidity. To date, there is no information on PCD-specific preference-based quality of life measures such as health utilities (HU). We cross-sectionally assessed HU in adult PCD patients and explored relationships with genotype, phenotype and quality of life (QOL)-PCD scales. Methods Diagnostic testing was performed according to international guidelines, while participants completed the visual analog scale (VAS), time trade off (TTO), standard gamble (SG), and EuroQol 5 dimensions (EQ5D) HU instruments, as well as the QOL-PCD questionnaire. Hierarchical regression was used to identify the QOL-PCD scales that are most predictive of HU. Results Among 31 patients, median HU are 0.75 (VAS), 0.86 (EQ5D), 0.91 (TTO) and 0.99 (SG). The underlying genotype is not associated with HU measures. VAS and EQ5D are associated with lung function, while TTO and SG values are not sensitive to any of the examined factors. Among the QOL-PCD scales, physical functioning and lower respiratory symptoms explained much of VAS (R2= 0.419) and EQ5D (R2= 0.538) variability. Conclusions Our study demonstrates that HU elicitation in PCD is feasible using both direct and indirect methods. Overall, HU scores are relatively high among adult patients, with higher scores observed in SG and TTO, followed by EQ5D and VAS. VAS and EQ5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Shakolas Educational Center of Clinical Medicine, Palaios Dromos Lefkosias- Lemesou 215/6, 2029 Aglantzia, Cyprus. Tel.+357.99467521 - +357.22895396.
| | - Maria G. Kakkoura
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Stavria Artemis Elia
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Phivos Ioannou
- Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus
| | - Pinelopi Anagnostopoulou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus
| | - Louiza Potamiti
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Maria A. Loizidou
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Mihalis I. Panayiotidis
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyriacos Kyriacou
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Andreas Hadjisavvas
- Department of Cancer Genetics, Therapeutics & Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Panayiotis K. Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus,Pediatric Pulmonology Unit, Hospital ‘Archbishop Makarios III’, Nicosia, Cyprus
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Mavrodi AG, Chatzopoulos SA, Aletras VH. Examining Willingness-to-Pay and Zero Valuations for a Health Improvement with Logistic Regression. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211028102. [PMID: 34271848 PMCID: PMC8287344 DOI: 10.1177/00469580211028102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Study aim was to elicit the Greek general population’s willingness-to-pay (WTP)
for a health improvement (recovery to perfect health), examine attitudinal
differences between willing- and unwilling-to-pay individuals regarding
healthcare services provision, and investigate —using a logistic regression
model—demographic/socioeconomic factors impact on their intention to pay for a
health improvement. A research tool was developed to conduct a cross-sectional
stated-preference telephone-based survey (January-February 2019) and a
representative sample (n = 1342) of the Greek general population was queried.
The computer-assisted telephone-interview (CATI) method was used to ensure
random sampling. WTP was elicited using the iterative bidding technique.
Participants’ attitudes toward healthcare services provision were assessed
through pre-defined statements. Test-retest reliability of these statements was
assessed using intraclass correlation coefficients (ICC). Logistic regression
was employed to identify sociodemographic factors’ effect on WTP intention.
Differences among individuals’ attitudes were assessed using the chi-square
test. All analyses were conducted using the IBM SPSS Software v.25.0. Analysis
showed acceptable reliability for WTP estimates (ICC = .67) and good reliability
for healthcare services assessment statements (ICC = .83-.94). Mean WTP was
estimated at €439.8. Respondents with higher educational level and higher
household income were more likely to be willing to pay for a health improvement.
On the contrary, older participants were less likely to be willing to pay. Most
participants who considered public healthcare services to be of high quality
were unwilling to pay. Logistic regression analysis led to the development of an
effective predictive model regarding factors affecting individuals’ WTP
intention for a health improvement. Further classification of unwilling-to-pay
individuals into protest responders and “true” zero valuators showed that
protest responders are unlikely to be representative of the population. Hence,
study results can be used for debiasing WTP responses, leading to a more
accurate use of WTP estimates by policy makers, exploiting WTP values in medical
interventions cost-benefit analysis within reimbursement decisions
framework.
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Mavrodi A, Aletras V. A Contingent Valuation Study for Eliciting a Monetary Value of a Quality-Adjusted Life-Year in the General Greek Population. Value Health Reg Issues 2020; 22:36-43. [PMID: 32731168 DOI: 10.1016/j.vhri.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/24/2019] [Accepted: 03/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To elicit a willingness-to-pay (WTP) per quality-adjusted life-year (QALY) estimate for the general Greek population and assess the impact of individuals' socio-demographic characteristics and motives on this estimate. METHODS A telephone-based survey was carried out employing a representative sample of the general Greek population (n = 1342). A computer-assisted telephone-interview method was adopted to ensure random sampling. A total of 528 participants reported a WTP value for a utility improvement from their current health to perfect health. Those individuals' motives were assessed through predefined statements. Test-retest reliability was assessed using intraclass correlation coefficient (ICC). Multiple linear regression (MLR) and one-way analysis of variance (ANOVA) tests were conducted to assess the effect of socioeconomic/demographic determinants and motive statements, respectively, on WTP/QALY. MLR was re-estimated considering as dependent variable the WTP/QALY estimate calculated for participants: (1) stating a WTP value ≤ their household income and (2) presenting higher certainty regarding stated WTP value (sensitivity analysis). RESULTS Analysis revealed good reliability for WTP/QALY estimates and motive statements (ICC values > 0.8). Mean WTP/QALY was €26 280. The respective 5% trimmed value was €14 862. Being a student and household income affected WTP/QALY. Sensitivity analysis did not produce markedly different WTP/QALY predictors, implying the robustness of results, irrespective of the participant group considered. Individuals who indicated the inability to cover basic family needs or pay tax claims as motives reported lower WTP/QALY values compared with those not viewing these aspects as motives. CONCLUSIONS Findings confirm that the World Health Organization's criterion used currently in Greek cost-effectiveness studies is not unreasonable. Additional research is essential to further explore WTP/QALY estimates in the Greek setting and facilitate informed decision making.
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Affiliation(s)
- Afentoula Mavrodi
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece.
| | - Vassilis Aletras
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
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De Cassai A, Bond O, Marini S, Panciera G, Furian L, Neri F, Andreatta G, Rigotti P, Feltracco P. [Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial]. Rev Bras Anestesiol 2020; 70:194-201. [PMID: 32534731 DOI: 10.1016/j.bjan.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/13/2020] [Accepted: 02/15/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV-guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study. METHODS We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the PPV Group received fluids whenever PPV was higher than 12%, patients in the Free Fluid Group received fluids following our institutional standard care protocol for kidney transplantations (10mL.kg-1.h-1). RESULTS Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge. CONCLUSION PPV-guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.
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Affiliation(s)
- Alessandro De Cassai
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália.
| | - Ottavia Bond
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Silvia Marini
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Giulio Panciera
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Lucrezia Furian
- Padua University Hospital, Department of Surgery, Oncology and Gastroenterology, Kidney and Pancreas Transplant Unit, Pádua, Itália
| | - Flavia Neri
- Padua University Hospital, Department of Surgery, Oncology and Gastroenterology, Kidney and Pancreas Transplant Unit, Pádua, Itália
| | - Giulio Andreatta
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
| | - Paolo Rigotti
- Padua University Hospital, Department of Surgery, Oncology and Gastroenterology, Kidney and Pancreas Transplant Unit, Pádua, Itália
| | - Paolo Feltracco
- University of Padova, Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, Padova, Itália
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De Cassai A, Bond O, Marini S, Panciera G, Furian L, Neri F, Andreatta G, Rigotti P, Feltracco P. Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32534731 PMCID: PMC9373208 DOI: 10.1016/j.bjane.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Kidney transplantation is the gold-standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study. Methods We conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the “PPV” group received fluids whenever PPV was higher than 12%, patients in the “free fluid” group received fluids following our institutional standard care protocol for kidney transplantations (10 mL.kg-1. h-1). Results Urinary output was similar at every time-point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge. Conclusion PPV guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.
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Stefanidou M, Evangelou G, Kontodimopoulos N, Koumaki D, Krueger-Krasagakis SE, Yosipovitch G, Krasagakis K. Willingness to pay and quality of life in patients with pruritic skin disorders. Arch Dermatol Res 2019; 311:221-230. [PMID: 30788568 DOI: 10.1007/s00403-019-01900-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
Abstract
Pruritic dermatosis is a frequent and burdensome disease. The objectives of this study were (1) to assess the willingness to pay (WTP) and the health-related quality of life (HRQoL) in patients with pruritic dermatoses and (2) to compare the results with data on socio-demographic data, and clinical features/symptoms of the patients. One hundred and three patients with pruritic dermatosis had participated in a non-interventional, cross-sectional study. Socio-demographic data, clinical features/symptoms, a health-related quality of life (HRQoL)-based and a dermatology-specific instrument (SF-6D and DLQI, respectively), and two utility indicators such as rating scale (RS) and time-trade-off (TTO) as well as willingness to pay (WTP) were recorded. In our study, there was a significant correlation between DLQI scores and WTP (p < 0.001). Time-trade-off (TTO) was also statistically correlated with SF-6D (p = 0.001). Regression models showed that daily duration and pruritus intensity were associated with lower HRQoL. Furthermore, WTP was the only measure revealing demographic and socio-economic characteristics such as age, education level, family status and income as predicting factors. No significant differences between groups of varying skin diseases were observed. HRQoL and WTP proved to be valid tools to assess the burden of disease in patients with pruritic dermatosis. However, further research with a larger number of patients is needed to validate the present findings.
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Affiliation(s)
- Maria Stefanidou
- Department of Dermatology, University Hospital of Heraklion, 71110, Crete, Greece
- Faculty of Social Sciences, Hellenic Open University, Patra, Greece
| | - Georgios Evangelou
- Department of Dermatology, University Hospital of Heraklion, 71110, Crete, Greece
| | | | - Dimitra Koumaki
- Department of Dermatology, University Hospital of Heraklion, 71110, Crete, Greece.
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van Nooten FE, Houghton K, van Exel J, van Agthoven M, Brouwer WBF, Stull DE. A (Latent) Class of Their Own: Response Patterns in Trading Off Quantity and Quality of Life in Time Trade-Off Exercises. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:1403-1410. [PMID: 29241900 DOI: 10.1016/j.jval.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 06/02/2017] [Accepted: 06/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Conflicting results regarding associations of time trade-off (TTO) valuations with respondent characteristics have been reported, mostly on the basis of regression analyses. Alternative approaches, such as the latent class analysis (LCA), may add to the further understanding of variations in TTO responses. OBJECTIVES To identify whether subgroups of respondents can be identified on the basis of their responses to TTO exercises and to investigate which respondent characteristics are associated with membership of the identified subgroups. METHODS Members of the Dutch general public, aged 18 to 65 years, completed a Web-based questionnaire concerning sociodemographic characteristics, three TTO exercises valuing health states described using the domains of the EuroQol five-dimensional questionnaire, and preference for quality versus quantity of life. LCA was used to identify patterns in the responses. Predictive variables were included in the final LCA model to identify the particular respondent characteristics that predict subgroup membership. RESULTS The sample consisted of 1067 respondents. Four latent classes were identified in the responses to TTO exercises. Two were high traders, focusing on quality of life and trading off a relatively high number of years. The other two were low traders, focusing on length of life. Predictive analyses revealed significant differences between subgroups in terms of age, sex, subjective life expectancy, and preference for quantity over quality of life. CONCLUSIONS We showed that distinct classes of respondents can be discerned in TTO responses from the general public, distinguishing subgroups of low and high traders. More research in this area should confirm our findings and investigate their implications for health state valuation exercises.
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Affiliation(s)
- F E van Nooten
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - K Houghton
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - J van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M van Agthoven
- Pharmaceutical Companies of Johnson & Johnson, Breda, The Netherlands
| | - W B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - D E Stull
- RTI Health Solutions, Research Triangle Park, NC, USA
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Mavrodi A, Aletras V, Spanou A, Niakas D. Eliciting the Monetary Value of a Quality-Adjusted Life Year in a Greek Outpatient Department in Times of Economic Austerity. PHARMACOECONOMICS - OPEN 2017; 1:291-300. [PMID: 29441505 PMCID: PMC5711751 DOI: 10.1007/s41669-017-0033-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Contingent valuation is widely used to determine individuals' willingness to pay (WTP) for a health gain. Our study aimed to elicit an empirical estimate of the monetary value of a quality-adjusted life year (QALY) in a Greek outpatient setting in times of economic austerity and assess the impact of patients' characteristics on their valuations. METHODS We used a questionnaire as a survey tool to determine the maximum WTP for a health gain of a hypothetical therapy and to evaluate patients' health-related quality of life (EuroQoL-5D-3L) and demographic and socioeconomic characteristics. EuroQoL tariffs were used to estimate health utilities. Mean WTP values were computed and ordinary least squares regressions performed on transformed Box-Cox and logarithmic dependent WTP per QALY variables to remedy observed skewness problems. RESULTS Analyses were performed for 167 patients with utility values less than unity. Mean WTP per QALY reported was similar for both payment vehicles examined: payments made out-of-pocket (€2629) and payments made through new tax imposition (€2407). Regression results showed that higher net monthly family income was associated with higher WTP per QALY for both payment vehicles. Moreover, the presence of a chronic condition and higher level of education were associated with higher out-of-pocket WTP per QALY and WTP per QALY through taxes, respectively. CONCLUSION The very low WTP per QALY estimates could be explained by the recent severe economic depression and austerity in Greece. In fact, family income was found to be a significant predictor of WTP per QALY. Since these estimates deviate significantly from the cost-effectiveness thresholds still employed in economic evaluations in this country, research should be undertaken promptly to further examine this important issue using a nationwide representative sample of the general population along with WTP and other methodologies.
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Affiliation(s)
- A Mavrodi
- Department of Business Administration, University of Macedonia, 156 Egnatia Str., Thessaloniki, 54636, Greece
| | - V Aletras
- Department of Business Administration, University of Macedonia, 156 Egnatia Str., Thessaloniki, 54636, Greece.
- School of Social Sciences, Hellenic Open University, 18 Parodos Aristotelous Str.,, 26335, Patra, Greece.
| | - A Spanou
- School of Social Sciences, Hellenic Open University, 18 Parodos Aristotelous Str.,, 26335, Patra, Greece
| | - D Niakas
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, Athens, 11527, Greece
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Kuspinar A, Pickard S, Mayo NE. Developing a Valuation Function for the Preference-Based Multiple Sclerosis Index: Comparison of Standard Gamble and Rating Scale. PLoS One 2016; 11:e0151905. [PMID: 27123850 PMCID: PMC4849717 DOI: 10.1371/journal.pone.0151905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/13/2016] [Indexed: 01/02/2023] Open
Abstract
Objective The standard gamble (SG) and rating scale (RS) are two approaches that can be employed to elicit health state preferences from patients in order to inform decision making. The objectives of this study were: (i) to contribute evidence towards the similarities and differences in the SG and the RS to reflect patient preferences, and (ii) to develop a multi-attribute utility function (MAUF) (i.e., scoring algorithm) for the PBMSI. Study Design Two samples were recruited for the study. The first sample provided cross-sectional data to generate the preference weights which were then used to develop (D) the MAUFD. The distribution of SG and RS were compared across levels of perceived difficulty. The second sample provided additional data to validate (V) the MAUF, termed MAUFV. Results The mean RS values ranged from 0.39 to 0.65, whereas the mean SG values were much higher ranging from 0.80 to 0.91. Correlations between the two methods were very low ranging from -0.29 to 0.15. Bland-Altman plots revealed the extent of differences in values produced by the two methods. Conclusion In contemplating trade-offs in the selection of a preference-based elicitation approach for a MAUF that could guide clinical decision making, results suggest the RS is preferable in terms of feasibility and validity for MS patients. The PBMSI with patient preferences shows promise as a measure of health-related quality of life for MS.
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Affiliation(s)
- Ayse Kuspinar
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- * E-mail:
| | - Simon Pickard
- Center for Pharmacoepidemiology and Pharmacoeconomic Research and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Nancy E. Mayo
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada
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van Nooten FE, van Exel NJA, Eriksson D, Brouwer WBF. "Back to the future": Influence of beliefs regarding the future on TTO answers. Health Qual Life Outcomes 2016; 14:4. [PMID: 26753687 PMCID: PMC4709901 DOI: 10.1186/s12955-015-0402-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background A common approach to obtain health state valuations is the time-tradeoff (TTO) method. Much remains unknown regarding the influence of responder characteristics on TTO answers. The objective of this study is to increase understanding of the influence that beliefs regarding future health and death, as well as desires to witness certain life events, have on respondents’ health state valuations. Methods An online survey was designed, including three TTO questions using a 10 year timeframe. Moreover, respondents completed demographic questions, the Health-Risk Attitude Scale (HRAS), the Expectations Regarding Aging (ERA) questionnaire, questions about beliefs regarding future health (i.e. life expectancy) and death (i.e. fear of death, belief in life after death and opinion about euthanasia), and about important life events taking place within the TTO timeframe. Regression analyses were performed in order to assess the influence of these different variables. Results One thousand sixty-seven respondents were included in the analyses. The following variables were significantly associated with years traded off: ERA mental health (decrease), ERA physical health (increase), HRAS (increase), support for euthanasia (increase), fear of death (decrease) and consideration of an important life event (decrease). The explained variance of the final model was low (0.08). Conclusion TTO responses may be influenced by considerations of future health, including life events and attitudes regarding health risks and death. Further investigation of TTO responses remains warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0402-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F E van Nooten
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - N J A van Exel
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | | | - W B F Brouwer
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. .,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Ibrahim AM, Sinno HH, Izadpanah A, Vorstenbosch J, Dionisopoulos T, Markarian MK, Lee BT, Lin SJ. Mastopexy for breast ptosis: Utility outcomes of population preferences. Plast Surg (Oakv) 2015; 23:103-7. [PMID: 26090352 DOI: 10.4172/plastic-surgery.1000916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states. OBJECTIVE To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics. METHODS Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant. RESULTS Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance. DISCUSSION For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to 'perfect health' than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema. CONCLUSIONS Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
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Affiliation(s)
- Ahmed Ms Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hani H Sinno
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; ; Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Ali Izadpanah
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Joshua Vorstenbosch
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tassos Dionisopoulos
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Mark K Markarian
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ibrahim AMS, Sinno HH, Lzadpanah A, Vorstenbosch J, Dionisopoulos T, Markarian MK, Lee BT, Lin SJ. Mastopexy for breast ptosis: Utility outcomes of population preferences. Plast Surg (Oakv) 2015. [DOI: 10.1177/229255031502300210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states. Objective To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics. Methods Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant. Results Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance. Discussion For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to ‘perfect health’ than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema. Conclusions Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
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Affiliation(s)
- Ahmed MS Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hani H Sinno
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Ali Lzadpanah
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Joshua Vorstenbosch
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tassos Dionisopoulos
- Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Mark K Markarian
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernard T Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Health Utilities Lost and Risk Factors Associated With HPV-induced Diseases in Men and Women: The HPV Italian Collaborative Study Group. Clin Ther 2015; 37:156-167.e4. [DOI: 10.1016/j.clinthera.2014.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/28/2014] [Accepted: 11/04/2014] [Indexed: 11/23/2022]
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Karopadi AN, Mason G, Rettore E, Ronco C. Cost of peritoneal dialysis and haemodialysis across the world. Nephrol Dial Transplant 2013; 28:2553-2569. [DOI: 10.1093/ndt/gft214] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Huang Y, Ramon D, Luan FL, Sung R, Samaniego M. Incidences of preformed and de novo donor-specific HLA antibodies and their clinicohistological correlates in the early course of kidney transplantation. Clin Transplant 2013; 26:247-53. [PMID: 23721029 DOI: 10.1111/j.1399-0012.2011.01469.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Our center started routine monitoring of preformed and de novo human leukocyte antigen donor-specific antibodies (DSA) in September 2010 using single antigen beads on the Luminex platform. Recipients with preformed DSA or other high immunological risk factors had serial DSA monitoring at 3, 6, and 12-months posttransplant, and low-risk recipients were screened only at 12-months. Surveillance biopsies were performed at 3, 6, and 12-months post-transplant for all recipients. In addition, for-cause biopsies and DSA testing were performed when clinically indicated for allograft dysfunction. Among 150 adult kidney and kidney/pancreas transplant recipients included in the analysis, 14% had preformed DSA and 7.8% of recipients without preformed DSA developed de novo DSA by 12-months. De novo DSA developed in 25% of recipients on cyclosporine compared to 5% of those on tacrolimus (p = 0.02). The incidences of acute rejection were 34%, 48%, and 70% in recipients with no DSA, with preformed DSA, and with de novo DSA, respectively (p = 0.05). In all recipients with de novo DSA and rejection, the first rejection episode preceded or was concurrent with the emergence of de novo DSA. Despite the difference in rejection incidences, the estimated glomerular filtration rate at 1-year was not significantly different between recipients with or without DSA.
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Affiliation(s)
- Yihung Huang
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, Michigan, USA.
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Chu LW, So JC, Wong LC, Luk JKH, Chiu PKC, Chan CSY, Kwan FSM, Chau J, Hui E, Woo J, McGhee SM. Community end-of-life care among Chinese older adults living in nursing homes. Geriatr Gerontol Int 2013; 14:273-84. [PMID: 23682743 DOI: 10.1111/ggi.12090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of the present study was to investigate the preference and willingness-to-pay (WTP) of older Chinese adults for community end-of-life care in a nursing home rather than a hospital. METHODS A total of 1540 older Chinese adults from 140 nursing homes were interviewed. Four hypothetical questions were asked to explore their preferences for end-of-life care. Using a discrete choice approach, specific questions explored acceptable trade-offs between three attributes: availability of doctors onsite, attitude of the care staff and additional cost of care per month. RESULTS Approximately 35% of respondents preferred end-of-life care in the nursing home, whereas 23% of them would consider it in a better nursing home. A good attitude of staff was the most important attribute of the care site. Respondents were willing to pay an extra cost of US$5 (HK$39) per month for more coverage of doctor's time, and US$49 (HK$379) for a better attitude of staff in the nursing home. The marginal WTP for both more coverage of doctor's time and better attitude of staff amounted to US$54 (HK$418). Respondents on government subsidy valued the cost attribute more highly, as expected, validating the hypothesis that those respondents would be less willing to pay an additional cost for end-of-life care. CONCLUSIONS Older Chinese adults living in nursing homes are willing to pay an additional fee for community end-of-life care services in nursing homes. Both the availability of the doctor and attitudes of nursing home staff are important, with the most important attribute being the staff attitudes. Geriatr Gerontol Int 2013; 14: 273-284.
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Affiliation(s)
- Leung-Wing Chu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; Acute Geriatric Unit, Grantham Hospital, Hong Kong
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Abstract
While kidney transplantation is the most cost-effective treatment available for end-stage renal disease (ESRD) and affords patients with the best quality of life, the current supply of kidneys does not meet the demand. A potential solution to increasing the supply is to compensate living donors for a kidney. The purpose of this study was to describe ESRD patient willingness to pay for a kidney. Using a self-administered survey, 107 patients in 31 U.S. states completed the survey. The quantitative method and descriptive survey design employed descriptive, correlational, nonparametric and multivariate statistical tests to evaluate the data. Of participants, 78.5% were willing to pay for a kidney; there were significant correlations between gender, health status, household income, preferred source of a kidney and willingness to pay. Men, patients with poor and fair health status and those with household incomes > or =$50,000 were more willing to pay. Step-wise regression analysis found price and doctor's influence accounting for 52% of variance in willingness to pay. As price increased and doctor's opinion mattered, willingness to pay increased. This study supports development of additional studies with larger sample sizes and patients on kidney transplant waiting lists.
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18
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Is renal transplantation the most cost-effective and preferable therapy for patients suffering from end-stage renal disease or not? Health Policy 2009; 89:329-31. [DOI: 10.1016/j.healthpol.2008.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 07/17/2008] [Indexed: 11/17/2022]
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Lloyd A, van Hanswijck de Jonge P, Doyle S, Cornes P. Health state utility scores for cancer-related anemia through societal and patient valuations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:1178-1185. [PMID: 19602216 DOI: 10.1111/j.1524-4733.2008.00394.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Fatigue is recognized as the most serious complication of chemotherapy for the majority of patients. This study aims to determine preferences and utility values for health state descriptions of anemia associated with cancer treatment. METHODS FACT-An clinical trial data were summarized to define health states associated with hemoglobin levels of 7.0-8.0, 8.0-9.0, 9.0-10.0, 10.0-10.5, 10.5-11.0, 11.0-12.0, and 12.0+ g/dL. Health state descriptions were reviewed by clinicians and two quality-of-life experts. Eighty-five members of the general public were asked to rate the health states using a visual analogue scale and standard gamble (SG). Twenty-six oncology patients were interviewed using the time trade-off (TTO). RESULTS The mean societal SG derived utility values showed a significant linear change from 0.583 +/- 0.067 (7-8 g/dL hemoglobin [Hb]) to 0.708 +/- 0.057 (12+ g/dL Hb). The patient TTO data ranged from 0.297 +/- 0.127 (7-8 g/dL Hb) to 0.611 +/- 0.092 (12+ g/dL Hb). CONCLUSIONS The health state utility scores from both groups show a decrement in line with worsening anemia. Furthermore, patients who have experienced cancer-related fatigue rate the more severe levels of anemia much lower than the general public.
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Affiliation(s)
- Andrew Lloyd
- Oxford Outcomes Ltd, Seacourt Tower, Oxford, UK.
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Liem YS, Bosch JL, Hunink MGM. Preference-based quality of life of patients on renal replacement therapy: a systematic review and meta-analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:733-41. [PMID: 18194399 DOI: 10.1111/j.1524-4733.2007.00308.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Various utility measures have been used to assess preference-based quality of life of patients with end-stage renal disease (ESRD). The purposes of this study were to summarize the literature on utilities of hemodialysis (HD), peritoneal dialysis (PD), and renal transplantation (RTx) patients, to compare utilities between these patient groups, and to obtain estimates for quality-of-life adjustment in economic analyses. METHODS We searched the English literature for studies that reported visual analog scale (VAS), time trade-off (TTO), standard gamble (SG), EuroQol-5D (EQ-5D), and health utilities index (HUI) values of ESRD patients. We extracted patient characteristics and utilities and calculated mean utilities and 95% confidence intervals (CIs) for categories defined by utility measure and treatment modality using random-effects models. RESULTS We identified 27 articles that met the inclusion criteria. VAS articles were too heterogeneous to summarize quantitatively and we found only one study reporting HUI values. Thus, we summarized utilities from TTO, SG, and EQ-5D studies. Mean TTO and EQ-5D-index values were lower for dialysis compared to RTx patients, though not statistically significant for TTO values (TTO values: HD 0.61, 95% CI 0.54-0.68; PD 0.73, 95% CI 0.61-0.85; RTx 0.78, 95% CI 0.63-0.93; EQ-5D-index values: HD 0.56, 95% CI 0.49-0.62; PD 0.58, 95% CI 0.50-0.67; RTx 0.81, 95% CI 0.72-0.90). Mean HD versus PD associated TTO, EQ-5D-index and EQ-VAS values were not statistically significantly different. CONCLUSION RTx patients tended to have a higher utility than dialysis patients. Among HD and PD patients, there were no statistically significant differences in utility.
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Affiliation(s)
- Ylian S Liem
- Assessment of Radiological Technology Program (ART Program), Department of Epidemiology and Biostatistics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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21
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Dale PL, Hutton J, Elgazzar H. Utility of health states in chronic kidney disease: a structured review of the literature. Curr Med Res Opin 2008; 24:193-206. [PMID: 18039434 DOI: 10.1185/030079908x253410] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To document published utilities for health states associated with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) and determine the most appropriate values for use in economic models to evaluate renal treatments in the UK. METHODS A structured literature review was conducted (MEDLINE, EMBASE, NHS EED and HTA) in order to identify relevant articles published between January 1990 and January 2006. In addition searches were conducted on websites of Health Technology Assessment (HTA) organizations and the Cost Effectiveness Analysis Registry. Articles were reviewed and those not containing utilities excluded. Results were assessed on the quality of the elicitation studies and their relevance to the UK HTA environment. RESULTS Thirty-five studies satisfied the inclusion criteria. Most studies were conducted in Canada (13), the US (10) and the Netherlands (4). Utilities were identified for all/most of the necessary states, but scores for individual states differed widely between studies and very few studies met the quality criteria. The majority of studies used the time trade-off (23) and standard gamble (11) to elicit utilities, while only six used EQ-5D. Seven studies provided community preferences. Two studies were judged to be directly relevant to economic evaluations in the UK. CONCLUSIONS Many studies have estimated utilities in ESRD patients, but only a few have estimated utilities based upon public preferences. Further empirical research is needed to produce more reliable utilities for economic modelling in the UK, especially in chronic kidney disease patients who do not require dialysis.
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Affiliation(s)
- P L Dale
- United BioSource Corporation, London, UK.
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Abstract
Renal transplantation is the preferred therapeutic option for patients with end-stage renal disease. Survival rates are much higher in patients who receive a transplant. Patients with renal failure have significant concomitant medical conditions, such as cardiovascular disease. This article provides an overview of the important issues to be considered in patients undergoing renal transplant, and discusses the anaesthetic management of these patients.
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Affiliation(s)
- H SarinKapoor
- Department of Anaesthesiology and Intensive Care, Fortis Hospital, Amritsar, India.
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Plantinga LC, Fink NE, Bass EB, Boulware LE, Meyer KB, Powe NR. Preferences for Current Health and Their Association With Outcomes in Patients With Kidney Disease. Med Care 2007; 45:230-7. [PMID: 17304080 DOI: 10.1097/01.mlr.0000250260.28692.9b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with chronic disease who express stronger preference for their current health might be expected to have better outcomes than patients who assign lower utility to their current health state. OBJECTIVE We sought to examine associations between preferences for current health and outcomes in a national cohort of incident hemodialysis patients. METHODS In 567 patients treated at 74 clinics, we measured patients' preferences by time trade-off on a 0-1 scale (1=willingness to sacrifice no life expectancy to achieve perfect health; 0=zero value of current health). Associations between these preferences and outcomes were examined with Poisson (hospitalization), logistic (progression of comorbidity and clinical performance), and Cox proportional hazards (mortality) models. RESULTS The distribution of preference scores was skewed, with a mean of 0.69 and a median of 0.83. Highest (1.0) scores were associated with decreased incidence of hospitalization (incidence risk ratio=0.88, 95% confidence interval=0.80-0.97), relative to the lowest (<0.50) scores, a finding that was consistent across gender and race, with women and white subjects having greater decreases (Pinteraction<0.001). Higher preferences for current health also were associated with less worsening of comorbidity. Adjusted risks of death for patients with intermediate (>or=0.50-1.0) and the highest preference scores for current health were not different from those with lower scores. CONCLUSION In patients with chronic kidney disease, a stronger preference for current health is associated with lower hospital admission rates and improved comorbidity but not better survival.
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Affiliation(s)
- Laura C Plantinga
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
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