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Lv R, Yang L, Li J, Wei X, Ren Y, Wang W, Hou J, Fang X. Relationship between social participation and life satisfaction in community-dwelling older adults: Multiple mediating roles of depression and cognitive function. Arch Gerontol Geriatr 2024; 117:105233. [PMID: 37956587 DOI: 10.1016/j.archger.2023.105233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Numerous studies have explored the relationship between social participation, depression, cognitive function, and life satisfaction in community-dwelling older adults. However, the results of these studies were not consistent. Therefore, the in-depth excavation of the complex relationship mechanism between these four variables is limited. This study aims to explore whether depression and cognitive function act as the multiple mediators between social participation and life satisfaction in community-dwelling older adults. METHODS This study used the meta-analytic structural equation modeling (MASEM) approach. Six databases were comprehensively searched to investigate the relationship between social participation, depression, cognitive function, and life satisfaction in community-dwelling older adults from inception to March 1, 2023. RESULTS The analysis included 50 articles that reported 66 effect sizes (N = 161,854). The MASEM found the relationship between social participation and life satisfaction was mediated by depression [β = 0.085, 95 % CI (0.053, 0.126)] and by cognitive function [β = 0.015, 95 % CI (0.002, 0.033)], respectively. Depression and cognitive function also played multiple mediating roles between social participation and life satisfaction in community-dwelling older adults [β = 0.005, 95 % CI (0.001, 0.012)]. CONCLUSIONS There was not only a direct association between social participation and life satisfaction, but also an association through multiple mediating roles of depression and cognitive function in community-dwelling older adults. In the process of using diverse interventions to promote social participation in community-dwelling older adults, more attention should be paid to their psychological status and cognitive function to eliminate intrinsic barriers so as to improve life satisfaction effectively.
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Affiliation(s)
- Runtian Lv
- School of Nursing, Qingdao University, China
| | - Li Yang
- School of Nursing, Qingdao University, China.
| | - Jia Li
- School of Nursing, Qingdao University, China
| | | | - Yawen Ren
- School of Nursing, Qingdao University, China
| | | | - Jiayu Hou
- School of Nursing, Qingdao University, China
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Sullivan KR, Ruggiero SM, Xian J, Thalwitzer KM, Ali R, Stewart S, Cosico M, Steinberg J, Goss J, Pfalzer AC, Horning KJ, Weitzel N, Corey S, Conway L, Rigby CS, Bichell TJ, Helbig I. A disease concept model for STXBP1-related disorders. Epilepsia Open 2023; 8:320-333. [PMID: 36625631 PMCID: PMC10235567 DOI: 10.1002/epi4.12688] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE STXBP1-related disorders are rare genetic epilepsies and neurodevelopmental disorders, but the impact of symptoms across clinical domains is poorly understood. Disease concept models are formal frameworks to assess the lived experience of individuals and their families and provide a basis for generating outcome measures. METHODS We conducted semistructured, qualitative interviews with 19 caregivers of 16 individuals with STXBP1-related disorders and 7 healthcare professionals. We systematically coded themes using NVivo software and grouped concepts into the domains of symptoms, symptom impact, and caregiver impact. We quantified the frequency of concepts throughout the lifespan and across clinical subgroups stratified by seizure history and developmental trajectories. RESULTS Over 25 hours of interviews, we coded a total of 3626 references to 38 distinct concepts. In addition to well-recognized clinical features such as developmental delay (n = 240 references), behavior (n = 201), and seizures (n = 147), we identified previously underrepresented symptoms including gastrointestinal (n = 68) and respiratory symptoms (n = 24) and pain (n = 30). The most frequently referenced symptom impacts were autonomy (n = 96), socialization (n = 64), and schooling (n = 61). Emotional impact (n = 354), support (n = 200), and daily life & activities (n = 108) were highly cited caregiver impacts. We found that seizures were more commonly referenced in infancy than in other age groups, while behavior and socialization were more likely to be referred to in childhood. We found that caregivers of individuals with ongoing seizures were less likely to reference developmental delay, possibly due to the relatively high impact of seizures. SIGNIFICANCE STXBP1-related disorders are complex conditions affecting a wide range of clinical and social domains. We comprehensively mapped symptoms and their impact on families to generate a comprehensive disease model as a foundation for clinical endpoints in future trials.
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Affiliation(s)
- Katie R. Sullivan
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sarah M. Ruggiero
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julie Xian
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kim M. Thalwitzer
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Rahma Ali
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sydni Stewart
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Mahgenn Cosico
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | - James Goss
- STXBP1 Foundation, ApexHolly SpringsNorth CarolinaUSA
| | | | - Kyle J. Horning
- Vanderbilt UniversityNashvilleTennesseeUSA
- COMBINEDBrainBrentwoodTennesseeUSA
| | | | | | - Laura Conway
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Terry Jo Bichell
- Vanderbilt UniversityNashvilleTennesseeUSA
- COMBINEDBrainBrentwoodTennesseeUSA
| | - Ingo Helbig
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyUniversity of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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van de Loo KFE, van Zeijl NT, Custers JAE, Janssen MCH, Verhaak CM. A conceptual disease model for quality of life in mitochondrial disease. Orphanet J Rare Dis 2022; 17:263. [PMID: 35841006 PMCID: PMC9287990 DOI: 10.1186/s13023-022-02411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/26/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous studies in patients with a mitochondrial disease (MD) highlight the high prevalence of cognitive impairments, fatigue, depression, and a lower quality of life (QoL). The relationship with biological and physiological factors remains complex. The aim of this study is to investigate the status of and interrelationships between biological and physiological functioning, cognitive functioning as well as fatigue, depression, societal participation, health perceptions, and QoL, by using the Wilson and Cleary conceptual disease model, adapted to MD. METHODS Patients with a genetically confirmed MD were included. The following health concepts in MD were investigated according to the conceptual model: (1) Biological and physiological: disease manifestation (Newcastle Mitochondrial Disease Adult Scale), (2) Symptom status: cognitive functioning, patient reported fatigue and depressive symptoms, (3) Functional health: societal participation, (4) Patient reported health perceptions, and (5) Overall QoL. Data were compared to healthy normative data and/or data from other patient groups. Correlations as well as a hierarchical regression analysis were performed to assess the relations between the different levels of health concepts in the conceptual model. RESULTS Of the 95 included patients, 42% had a severe disease manifestation. Comparable or worse than normative data and other patient groups, 35% reported cognitive impairments, 80% severe fatigue, and 27% depressive symptoms. Patients experienced impairments in societal participation and QoL. Disease manifestation was significantly correlated with cognitive functioning, societal participation, physical functioning and overall QoL, but not with fatigue or depressive symptoms. Almost all outcome measures regarding functional health, health perceptions and QoL were correlated with symptom status variables. Overall QoL was significantly predicted by fatigue and physical functioning. CONCLUSIONS Symptom status is related to the functional health, health perceptions and QoL in patients with MD. Moreover, fatigue and physical functioning are important contributors to the overall QoL of MD patients. In order to provide adequate patient care it is important to have a broad view on patients' functioning, not only by providing a proper clinical assessment, but also to screen for symptom status; cognitive functioning, fatigue and depression.
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Affiliation(s)
- Kim F E van de Loo
- Department of Medical Psychology, Radboud Center for Mitochondrial Medicine, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Nander T van Zeijl
- Department of Internal Medicine, Radboud Center for Mitochondrial Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Center for Mitochondrial Medicine, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Mirian C H Janssen
- Department of Internal Medicine, Radboud Center for Mitochondrial Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Christianne M Verhaak
- Department of Medical Psychology, Radboud Center for Mitochondrial Medicine, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Hamed A, An Haack K, Gwaltney C, Baranowski E, Stewart A, Krupnick R, Tyler M, Sparks S, Paty J. Qualitative interviews to improve patient-reported outcome measures in late-onset Pompe disease: the patient perspective. Orphanet J Rare Dis 2021; 16:428. [PMID: 34641935 PMCID: PMC8513325 DOI: 10.1186/s13023-021-02067-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Late-onset Pompe Disease (LOPD) is a rare, heterogeneous disease manifested by a range of symptoms varying in severity. Research establishing the frequency of these symptoms and their impact on patients’ daily lives is limited. The objective of this study was to develop a conceptual model that captures the most relevant symptoms and functional limitations experienced by patients with LOPD, to inform the development of new patient-reported outcome (PRO) tools.
Methods A preliminary conceptual model was constructed following a literature review and revised through interviews with expert clinicians to identify important and relevant concepts regarding symptoms and impacts of LOPD. This preliminary model informed the development of a qualitative patient interview guide, which was used to gather the patient perspective on symptoms and impacts relating to LOPD or its treatment (including symptom/impact frequency and levels of disturbance). Patient interviews aided further refinement of the conceptual model. The findings from the patient interviews were triangulated with the literature review and clinician interviews to identify the most relevant and significant effects of LOPD from the patient perspective. Results Muscle weakness, fatigue, pain, and breathing difficulties (especially while lying down) were the most common and highly disturbing symptoms experienced by patients. Limitations associated with mobility (e.g., difficulty rising from a sitting position, getting up after bending) and activities of daily living, (e.g., reduced ability to participate in social/family activities or work/study) were the most frequently reported impacts with the highest levels of disturbance on the patient’s daily life. These identified symptoms and impacts were included in the new conceptual model of disease. Conclusions This qualitative patient interview study, also informed by a literature review and clinician interviews, identified the most frequent and relevant symptoms and the functional impact of LOPD on patients. The study interviews also captured the patient-preferred language to describe symptoms and impacts of LOPD. The results from this study can be used to develop future PRO instruments that are tailored to the specific symptoms and impacts experienced by patients with LOPD. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02067-x.
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Affiliation(s)
- Alaa Hamed
- Sanofi Genzyme, 50 Binney Street, Cambridge, MA, 02142, USA
| | | | | | | | - Andrew Stewart
- Sanofi Genzyme, 50 Binney Street, Cambridge, MA, 02142, USA
| | | | | | - Susan Sparks
- Sanofi Genzyme, 50 Binney Street, Cambridge, MA, 02142, USA.
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Positive association between physical outcomes and patient-reported outcomes in late-onset Pompe disease: a cross sectional study. Orphanet J Rare Dis 2020; 15:232. [PMID: 32883321 PMCID: PMC7469279 DOI: 10.1186/s13023-020-01469-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Pompe disease is a rare, progressive metabolic myopathy. The aim of this study is to investigate the associations of physical outcomes with patient-reported outcome measures (PROMs) in late-onset Pompe disease. Methods We included 121 Dutch adult patients with Pompe disease. Physical outcomes comprised muscle strength (manual muscle testing using Medical Research Council [MRC] grading, hand-held dynamometry [HHD]), walking ability (6-min walk test [6MWT]), and pulmonary function (forced vital capacity [FVC] in upright and supine positions). PROMs comprised quality of life (Short Form 36 health survey [SF-36]), participation (Rotterdam Handicap Scale [RHS]) and daily-life activities (Rasch-Built Pompe-Specific Activity [R-PAct] Scale). Analyses were cross-sectional: the time-point before, and closest to, start of Enzyme Replacement Therapy was chosen. Associations between PROMs and physical outcomes were investigated using linear regression models. Results RHS and R-PAct scores were better in patients with higher FVC supine and upright, HHD, MRC and 6MWT scores, accounting for the effect of sex, disease duration, use of wheelchair and ventilator support. While the SF-36 Physical Component Summary (PCS) was correlated positively with FVC upright, HHD, MRC and 6MWT scores, there was no significant relationship between the SF-36 Mental Component Summary (MCS) and any of the physical outcomes. Conclusions Participation, daily-life activities, and the physical component of quality of life of adult Pompe patients are positively correlated to physical outcomes. This work serves as a first step towards assessing how changes over time in physical outcomes are related to changes in PROMs, and to define the minimal change in physical outcomes required to make an important difference for the patient.
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6
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Berger KI, Kanters S, Jansen JP, Stewart A, Sparks S, Haack KA, Bolzani A, Siliman G, Hamed A. Forced vital capacity and cross-domain late-onset Pompe disease outcomes: an individual patient-level data meta-analysis. J Neurol 2019; 266:2312-2321. [PMID: 31187190 PMCID: PMC6687674 DOI: 10.1007/s00415-019-09401-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 11/28/2022]
Abstract
Background Late-onset Pompe disease (LOPD) is a rare, metabolic disease primarily affecting the musculoskeletal and respiratory systems. Forced vital capacity (FVC) is commonly used to measure pulmonary function; however, associations between FVC and other LOPD outcomes remain unclear. Methods A systematic literature review was conducted on November 2015, updated September 2016 and supplemented with clinical trial data from the sponsor. Outcomes included: 6-min walk test distance (6MWT), FVC, maximal inspiratory/expiratory pressure (MIP/MEP), Medical Research Council-skeletal muscle strength score (MRC), 36-item short-form survey-physical component score (SF-36), Rotterdam Handicap Scale (RHS), Fatigue Severity Scale (FSS) and survival. Individual patient data meta-analysis was used for cross-sectional analyses and longitudinal analyses to determine associations between percent of predicted FVC and LOPD measures and outcomes. Results Fifteen studies were selected. From cross-sectional analyses, FVC and MRC were most strongly associated. Specifically, patients with 10% higher FVC (a round number for illustrative purposes only) were associated with a 4.72% (95% confidence interval [CI]: 3.37, 6.07) higher MRC score, indicating a positive association. Similarly, slopes for the 6MWT and SF-36 relative to a 10% higher FVC were estimated at 33.2 meters (95% CI 24.0, 42.4) and 1.2% (95% CI 0.24, 2.16%), respectively. From longitudinal analyses, a 10% incremental increase in predicted FVC was associated with an average increase of 4.12% in MRC score (95% CI 1.29, 6.95), 35.6 m in the 6MWT (95% CI 19.9, 51.6), and 1.34% in SF-36 (95% CI 0.08, 2.60). There was insufficient data to conduct analyses for RHS, FSS and survival. Conclusions FVC is positively associated with LOPD measures and outcomes across multiple domains. Additionally, longitudinal changes in FVC are positively associated with changes in the 6MWT, MRC and SF-36. Electronic supplementary material The online version of this article (10.1007/s00415-019-09401-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kenneth I Berger
- André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA. .,Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, NY, USA.
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7
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Andela CD, Lobatto DJ, Pereira AM, van Furth WR, Biermasz NR. How non-functioning pituitary adenomas can affect health-related quality of life: a conceptual model and literature review. Pituitary 2018; 21:208-216. [PMID: 29302835 PMCID: PMC5849670 DOI: 10.1007/s11102-017-0860-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After treatment for a non-functioning pituitary adenoma (NFA) health-related quality of life (HR-QoL) improves considerably. However, the literature about the normalization of HR-QoL after treatment is inconclusive. Some researchers described a persistently decreased HR-QoL compared to reference data, while others did not. Considering this variety in observed HR-QoL outcomes, the aim of the present review was to provide a literature overview of health outcomes in patients with a NFA, using a conceptual HR-QoL model. A concrete conceptualization of the health outcomes of patients with a NFA can be helpful to understand the observed variety in HR-QoL outcomes and to improve clinical care and guidance of these patients. For this conceptualization, the Wilson and Cleary model was used. This model has a biopsychosocial character and has been validated in several patient populations. In the present review, health outcomes of patients with a NFA were described at each stage of the model e.g. biological and physiological variables, symptom status, functional status, general health perceptions and overall HR-QoL. The Wilson-Cleary model elucidates that elements at each stage of the model can contribute to the impairment in HR-QoL of patients with a NFA, which explains the reported variety in the literature. Furthermore, by applying the model, potential interventions targeting these elements can be identified. While optimal biomedical treatment has always been the focus, it is clearly not sufficient for good HR-QoL in patients with a NFA. Further improvement of HR-QoL should be supported by a pituitary specific care trajectory, including psychosocial care (e.g. self-management training), to beneficially affect characteristics of the patient and the (healthcare) environment, with the utmost goal to optimize HR-QoL in patients after treatment.
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Affiliation(s)
- Cornelie D Andela
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Ricci G, Baldanzi S, Seidita F, Proietti C, Carlini F, Peviani S, Antonini G, Vianello A, Siciliano G. A mobile app for patients with Pompe disease and its possible clinical applications. Neuromuscul Disord 2018; 28:471-475. [PMID: 29655528 DOI: 10.1016/j.nmd.2018.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
In recent years, the potential of smart technology to provide innovative solutions for disease management has raised high expectations for patients' and healthcare professionals' community. We developed a mobile app, called AIGkit, specifically designed for adult patients with Pompe disease, with the aim to help them manage the burden of illness-related factors, and also to provide clinicians with continuous tracking of each patient in real-time and ambient conditions of everyday life. We present the AIGkit as an innovative approach exploiting cutting-edge technology to improve quality of care and research into neuromuscular disorders.
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Affiliation(s)
- Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Sigrid Baldanzi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Fabrizio Seidita
- Associazione Italiana Glicogenosi - ONLUS, Via Roma 2/G, 20090 Assago (Milan), Italy
| | - Chiara Proietti
- Vidiemme Consulting s.r.l, Via Natale Battaglia 8, 20127 Milan, Italy
| | - Francesca Carlini
- Vidiemme Consulting s.r.l, Via Natale Battaglia 8, 20127 Milan, Italy
| | - Silvia Peviani
- Vidiemme Consulting s.r.l, Via Natale Battaglia 8, 20127 Milan, Italy
| | - Giovanni Antonini
- Department of Neurology, S. Andrea Hospital, University of Rome "Sapienza", via Grottarossa 1035, 00189 Rome, Italy
| | - Andrea Vianello
- Department of Cardio-Thoracic, Respiratory Pathophysiology Division, University-City Hospital of Padova, Via Giustiniani 2, Padova, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy.
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Kanters TA, van der Ploeg AT, Kruijshaar ME, Rizopoulos D, Redekop WK, Rutten-van Mӧlken MPMH, Hakkaart-van Roijen L. Cost-effectiveness of enzyme replacement therapy with alglucosidase alfa in adult patients with Pompe disease. Orphanet J Rare Dis 2017; 12:179. [PMID: 29237491 PMCID: PMC5729274 DOI: 10.1186/s13023-017-0731-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pompe disease is a rare, progressive, metabolic disease, and the first treatable inheritable muscle disorder. Enzyme replacement therapy (ERT) with alglucosidase alfa is disease specific and the only medicinal product authorized for the treatment of Pompe disease. Costs of ERT are very high as for most orphan drugs. This study investigates the cost-effectiveness of ERT compared to supportive treatment in adult patients with Pompe disease. METHODS Survival probabilities were estimated from an international observational dataset (n = 283) using a time-dependent Cox model. Quality of life was estimated on a Dutch observational dataset using a previously developed conceptual model which links clinical factors to quality of life. Costs included costs of ERT, costs of drug administration and other healthcare costs. Cost-effectiveness was estimated using a patient-level simulation model (n = 90), synthesising the information from underlying models for survival, quality of life and costs. The cost-effectiveness model estimated the (difference in) lifetime effects and costs for both treatments. Two scenarios were modelled: (1) a worse case scenario with no extrapolation of the survival gain due to ERT beyond the observed period (i.e. from 10 years onwards); and (2) a best case scenario with lifetime extrapolation of the survival gain due to ERT. Effects were expressed in (quality adjusted) life years (QALYs). Costs were discounted at 4.0% and effects at 1.5%. RESULTS Substantial increases in survival were estimated - discounted incremental life years of ERT ranged from 1.9 years to 5.4 years in the scenarios without and with extrapolation of survival gains beyond the observed period. Quality of life was also significantly better for patients receiving ERT. Incremental costs were considerable and primarily consisted of the costs of ERT. Incremental costs per QALY were €3.2 million for scenario 1 and €1.8 million for scenario 2. CONCLUSIONS The availability of extended, prospectively collected, longitudinal observational data on the most important input parameters required to construct a cost-effectiveness model is quite exceptional for orphan diseases. The cost-effectiveness model showed substantial survival gains from ERT. Despite these substantial gains, ERT was not cost-effective in the treatment of adult Pompe disease because of the high cost of treatment.
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Affiliation(s)
- Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000DR, Rotterdam, the Netherlands.
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics Sophia's Children's Hospital, Rotterdam, the Netherlands
| | - Michelle E Kruijshaar
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics Sophia's Children's Hospital, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - W Ken Redekop
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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