A willingness-to-pay assessment of parents' preference for shorter duration treatment of acute otitis media in children

Validations of the OM-6 Parent-Proxy Survey for Infants/Toddlers with Otitis Media

Objective To validate the Otitis Media-6 (OM-6), a parent-proxy quality-of-life (QOL) questionnaire for infants/young children with OM, against other previously validated generic QOL questionnaires. Study Design Multi-institutional cross-sectional study. Setting Twenty-three otolaryngology, pediatric, and family practices across the United States. Subjects and Methods Caregivers of 6- to 24-month-old children with a history of OM completed the OM-6, OM History Form, and Pediatric Quality of Life (PedsQL) Infant Scales survey. Principal components analysis (PCA) examined the underlying factor structure of items on the OM-6, and Cronbach's α measured the internal consistency of items on each factor. Discriminant validity was assessed with receiver operating curves (ROCs). Results Surveys from 1045 patients were analyzed. The overall OM-6 was strongly to moderately correlated with the PedsQL Infant Scales scores (Pearson r = -0.649 for ages 6-12 months and -0.566 for ages 13-24 months). Two underlying constructs, "Behavior and Symptoms" and "Hearing and Speech," emerged from the PCA. Each factor and the overall OM-6 showed excellent internal consistency reliability (each Cronbach's α >0.75). The areas under the curve on the ROC analyses were <0.65 for recurrent and chronic OM using a variety of frequency and chronicity cut-points and definitions. Conclusion The OM-6 measures 2 underlying QOL constructs, Behavior and Symptoms and Hearing/Speech. The overall OM-6 showed acceptably high internal consistency reliability and good construct validity. However, the ability of the OM-6 to identify children who have more severe clinical recurrent or chronic OM vs milder disease was not supported by our analysis.

Understanding Patient Preferences in Medication Nonadherence: A Review of Stated Preference Data

Nonadherence is a global problem undermining the cost-effectiveness of evidence-based medications. Aligning treatment choices with patient preferences may promote adherent behaviour: eliciting patient treatment preferences may help resolve the problem of nonadherence. As there is no reliable measure of nonadherent behaviour that can be used to derive preferences, stated-preference techniques offer a robust alternative. To understand patient preferences in medication nonadherence, we systematically appraised full-text English studies (from database inception to 24 February 2014) involving participants evaluating hypothetical scenarios to elicit preferences as an explicit means to understand medication nonadherence. Study characteristics (e.g. setting, disease, stated-preference method), attribute type and influence on choice were extracted. Seventeen full-text articles (4,456 patients) were included in the review, which reports stated-preference elicitation studies across a wide range of chronic and acute conditions. All studies were conducted in high-income settings. The influence of drug-related factors was predominant in patients' preferences for treatment. Patients preferred efficacious over safe medications except when considering the duration of therapy, but dosing and cost appeared more important when contemplating adherence. Patient characteristics, particularly medication experience, significantly influenced preferences. A disparity between stated preferences for treatment and adherence was reported. When using stated-preference techniques to understand nonadherence, this manuscript highlights that there is much room for methodological development. Studies outside of high-income settings are needed, particularly in relation to chronic diseases, for which nonadherence poses a substantial economic burden to health systems and patients. To inform the problem of sustaining adherence, prospective research is needed to understand how preferences change with time. The usefulness of stated-preference techniques to inform policy and practice requires a better understanding of how stated preferences relate to actual adherence behaviour.

A 3-day regimen with azithromycin 1.5% eyedrops for the treatment of purulent bacterial conjunctivitis in children: efficacy on clinical signs and impact on the burden of illness

PURPOSE

To compare the efficacy of azithromycin 1.5% versus tobramycin 0.3% eyedrops on clinical ocular signs and symptoms of bacterial conjunctivitis in children and to assess the parents' satisfaction regarding the dosing regimen.

PATIENTS AND METHODS

An international, multicenter, randomized, investigator-masked, controlled clinical trial conducted in children (1 day to 18 years old) with bulbar conjunctival hyperemia and purulent discharge. Azithromycin 1.5% was administered as 1 drop twice daily for 3 days, and tobramycin 0.3% as 1 drop every 2 hours for 2 days, then 4 times daily for 5 days.

RESULTS

A total of 286 patients (mean age: 3.2 years) were enrolled. In children with bacteriologically positive cultures (N=203), azithromycin produced a significantly greater improvement in conjunctival discharge (P<0.01) and a trend (P=0.054) toward improvement in conjunctival hyperemia at day 7 than did tobramycin. Complete resolution of conjunctival discharge was significantly more frequent at day 3 on azithromycin than tobramycin (P=0.005). More parents found azithromycin easier to use (in terms of treatment duration, total number of instillations, instilling drops during the day, and difficulty in performing daily activities) than tobramycin.

CONCLUSION

The azithromycin 1.5% regimen produced a rapid resolution of cardinal signs of purulent bacterial conjunctivitis with a more convenient dosage regimen. Such improved convenience is likely to improve compliance and lessen the burden of illness for patients and carers.

Caregiver Quality of Life Is Related to Severity of Otitis Media in Children

OBJECTIVE

Otitis media (OM) in children is the most frequent reason for physician visits in developed countries and burdens caregivers, society, and the child. Our objective was to describe the impact of OM severity on parent/caregiver quality of life (QoL).

STUDY DESIGN

Multi-institutional prospective cross-sectional study.

SETTING

Otolaryngology, family, and pediatric practices.

SUBJECTS AND METHODS

Children 6 to 24 months old with and without a primary diagnosis of recurrent OM and their caregivers. Physicians provided patient history, and parents/caregivers completed a Family Information Form, the PedsQL Family Impact survey, the Patient Reported Outcomes Measurement Information System (PROMIS) survey, and the OM 6-item severity survey (OM-6).

RESULTS

A total of 2413 subjects were enrolled and data from 1208 patients and physician were analyzed. The average child age was 16 months, and 54% were male. The mean OM-6 score was 3.2. The mean PedsQL Family Impact score for parents was 66.9 from otolaryngology sites and 78.8 from pediatrics/family practice sites (P < .001). Higher (worse) OM-6 scores correlated significantly with worse PedsQL Family Impact scores (Pearson r = -0.512, P < .01). Similarly, increasing OM-6 scores strongly correlated with increased parental anxiety, depression, and fatigue, as well as decreased satisfaction (all P < .01).

CONCLUSIONS

Worse PedsQL Family Impact and PROMIS scores were highly correlated with elevated OM-6 scores, suggesting that severity of childhood OM significantly affects parent/caregiver QoL. Understanding the impact of a child's illness on parent/caregiver QoL can help physicians counsel patients and families and provide better family-centered, compassionate care.

Impact of Otitis Media Severity on Children's Quality of Life

OBJECTIVE

Children with otitis media (OM) suffer sleep disturbances, loss of appetite, earache, and behavioral problems. Our objective was to quantitate the average burden of OM and to compare the associated impact of tympanostomy tubes on infant health related quality of life (HR-QoL).

STUDY DESIGN

Multi-institutional prospective cross-sectional study.

SETTING

Otolaryngology, family practice, and pediatric clinics.

SUBJECTS AND METHODS

Children ages 6 to 24 months of age with or without recurrent OM. Patient history, the PedsQL Infant QoL survey, and the 6-item child with OM survey (Otitis Media 6 [OM-6]) were collected from providers and parents.

RESULTS

Data from 1208 patients were analyzed. Mean age was 14.7 months, and 54% were male. The mean OM-6 score of children with recurrent OM was 3.3, whereas similarly aged well-children had a mean OM-6 score of 2.5. The mean PedsQL Infant scores of recurrent OM patients were significantly worse than those of children from well-child visits. Worse OM-6 scores were correlated with poorer PedsQL Infant scores, Pearson r = -0.581 (1-12 months) and -0.558 (13-24 months), P < .001. Otolaryngology patients who were recommended to undergo ear tube placement had significantly poorer OM-6 scores and worse PedsQL Infant scores, whereas patients with prior tube placement had significantly better OM-6 and PedsQL Infant scores.

CONCLUSION

Children with recurrent OM had significantly worse HR-QoL than similarly aged healthy children. Increased burden of OM strongly affected HR-QoL, and recommendation for tube placement was associated with increased disease burden and poorer HR-QoL. The presence of tympanostomy tubes was associated with better OM-6 and PedsQL Infant scores.

Willingness-to-pay to avoid the time spent and discomfort associated with screening colonoscopy

BACKGROUND

The screening colonoscopy process requires a considerable amount of time and some discomfort for patients.

OBJECTIVE

We sought to use willingness-to-pay (WTP) to value the time required and the discomfort associated with screening colonoscopy. In addition, we aimed to explore some of the differences between and potential uses of the WTP and the human capital methods.

METHODS

Subjects completed a diary recording time and a questionnaire including WTP questions to value the time and discomfort associated with colonoscopy. We also valued the elapsed time reported in the diaries (but not the discomfort) using the human capital method.

RESULTS

110 subjects completed the study. Mean WTP to avoid the time and discomfort was $263. Human capital values for elapsed time were greater. Linear regressions showed that WTP was influenced most by the difficulty of the preparation, which added $147 to WTP (p=0.03).

CONCLUSIONS

WTP values to avoid the time and discomfort associated with the screening colonoscopy process were substantially lower than most of the human capital values for elapsed time alone. The human capital method may overestimate the value of time in situations that involve an irregular, episodic series of time intervals, such as preparation for or recovery after colonoscopy.

Are adult patients more tolerant of treatment risks than parents of juvenile patients?

Understanding patient-specific differences in risk tolerance for new treatments that offer improved efficacy can assist in making difficult regulatory and clinical decisions for new treatments that offer both the potential for greater effectiveness in relieving disease symptoms, but also risks of disabling or fatal side effects. The aim of this study is to elicit benefit-risk trade-off preferences for hypothetical treatments with varying efficacy and risk levels using a stated-choice (SC) survey. We derive estimates of "maximum acceptable risk" (MAR) that can help decisionmakers identify welfare-enhancing alternatives. In the case of children, parent caregivers are responsible for treatment decisions and their risk tolerance may be quite different than adult patients' own tolerance for treatment-related risks. We estimated and compared the willingness of Crohn's disease (CD) patients and parents of juvenile CD patients to accept serious adverse event (SAE) risks in exchange for symptom relief. The analyzed data were from 345 patients over the age of 18 and 150 parents of children under the age of 18. The estimation results provide strong evidence that adult patients and parents of juvenile patients are willing to accept tradeoffs between treatment efficacy and risks of SAEs. Parents of juvenile CD patients are about as risk tolerant for their children as adult CD patients are for themselves for improved treatment efficacy. SC surveys provide a systematic method for eliciting preferences for benefit-risk tradeoffs. Understanding patients' own risk perceptions and their willingness to accept risks in return for treatment benefits can help inform risk management decision making.

Willingness to Pay for a Cure in Patients with Chronic Gout

Introduction. Gout is a chronic painful inflammatory arthritis. The authors interviewed patients with chronic stable gout to assess their hypothetical willingness to pay (WTP) to be cured of their gout. Patients and Methods. Patients with gout were asked how much money they would be willing to pay every month out of pocket or as a co-pay to cure their gout. To assess determinants of WTP amounts, the authors performed stepwise multivariable linear regression analysis, controlling for demographics, health status, and relative concern about gout. Results. Of the 78 patients, 70 (90%) were male, 54 (69%) were Caucasian, 21 (27%) were African American, and 32 (41%) had annual incomes < $25,000. The median WTP amount was $25 ($0, $75) per month, and the mean (s ) was $52 ($74) per month (range, $0-$350); 23 (30%) patients were unwilling to pay any amount. Patients who rated their gout as their top health concern were willing to pay a median of $63 ($25, $100) per month. In multivariable analysis, gout as the top health concern, greater frequency of gouty attacks over the past 1 y, and younger age were significantly associated with WTP amounts (R2 =0:19 ). Conclusion. Many patients with chronic gout would be willing to pay money every month in perpetuity to be cured of their gout. Younger patients, patients whose main health concern is gout, and patients with frequent attacks are willing to pay the most.

Topical retapamulin ointment (1%, wt/wt) twice daily for 5 days versus oral cephalexin twice daily for 10 days in the treatment of secondarily infected dermatitis: results of a randomized controlled trial

BACKGROUND

New antibacterial agents with activity against pathogenic strains resistant to established antibiotics are needed to treat patients with secondarily infected dermatitis (SID).

OBJECTIVE

We sought to determine the clinical safety and efficacy of topical retapamulin ointment 1% versus oral cephalexin for the treatment of SID.

METHODS

Patients with SID were randomly assigned to retapamulin ointment 1% (twice daily [bid]) for 5 days, or oral cephalexin (500 mg bid) for 10 days. The primary efficacy end point was clinical response at follow-up. Secondary outcomes included microbiologic response at follow-up, safety, and compliance.

RESULTS

Retapamulin was as effective as cephalexin (clinical success rates at follow-up: 85.9% and 89.7%, respectively). Microbiologic success rates at follow-up were 87.2% for retapamulin and 91.8% for cephalexin. Retapamulin was well tolerated and the topical formulation was preferred over the oral drug.

LIMITATIONS

An imbalance existed in the number of patients with the clinical outcome "unable to determine" (15 retapamulin, 2 cephalexin), mainly because of their failure to attend the study visit. If those who failed to attend visits (who did not withdraw as a result of drug-related events) are removed from the analysis, the clinical success rates are 89.9% for retapamulin and 89.7% for cephalexin.

CONCLUSIONS

Retapamulin ointment 1% (bid) for 5 days was as effective as oral cephalexin (bid) for 10 days in treatment of patients with SID, and was well tolerated.