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Pilz MJ, Seyringer S, Al-Naesan I, King MT, Bottomley A, Norman R, Schlosser L, Hell T, Gamper EM. Cancer-Specific Health Utilities: Evaluation of Core Measurement Properties of the EORTC QLU-C10D in Lung Cancer Patients-Data from Four Multicentre LUX-Lung Trials, Applying Six Country Tariffs. PHARMACOECONOMICS - OPEN 2024; 8:627-640. [PMID: 38696019 PMCID: PMC11252099 DOI: 10.1007/s41669-024-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Cost-utility analysis generally requires valid preference-based measures (PBMs) to assess the utility of patient health. While generic PBMs are widely used, disease-specific PBMs may capture additional aspects of health relevant for certain patient populations. This study investigates the construct and concurrent criterion validity of the cancer-specific European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility-Core 10 dimensions (QLU-C10D) in non-small-cell lung cancer patients. METHODS We retrospectively analysed data from four multicentre LUX-Lung trials, all of which had administered the EORTC Quality of Life Questionnaire (QLQ-C30) and the EQ-5D-3L. We applied six country-specific value sets (Australia, Canada, Italy, the Netherlands, Poland, and the United Kingdom) to both instruments. Criterion validity was assessed via correlations between the instruments' utility scores. Correlations of divergent and convergent domains and Bland-Altman plots investigated construct validity. Floor and ceiling effects were assessed. RESULTS The comparison of the EORTC QLU-C10D and EQ-5D-3L produced homogenous results for five of the six country tariffs. High correlations of utilities (r > 0.7) were found for all country tariffs except for the Netherlands. Moderate to high correlations of converging domain pairs (r from 0.472 to 0.718) were found with few exceptions, such as the Social Functioning-Usual Activities domain pair (max. r = 0.376). For all but the Dutch tariff, the EORTC QLU-C10D produced consistently lower utility values compared to the EQ-5D-3L (x̄ difference from - 0.082 to 0.033). Floor and ceiling effects were consistently lower for the EORTC QLU-C10D (max. 4.67% for utilities). CONCLUSIONS The six country tariffs showed good psychometric properties for the EORTC QLU-C10D in lung cancer patients. Criterion and construct validity was established. The QLU-C10D showed superior measurement precision towards the upper and lower end of the scale compared to the EQ-5D-3L, which is important when cost-utility analysis seeks to measure health change across the severity spectrum.
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Affiliation(s)
- Micha J Pilz
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Simone Seyringer
- Department of Nuclear Medicine, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Imad Al-Naesan
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Madeleine T King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Lisa Schlosser
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
| | - Tobias Hell
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
| | - Eva Maria Gamper
- Department of Nuclear Medicine, Medical University of Innsbruck, 6020, Innsbruck, Austria.
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Karam SG, Zhang Y, Pardo-Hernandez H, Siebert U, Koopman L, Noyes J, Tarride JE, Stevens AL, Welch V, Saz-Parkinson Z, Ens B, Devji T, Xie F, Hazlewood G, Mbuagbaw L, Alonso-Coello P, Brozek JL, Schünemann HJ. ROBVALU: a tool for assessing risk of bias in studies about people's values, utilities, or importance of health outcomes. BMJ 2024; 385:e079890. [PMID: 38866410 PMCID: PMC11167527 DOI: 10.1136/bmj-2024-079890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Samer G Karam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL-University for Health Sciences and Technology, Hall in Tirol, Austria
- Center for Health Decision Science and Departments of Epidemiology and Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Koopman
- Department of Specialist Medical Care, National Health Care Institute, Diemen, Netherlands
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Wales, UK
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
- Programs for Assessment of Technologies in Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Adrienne L Stevens
- Centre for Immunisation Programmes, Public Health Agency of Canada, ON, Canada
| | - Vivian Welch
- Bruyère Research Institute and, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Brendalynn Ens
- Implementation Support and Knowledge Mobilisation, Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - Tahira Devji
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anaesthesia, McMaster University, Hamilton, ON, Canada
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Sant Quintí, Barcelona, Spain
| | - Jan L Brozek
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, ON, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Clinical Epidemiology and Research Centre (CERC), Humanitas Universityand Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Pilz MJ, Seyringer S, Hallsson LR, Bottomley A, Jansen F, King MT, Norman R, Rutten MJ, Verdonck-de Leeuw IM, Siersema PD, Gamper EM. The EORTC QLU-C10D is a valid cancer-specific preference-based measure for cost-utility and health technology assessment in the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01670-6. [PMID: 38483665 DOI: 10.1007/s10198-024-01670-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/10/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Cost-utility analysis typically relies on preference-based measures (PBMs). While generic PBMs are widely used, disease-specific PBMs can capture aspects relevant for certain patient populations. Here the EORTC QLU-C10D, a cancer-specific PBM based on the QLQ-C30, is validated using Dutch trial data with the EQ-5D-3L as a generic comparator measure. METHODS We retrospectively analysed data from four Dutch randomised controlled trials (RCTs) comprising the EORTC QLQ-C30 and the EQ-5D-3L. Respective Dutch value sets were applied. Correlations between the instruments were calculated for domains and index scores. Bland-Altman plots and intra-class correlations (ICC) displayed agreement between the measures. Independent and paired t-tests, effect sizes and relative validity indices were used to determine the instruments' performance in detecting clinically known-group differences and health changes over time. RESULTS We analysed data from 602 cancer patients from four different trials. In overall, the EORTC QLU-C10D showed good relative validity with the EQ-5D-3L as a comparator (correlations of index scores r = 0.53-0.75, ICCs 0.686-0.808, conceptually similar domains showed higher correlations than dissimilar domains). Most importantly, it detected 63% of expected clinical group differences and 50% of changes over time in patients undergoing treatment. Both instruments showed poor performance in survivors. Detection rate and measurement efficiency were clearly higher for the QLU-C10D than for the EQ-5D-3L. CONCLUSIONS The Dutch EORTC QLU-C10D showed good comparative validity in patients undergoing treatment. Our results underline the benefit that can be achieved by using a cancer-specific PBM for generating health utilities for cancer patients from a measurement perspective.
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Affiliation(s)
- Micha J Pilz
- University Hospital of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall, I.T., Austria
| | - Simon Seyringer
- Department of Nuclear Medicine, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Lára R Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall, I.T., Austria
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Femke Jansen
- Department Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7-9, Amsterdam, The Netherlands
| | - Madeleine T King
- School of Psychology, University of Sydney, New South Wales, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Marianne J Rutten
- Center of Gynaecologic Oncology Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7-9, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center, Rotterdam, The Netherlands
| | - Eva Maria Gamper
- University Hospital of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria.
- Department of Nuclear Medicine, Medical University of Innsbruck, 6020, Innsbruck, Austria.
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Kennedy K, Sarohia G, Podbielski D, Pickard S, Tarride JE, Xie F. Systematic methodological review of health state values in glaucoma cost-utility analyses. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01663-x. [PMID: 38411844 DOI: 10.1007/s10198-023-01663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/21/2023] [Indexed: 02/28/2024]
Abstract
IMPORTANCE Describing the characteristics and sources of health state utility values and reporting practice in the literature of cost-utility analyses facilitates an understanding of the level of the transparency, validity, and generalizability of cost-utility analyses. Improving the quality of reporting will support investigators in describing the incremental value of emerging glaucoma interventions. OBJECTIVE To describe the state of practice among published glaucoma cost-utility analysis studies, focusing on valuation of health and the quality of reporting. EVIDENCE REVIEW We searched several databases including Medline, CINHAL, Embase, Web of Science, Scopus, Biosis previews, the Health Economic Evaluations Database, and the NHS Economic Evaluation Database (NHS EED). We included full-text, English, published cost-utility analyses of glaucoma interventions with quality-adjusted life years (QALYs) as the primary outcome measure to calculate incremental cost-utility ratios. Excluded studies were non-English language, reviews, editorials, protocols, or other types of economic studies (cost-benefit, cost-minimization, cost-effectiveness). Study characteristics, operational definitions of glaucoma health states and health state utilities were extracted. The original source of the health utility was reviewed to determine the scale of measurement and the source of preference weighting. Items from the Systematic Review of Utilities for Cost-Effectiveness (SpRUCE checklist) were used to assess the reporting and quality of health utilities in glaucoma CUA. FINDINGS 43 CUAs were included, with 11 unique sources of health utilities. A wide range of health utilities for the same Hodapp-Parrish-Anderson glaucoma health states were reported; ocular hypertension (0.84-0.95), mild (0.68-0.94), moderate (0.57-0.92), advanced (0.58-0.88), severe/blind (0.46-0.76), and bilateral blindness (0.26-0.5). Most studies reported the basis for using health utilities (34, 79%) and any assumptions or adjustments applied to the health utilities (22, 51%). Few studies reported a framework for assessing the relevance of health utilities to a decision context (8, 19%). Even fewer (3, 7%) applied a systematic search strategy to identify health utilities and used a structured assessment of quality for inclusion. Overall, reporting has not improved over time. CONCLUSIONS AND RELEVANCE This review describes that few CUAs describe important rationale for using health state utility values. Including additional details on the search, appraisal, selection, and inclusion process of health utility values improves transparency, generalizability and supports the assessment of the validity of study conclusions. Future investigations should aim to use health utilities on the same scale of measurement across health states and consider the source and relevance to the decision context/purpose of conducting that cost-utility study.
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Affiliation(s)
- Kevin Kennedy
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T1Z3, Canada.
| | - Gurkaran Sarohia
- Department of Ophthalmology and Visual Sciences, University of Alberta, 400, 10924, 107 Avenue, Edmonton, AB, T5H 0X5, Canada
| | | | - Simon Pickard
- College of Pharmacy-Pharmacy Systems Outcomes and Policy, University of Illinois Chicago, Chicago, USA
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Walter N, Hierl K, Rupp M, Alt V. Basics of health economics for clinical trials in orthopaedic trauma. Injury 2023; 54 Suppl 5:110878. [PMID: 37923505 DOI: 10.1016/j.injury.2023.110878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 11/07/2023]
Abstract
With the rise in global healthcare spending, medical decision-making is increasingly based on health economics outcomes. This narrative review aims to provide an overview of cost-effectiveness analysis (CEA) and cost-utility analysis (CUA), including their advantages and limitations, and outline practical aspects for implementing health economics in clinical trials for orthopaedic trauma. Both CEA and CUA offer several advantages. Firstly, they consider the costs as well as benefits of an intervention, providing a more comprehensive picture of its economic impact. Secondly, they provide a clear and straightforward metric for comparing interventions, which can help decision-makers make informed choices. However, there are methodological shortcomings that must be acknowledged, such as the lack of standardized instruments for assessing health utility measures, which can result in a wide range of cost-benefit ratios. In addition, a consensus on the willingness-to-pay threshold still needs to be reached to develop decision rules for cost-effectiveness similar to clinical effectiveness. Methods such as CEA and CUA should be incorporated into clinical trials in orthopaedic trauma research. Practical aspects for this include planning in advance, preferably in cooperation with a health economist. Selecting appropriate outcome measures is crucial, and both the medical effects of interventions and quality of life instruments should be carefully chosen to ensure comparability with previous studies. Additionally, the potential impact on clinical practice and healthcare policies should be considered. Direct as well as indirect costs should be assessed, and quality assurance with well-established checklists should be confirmed.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany; Department of Psychosomatic Medicine, University Hospital Regensburg, Germany.
| | - Katja Hierl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
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Sheikh Y, Asunramu H, Low H, Gakhar D, Muthukumar K, Yassin H, de Preux L. A Cost-Utility Analysis of Mesh Prophylaxis in the Prevention of Incisional Hernias following Stoma Closure Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13553. [PMID: 36294132 PMCID: PMC9602752 DOI: 10.3390/ijerph192013553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Stoma closure is a widely performed surgical procedure, with 6295 undertaken in England in 2018 alone. This procedure is associated with significant complications; incisional hernias are the most severe, occurring in 30% of patients. Complications place considerable financial burden on the NHS; hernia costs are estimated at GBP 114 million annually. As recent evidence (ROCSS, 2020) found that prophylactic meshes significantly reduce rates of incisional hernias following stoma closure surgery, an evaluation of this intervention vs. standard procedure is essential. METHODS A cost-utility analysis (CUA) was conducted using data from the ROCSS prospective multi-centre trial, which followed 790 patients, randomly assigned to mesh closure (n = 394) and standard closure (n = 396). Quality of life was assessed using mean EQ-5D-3L scores from the trial, and costs in GBP using UK-based sources over a 2-year time horizon. RESULTS The CUA yielded an incremental cost-effectiveness ratio (ICER) of GBP 128,356.25 per QALY. Additionally, three univariate sensitivity analyses were performed to test the robustness of the model. CONCLUSION The results demonstrate an increased benefit with mesh prophylaxis, but at an increased cost. Although the intervention is cost-ineffective and greater than the ICER threshold of GBP 30,000/QALY (NICE), further investigation into mesh prophylaxis for at risk population groups is needed.
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Affiliation(s)
- Yusuf Sheikh
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK
| | - Hareef Asunramu
- Faculty of Medicine, Imperial College London, London SW7 2DD, UK
| | - Heather Low
- Faculty of Medical Sciences, University College London, London WC1E 6DE, UK
| | - Dev Gakhar
- Faculty of Medicine, Imperial College London, London SW7 2DD, UK
| | | | - Husam Yassin
- Faculty of Medicine, Imperial College London, London SW7 2DD, UK
| | - Laure de Preux
- Department of Economics and Public Policy, Business School, Imperial College London, London SW7 2AZ, UK
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Malik M, Gu NY, Hussain A, Saleem S, Purba FD, Al Sayah F. A Pilot Study of Valuation Methods of the EQ-5D and the Impact of Literacy, Cultural and Religious Factors on Preferences. Value Health Reg Issues 2022; 30:48-58. [DOI: 10.1016/j.vhri.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/21/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
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Touré M, Lesage A, Poder TG. Development of a balanced instrument to measure global health-related quality of life: The 13-MD. Front Psychiatry 2022; 13:837510. [PMID: 36147971 PMCID: PMC9485584 DOI: 10.3389/fpsyt.2022.837510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Generic instruments are of interest in measuring global health-related quality of life (GHRQoL). Their applicability to all patients, regardless of their health profile, allows program comparisons of whether the patients share the same disease or not. In this setting, quality-adjusted life-year (QALY) instruments must consider GHRQoL to allow the best programs to emerge for more efficiency in health resource utilization. However, many differences may be perceived among the existing generic instruments relative to their composition, where dimensions related to physical aspects of health are generally depicted more often than dimensions related to mental or social aspects. The objective of this study was to develop a generic instrument that would be complete in its covered meta-dimensions and reflect, in a balanced way, the important aspects of GHRQoL. To this end, a Delphi procedure was held in four rounds, gathering 18 participants, including seven patients, six caregivers, and five citizens. The structure of the instrument derived from the Delphi procedure was submitted to psychometric tests using data from an online survey involving the general population of Quebec, Canada (n = 2,273). The resulting questionnaire, the 13-MD, showed satisfying psychometric properties. It comprises 33 items or dimensions, with five to seven levels each. The 13-MD reflects, in a balanced form, the essential aspects of GHRQoL by including five meta-dimensions for physical health, four meta-dimensions for mental health, three meta-dimensions for social health, and one meta-dimension for sexuality and intimacy. The next step will involve the development of a value set for the 13-MD to allow QALY calculation.
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Affiliation(s)
- Moustapha Touré
- Department of Economics, Business School, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de Recherche de l'IUSMM, CIUSSS de l'Est de L'île de Montréal, Montréal, QC, Canada
| | - Alain Lesage
- Centre de Recherche de l'IUSMM, CIUSSS de l'Est de L'île de Montréal, Montréal, QC, Canada.,Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Thomas G Poder
- Centre de Recherche de l'IUSMM, CIUSSS de l'Est de L'île de Montréal, Montréal, QC, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC, Canada
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Zerguine H, Goode AD, Abbott A, Johnston V, Healy GN. Factors impacting workplace investment in sit-stand workstations from the perspective of purchasing decision-makers. APPLIED ERGONOMICS 2022; 98:103558. [PMID: 34411850 DOI: 10.1016/j.apergo.2021.103558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
This explanatory sequential mixed-method study explored the factors associated with the investment (or not) in sit-stand workstations (SSWs) and alternative initiatives to reduce prolonged sitting at work from the perspective of furniture purchasing decision-makers in Australian workplaces. Participants (n = 270) from >200 organisations across 19 industry sectors completed an online survey. Seven interviews were conducted in a sub-sample of participants from organisations without SSWs. The majority (80%) of workplaces reported having invested in SSWs. Workplaces without SSWs, opposed to those with SSWs, were more likely to be private (79.6% vs. 43.5%), of small/medium size (70.4% vs. 35.6%) and without a wellness program (57.4% vs. 22.2%) (all p < 0.05). Financial implications were the main reason for not investing in SSWs. Exercise and stretch breaks were alternative initiatives to reducing sedentary behaviour at work. Better evidence on the return on investment is needed to support purchasing decisions on SSWs.
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Affiliation(s)
- Haroun Zerguine
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Brisbane, QLD, 4072, Australia.
| | - Ana D Goode
- The University of Queensland, School of Public Health, Herston, Brisbane, QLD 4006, Australia
| | - Alison Abbott
- Workplace Health and Safety Queensland, Office of Industrial Relations, Queensland Government, Australia
| | - Venerina Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Brisbane, QLD, 4072, Australia
| | - Genevieve N Healy
- The University of Queensland, School of Public Health, Herston, Brisbane, QLD 4006, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; School of Physiotherapy and Exercise Science, Curtin University, Perth, WA 6845, Australia
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10
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A Systematic Review of Health State Utility Values in the Plastic Surgery Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3944. [PMID: 34849317 PMCID: PMC8615317 DOI: 10.1097/gox.0000000000003944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/15/2021] [Indexed: 01/23/2023]
Abstract
Cost-utility analyses assess health gains acquired by interventions by incorporating weighted health state utility values (HSUVs). HSUVs are important in plastic and reconstructive surgery (PRS) because they include qualitative metrics when comparing operative techniques or interventions. We systematically reviewed the literature to identify the extent and quality of existing original utilities research within PRS. Methods A systematic review of articles with original PRS utility data was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines. Subspecialty, survey sample size, and respondent characteristics were extracted. For each HSUV, the utility measure [direct (standard gamble, time trade off, visual analog scale) and/or indirect], mean utility score, and measure of variance were recorded. Similar HSUVs were pooled into weighted averages based on sample size if they were derived from the same utility measure. Results In total, 348 HSUVs for 194 disease states were derived from 56 studies within seven PRS subspecialties. Utility studies were most common in breast (n = 17, 30.4%) and hand/upper extremity (n = 15, 26.8%), and direct measurements were most frequent [visual analog scale (55.4%), standard gamble (46.4%), time trade off (57.1%)]. Studies surveying the general public had more respondents (n = 165, IQR 103-299) than those that surveyed patients (n = 61, IQR 48-79) or healthcare professionals (n = 42, IQR 10-109). HSUVs for 18 health states were aggregated. Conclusions The HSUV literature within PRS is scant and heterogeneous. Researchers should become familiar with these outcomes, as integrating utility and cost data will help illustrate that the impact of certain interventions are cost-effective when we consider patient quality of life.
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11
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Abstract
Achieving health equity has proven elusive for two reasons. First, most research has focused on changing the behavior of individuals; however, policies that address socioeconomic factors or change the context to facilitate healthy decisions tend to be more effective. Second, health disparity science and evidence are not consistently used to guide policy makers, even those seeking health equity. In this perspective, we discuss economic evaluation tools that researchers can use to assist decision-makers in conducting research or evaluating policy: self-reported health-related quality of life surveys and cost-benefit analysis evaluations informed with willingness to pay research and analyses.
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Affiliation(s)
- Maria Isabel Roldós
- City University of New York (CUNY) Institute for Health Equity, Bronx, New York, USA
- Department of Health Services Administration, School of Health Sciences, Human Services and Nursing (HS2N), Lehman College–CUNY, Bronx, New York, USA
| | - Nancy Breen
- Office of Science Policy, Planning, Evaluation, and Reporting (OSPPER), National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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12
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Turner HC, Archer RA, Downey LE, Isaranuwatchai W, Chalkidou K, Jit M, Teerawattananon Y. An Introduction to the Main Types of Economic Evaluations Used for Informing Priority Setting and Resource Allocation in Healthcare: Key Features, Uses, and Limitations. Front Public Health 2021; 9:722927. [PMID: 34513790 PMCID: PMC8424074 DOI: 10.3389/fpubh.2021.722927] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Economic evidence is increasingly being used for informing health policies. However, the underlining principles of health economic analyses are not always fully understood by non-health economists, and inappropriate types of analyses, as well as inconsistent methodologies, may be being used for informing health policy decisions. In addition, there is a lack of open access information and methodological guidance targeted to public health professionals, particularly those based in low- and middle-income country (LMIC) settings. The objective of this review is to provide a comprehensive and accessible introduction to economic evaluations for public health professionals with a focus on LMIC settings. We cover the main principles underlining the most common types of full economic evaluations used in healthcare decision making in the context of priority setting (namely cost-effectiveness/cost-utility analyses, cost-benefit analyses), and outline their key features, strengths and weaknesses. It is envisioned that this will help those conducting such analyses, as well as stakeholders that need to interpret their output, gain a greater understanding of these methods and help them select/distinguish between the different approaches. In particular, we highlight the need for greater awareness of the methods used to place a monetary value on the health benefits of interventions, and the potential for such estimates to be misinterpreted. Specifically, the economic benefits reported are typically an approximation, summarising the health benefits experienced by a population monetarily in terms of individual preferences or potential productivity gains, rather than actual realisable or fiscal monetary benefits to payers or society.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Rachel A Archer
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Laura E Downey
- School of Public Health, Imperial College London, London, United Kingdom
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Modelling and Economics Unit, Public Health England, London, United Kingdom
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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13
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Ruwaard D, Tsiachristas A. Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:795-803. [PMID: 34119077 DOI: 10.1016/j.jval.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. METHODS A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. RESULTS Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. CONCLUSIONS MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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14
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Touré M, Kouakou CRC, Poder TG. Dimensions Used in Instruments for QALY Calculation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4428. [PMID: 33919471 PMCID: PMC8122477 DOI: 10.3390/ijerph18094428] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022]
Abstract
Economic assessment is of utmost importance in the healthcare decision-making process. The quality-adjusted life-year (QALY) concept provides a rare opportunity to combine two crucial aspects of health, i.e., mortality and morbidity, into a single index to perform cost-utility comparison. Today, many tools are available to measure morbidity in terms of health-related quality of life (HRQoL) and a large literature describes how to use them. Knowing their characteristics and development process is a key point for elaborating, adapting, or selecting the most well-suited instrument for further needs. In this aim, we conducted a systematic review on instruments used for QALY calculation, and 46 studies were selected after searches in four databases: Medline EBSCO, Scopus, ScienceDirect, and PubMed. The search procedure was done to identify all relevant publications up to 18 June 2020. We mainly focused on the type of instrument developed (i.e., generic or specific), the number and the nature of dimensions and levels used, the elicitation method and the model selected to determine utility scores, and the instrument and algorithm validation methods. Results show that studies dealing with the development of specific instruments were mostly motivated by the inappropriateness of generic instruments in their field. For the dimensions' and levels' selection, item response theory, Rasch analysis, and literature review were mostly used. Dimensions and levels were validated by methods like the Loevinger H, the standardised response mean, or discussions with experts in the field. The time trade-off method was the most widely used elicitation method, followed by the visual analogue scale. Random effects regression models were frequently used in determining utility scores.
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Affiliation(s)
- Moustapha Touré
- Department of Economics, Business School, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (M.T.); (C.R.C.K.)
- Centre de Recherche de l’IUSMM, CIUSSS de l’Est de L’île de Montréal, Montréal, QC H1N 3V2, Canada
| | - Christian R. C. Kouakou
- Department of Economics, Business School, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (M.T.); (C.R.C.K.)
- Centre de Recherche de l’IUSMM, CIUSSS de l’Est de L’île de Montréal, Montréal, QC H1N 3V2, Canada
| | - Thomas G. Poder
- Centre de Recherche de l’IUSMM, CIUSSS de l’Est de L’île de Montréal, Montréal, QC H1N 3V2, Canada
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
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15
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Hanmer J. Cross-sectional validation of the PROMIS-Preference scoring system by its association with social determinants of health. Qual Life Res 2021; 30:881-889. [PMID: 33161483 PMCID: PMC7954821 DOI: 10.1007/s11136-020-02691-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE PROMIS-Preference (PROPr) is a generic, societal, preference-based summary score that uses seven domains from the Patient-Reported Outcomes Measurement Information System (PROMIS). This report evaluates construct validity of PROPr by its association with social determinants of health (SDoH). METHODS An online panel survey of the US adult population included PROPr, SDoH, demographics, chronic conditions, and four other scores: the EuroQol-5D-5L (EQ-5D-5L), Health Utilities Index (HUI) Mark 2 and Mark 3, and the Short Form-6D (SF-6D). Each score was regressed on age, gender, health conditions, and a single SDoH. The SDoH coefficient represents the strength of its association to PROPr and was used to assess known-groups validity. Convergent validity was evaluated using Pearson correlations between different summary scores and Spearman correlations between SDoH coefficients from different summary scores. RESULTS From 4142 participants, all summary scores had statistically significant differences for variables related to education, income, food and financial insecurity, and social interactions. Of the 42 SDoH variables tested, the number of statistically significant variables was 27 for EQ-5D-5L, 17 for HUI Mark 2, 23 for HUI Mark 3, 27 for PROPr, and 27 for SF-6D. The average SDoH coefficients were - 0.086 for EQ-5D-5L, - 0.039 for HUI Mark 2, - 0.063 for HUI Mark 3, - 0.064 for PROPr, and - 0.037 for SF-6D. Despite the difference in magnitude across the measures, Pearson correlations were 0.60 to 0.76 and Spearman correlations were 0.74 to 0.87. CONCLUSIONS These results provide evidence of construct validity supporting the use of PROPr monitor population health in the general US population.
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Affiliation(s)
- Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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16
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Sathish T, Oldenburg B, Thankappan KR, Absetz P, Shaw JE, Tapp RJ, Zimmet PZ, Balachandran S, Shetty SS, Aziz Z, Mahal A. Cost-effectiveness of a lifestyle intervention in high-risk individuals for diabetes in a low- and middle-income setting: Trial-based analysis of the Kerala Diabetes Prevention Program. BMC Med 2020; 18:251. [PMID: 32883279 PMCID: PMC7472582 DOI: 10.1186/s12916-020-01704-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/10/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Data on the cost-effectiveness of lifestyle-based diabetes prevention programs are mostly from high-income countries, which cannot be extrapolated to low- and middle-income countries. We performed a trial-based cost-effectiveness analysis of a lifestyle intervention targeted at preventing diabetes in India. METHODS The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial of 1007 individuals conducted in 60 polling areas (electoral divisions) in Kerala state. Participants (30-60 years) were those with a high diabetes risk score and without diabetes on an oral glucose tolerance test. The intervention group received a 12-month peer-support lifestyle intervention involving 15 group sessions delivered in community settings by trained lay peer leaders. There were also linked community activities to sustain behavior change. The control group received a booklet on lifestyle change. Costs were estimated from the health system and societal perspectives, with 2018 as the reference year. Effectiveness was measured in terms of the number of diabetes cases prevented and quality-adjusted life years (QALYs). Three times India's gross domestic product per capita (US$6108) was used as the cost-effectiveness threshold. The analyses were conducted with a 2-year time horizon. Costs and effects were discounted at 3% per annum. One-way and multi-way sensitivity analyses were performed. RESULTS Baseline characteristics were similar in the two study groups. Over 2 years, the intervention resulted in an incremental health system cost of US$2.0 (intervention group: US$303.6; control group: US$301.6), incremental societal cost of US$6.2 (intervention group: US$367.8; control group: US$361.5), absolute risk reduction of 2.1%, and incremental QALYs of 0.04 per person. From a health system perspective, the cost per diabetes case prevented was US$95.2, and the cost per QALY gained was US$50.0. From a societal perspective, the corresponding figures were US$295.1 and US$155.0. For the number of diabetes cases prevented, the probability for the intervention to be cost-effective was 84.0% and 83.1% from the health system and societal perspectives, respectively. The corresponding figures for QALY gained were 99.1% and 97.8%. The results were robust to discounting and sensitivity analyses. CONCLUSIONS A community-based peer-support lifestyle intervention was cost-effective in individuals at high risk of developing diabetes in India over 2 years. TRIAL REGISTRATION The trial was registered with Australia and New Zealand Clinical Trials Registry ( ACTRN12611000262909 ). Registered 10 March 2011.
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Affiliation(s)
- Thirunavukkarasu Sathish
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. .,Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, L8L 2X2, ON, Canada.
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, University of Melbourne, Melbourne, Australia
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Pilvikki Absetz
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Robyn J Tapp
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, Australia
| | - Paul Z Zimmet
- Central Clinical School, Monash University, Melbourne, UK
| | - Sajitha Balachandran
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Population Research Centre, University of Kerala, Trivandrum, Kerala, India
| | - Suman S Shetty
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Zahra Aziz
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Kerala, Australia
| | - Ajay Mahal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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17
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Selva-Sevilla C, Ferrara P, Gerónimo-Pardo M. Interchangeability of the EQ-5D and the SF-6D, and comparison of their psychometric properties in a spinal postoperative Spanish population. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:649-662. [PMID: 32065301 DOI: 10.1007/s10198-020-01161-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE EuroQol-5D (EQ-5D) and Short-Form Six-Dimensions (SF-6D) are widely used to calculate quality-adjusted life-years in cost-utility analysis. The choice of the instrument could influence the results of cost-utility analysis. Our objective was to compare the psychometric properties of the EQ-5D and SF-6D in a postoperative Spanish population, as well as assess their interchangeability in a cost-utility analysis. DESIGN Ambispective study. SETTING Tertiary public hospital. PARTICIPANTS 275 Spanish patients who had undergone surgery for lumbar disc herniation. INTERVENTION(S) Patients completed EQ-5D-3L and Short-Form 36 (SF-36v2) questionnaires. Internal consistency, floor and ceiling effects, agreement, and construct validity (convergent validity, including dimension-to-dimension correlations, and "known groups" validity) were assessed. The Spanish tariffs were applied. MAIN OUTCOME MEASURE(S) Cronbach's α coefficient, Spearman's rank correlation coefficient, Lin's concordance correlation coefficient, intraclass correlation coefficient and Bland-Altman plot. RESULTS Main findings were: (a) lack of agreement between EQ-5D and SF-6D utilities (Lin's concordance correlation coefficient: 0.664 [95% CI: 0.600-0.720]; the Bland-Altman plot showed a mean difference of 0.0835 and wide limits of agreement [- 0.2602-0.4272]). (b) Lack of correlation between domains that theoretically measure similar aspects of quality of life, with the exception of "pain" domain. CONCLUSIONS The preference-based EQ-5D and SF-6D instruments showed valid psychometric properties to assess generic outcome in a Spanish population who had undergone surgery for lumbar disc herniation; however, utility scores derived from the measures were different. Thus, these two instruments cannot be used interchangeably to perform a cost-utility analysis, and they should both be included in sensitivity analyses.
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Affiliation(s)
- Carmen Selva-Sevilla
- Department of Applied Economy, Facultad de Ciencias Económicas y Empresariales de Albacete, Universidad de Castilla La-Mancha, Pza. De la Universidad, 1, 02071, Albacete, Spain.
| | - Paula Ferrara
- Department of Neurosurgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Manuel Gerónimo-Pardo
- Department of Anesthesiology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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18
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Similar responses to EQ-5D-3L by two elicitation methods: visual analogue scale and time trade-off. BMC Med Res Methodol 2020; 20:118. [PMID: 32410582 PMCID: PMC7227357 DOI: 10.1186/s12874-020-01008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 05/05/2020] [Indexed: 01/01/2023] Open
Abstract
Background Health-related quality of life (HRQoL) is often measured using EQ-5D-3L by the elicitation methods of visual analogue scale (VAS) and time trade-off (TTO). Although many countries have constructed both national VAS and TTO value sets, the fact that VAS and TTO value sets produces different values bewilders researchers and policymakers. The aim of this study is to explore certain conditions which could yield similar value sets using VAS and TTO. Methods A homogeneous sample of medical school students was selected to value 18 hypothetical health states using VAS and TTO methods. The 18 hypothetical health states were produced by orthogonal design (L18, 2*3^7). The range of rescaled values was transformed into − 1 ~ 0 ~ 1. The investigations via different methods were carried out by computer-assisted personal interviewing with a wash-time interval of 72 h. Value sets for VAS and TTO were constructed using general least square regression models. Independent variables were composed of 10 dummy variables from 5 dimensions and including or omitting both constant and N3 terms. Results Three hundred thirteen medical students participated. The mean age was 21.03 ± 0.44 years and 56.2% were female. The four regression models (for each method with and without constant and N3 terms) were all statistically significant (P < 0.05) with high goodness-of-fit (Adj. R2 > 0.94 and MAE < 0.033). Differences between the coefficients of the 10 dummy variables corresponding to each model were all less than 0.059. Pearson correlation coefficients between observed means and predicted values exceeded 0.981. Fitted curves of VAS and TTO largely coincided. Conclusions VAS and TTO can generate similar responses under certain conditions, suggesting that the two valuation methods could be equivalent intrinsically. The VAS method appears a more valid approach for valuation in the general population due to its greater simplicity and feasibility.
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Rashaan ZM, Krijnen P, Kwa KAA, van Baar ME, Breederveld RS, van den Akker‐van Marle ME. Long-term quality of life and cost-effectiveness of treatment of partial thickness burns: A randomized controlled trial comparing enzyme alginogel vs silver sulfadiazine (FLAM study). Wound Repair Regen 2020; 28:375-384. [PMID: 32022363 PMCID: PMC7217050 DOI: 10.1111/wrr.12799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
The clinical effectiveness and scar quality of the randomized controlled trial comparing enzyme alginogel with silver sulfadiazine (SSD) for treatment of partial thickness burns were previously reported. Enzyme alginogel did not lead to faster wound healing (primary outcome) or less scar formation. In the current study, the health-related quality of life (HRQoL), costs, and cost-effectiveness of enzyme alginogel compared with SSD in the treatment of partial thickness burns were studied. HRQoL was evaluated using the Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L questionnaire 1 week before discharge and at 3, 6, and 12 months postburn. Costs were studied from a societal perspective (health care and nonhealth-care costs) for a follow-up period of 1 year. A cost-effectiveness analysis was performed using cost-effectiveness acceptability curves and comparing differences in societal costs and Quality Adjusted Life Years (QALYs) at 1 year postburn. Forty-one patients were analyzed in the enzyme alginogel group and 48 patients in the SSD group. None of the domains of BSHS-B showed a statistically significant difference between the treatment groups. Also, no statistically significant difference in QALYs was found between enzyme alginogel and SSD (difference -0.03; 95% confidence interval [CI], -0.09 to 0.03; P = .30). From both the health care and the societal perspective, the difference in costs between enzyme alginogel and SSD was not statistically significant: the difference in health-care costs was €3210 (95% CI, €-1247 to €7667; P = .47) and in societal costs was €3377 (95% CI €-6229 to €12 982; P = .49). The nonsignificant differences in costs and quality-adjusted life-years in favor of SSD resulted in a low probability (<25%) that enzyme alginogel is cost-effective compared to SSD. In conclusion, there were no significant differences in quality of life between both treatment groups. Enzyme alginogel is unlikely to be cost-effective compared with SSD in the treatment of partial thickness burns.
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Affiliation(s)
- Zjir M. Rashaan
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
- Department of SurgeryRed Cross HospitalBeverwijkNetherlands
- Burn Centre, Red Cross HospitalBeverwijkNetherlands
| | - Pieta Krijnen
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
| | - Kelly AA Kwa
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
- Burn Centre, Red Cross HospitalBeverwijkNetherlands
| | - Margriet E. van Baar
- Association of Dutch Burn Centres, Maasstad HospitalRotterdamNetherlands
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamNetherlands
| | - Roelf S. Breederveld
- Department of SurgeryLeiden University Medical CentreLeidenNetherlands
- Burn Centre, Red Cross HospitalBeverwijkNetherlands
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Abstract
Because of the rising health care costs in the United States, there has been a focus on value-based care and improving the cost-effectiveness of surgical procedures. Patient-reported outcome measures (PROMs) can not only give physicians and health care providers immediate feedback on the well-being of the patients but also be used to assess health and determine outcomes for surgical research purposes. Recently, PROMs have become a prominent tool to assess the cost-effectiveness of spine surgery by calculating the improvement in quality-adjusted life years (QALY). The cost of a procedure per QALY gained is an essential metric to determine cost-effectiveness in universal health care systems. Common patient-reported outcome questionnaires to calculate QALY include the EuroQol-5 dimensions, the SF-36, and the SF-12. On the basis of the health-related quality of life outcomes, the cost-effectiveness of various spine surgeries can be determined, such as cervical fusions, lumbar fusions, microdiscectomies. As the United States attempts to reduce costs and emphasize value-based care, PROMs may serve a critical role in spine surgery moving forward. In addition, PROM-driven QALYs may be used to analyze novel spine surgical techniques for value-based improvements.
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21
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Naunheim MR, Goldberg L, Dai JB, Rubinstein BJ, Courey MS. Measuring the impact of dysphonia on quality of life using health state preferences. Laryngoscope 2020; 130:E177-E182. [DOI: 10.1002/lary.28148] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Harvard Medical School Boston Massachusetts U.S.A
| | - Leanne Goldberg
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | - Jennifer B. Dai
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | | | - Mark S. Courey
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
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Blüher M, Saunders SJ, Mittard V, Torrejon Torres R, Davis JA, Saunders R. Critical Review of European Health-Economic Guidelines for the Health Technology Assessment of Medical Devices. Front Med (Lausanne) 2019; 6:278. [PMID: 31850356 PMCID: PMC6895571 DOI: 10.3389/fmed.2019.00278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/14/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Health-technology assessment (HTA) is a recognized mechanism to determine the relative benefits of innovative medical technologies. One aspect is their health-economic impact. While the process and methodology for pharmaceuticals is well-established, guidance for medical devices is sparse. Aim: To provide an overview of the health-economic aspect in current European HTA guidelines concerning medical devices and identifying issues raised and potential improvements proposed in recent literature. Methodology: Available guidelines by European agencies were each reviewed and summarized. To complement this, a full systematic review of current literature concerning potential improvements to existing HTA practices for medical devices, from PubMed and EMBASE, was conducted; the focus was on health economics. Authors could only review documents in English, French, or German. The systematic review yielded 518 unique articles concerning HTA for medical devices, 32 of which were considered for full-text review after screening of all abstracts. Results: There is very limited consensus in—and mostly a complete lack of—guidance specific to medical devices in official HTA guidelines, for both clinical and economic analyses. Twenty two of 41 European countries had published official HTA guidance in English, French, or German. Among these only 4 (England, France, the Netherlands, and Sweden) dedicated a chapter or separate document to medical devices. In the literature, there is sufficient evidence to suggest medical devices need to be addressed separately from pharmaceuticals. However, mostly challenges are discussed rather than implementable solutions offered. We present the following set of frequently discussed issues and summarize any solutions that pertain to them: a weak evidence base, learning-curve effects, organizational impact, incremental innovation, diversity of devices, dynamic pricing, and transferability. We further combine reviewed information to suggest a set of possible best practices for health-economic assessment of medical devices. Conclusion: For greater efficiency in medical-device innovation, European agencies should look to (re-)address the specific requirements of medical devices in their HTA guidelines. When both the health-economic and data requirements for the HTA of medical devices are defined, the development of practical solutions will likely follow.
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Seixas BV, Dionne F, Conte T, Mitton C. Assessing value in health care: using an interpretive classification system to understand existing practices based on a systematic review. BMC Health Serv Res 2019; 19:560. [PMID: 31409369 PMCID: PMC6693163 DOI: 10.1186/s12913-019-4405-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing adequate strategies to assess the value of health services plays a central role in the effort to deal with the financial pressures faced by health care systems worldwide. This study aimed to understand which approaches to value assessment have been used in developed countries. METHODS We conducted a rapid review and a gray literature search to identify value assessment frameworks. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. In addition, we developed an interpretive classification system to make sense of existing approaches. RESULTS One thousand one hundred seventy-six references were identified and 38 papers were selected for full-review. Among these 38 articles, 22 distinct approaches to assess value of health care interventions were identified and classified according to four points: 1) use of single or multiple considerations to base value estimates; 2) use of disease-specific or generic criteria; 3) reliance on process-based or outcomes-based consideration; and 4) type of input and evidence considered. CONCLUSIONS The contextual nature of value assessment in health care becomes evident with the diversity of existing approaches. Despite the predominance of cases relying on the Incremental cost-effectiveness ratio as the measure of value, this approach has not been sufficient to meet the needs of decision-makers. The use of multiple criteria has become more and more important, as well as the consideration of patient-reported measures. Considerations of costs are not always explicit and consistent.
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Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA.
| | | | - Tania Conte
- Center for Clinical Epidemiology and Evaluation, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
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Bjerk M, Brovold T, Davis JC, Bergland A. Evaluating a falls prevention intervention in older home care recipients: a comparison of SF-6D and EQ-5D. Qual Life Res 2019; 28:3187-3195. [PMID: 31364036 DOI: 10.1007/s11136-019-02258-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) is an important outcome in economic evaluations of health care interventions for older adults. The aim of this study was to compare two commonly used preference-based utility measures, SF-6D and EQ-5D, to provide knowledge on their applicability when evaluating falls prevention interventions in primary health care. METHODS The study is a secondary analysis of longitudinal data from a randomised controlled trial, which included 155 older home care recipients participating in a falls prevention intervention in Norway. HRQOL was measured by SF-6D and EQ-5D. Physical function was measured by Berg Balance Scale, 4-m walk test, 30-s sit-to-stand and Falls Efficacy Scale International. Assessments were performed at baseline, 3 months and 6 months. The agreement between SF-6D and EQ-5D was examined using Bland-Altman plots and Spearman correlations. Elasticities from regression analysis were employed to compare the instruments' responsiveness. RESULTS SF-6D and EQ-5D were strongly correlated (0.71), but there were differences in the instruments' agreement and domains of HRQOL covered. Participants with a higher mean HRQOL and/or better physical function scored generally higher on EQ-5D. Participants with a lower mean HRQOL and/or poorer physical function achieved a relatively higher score on SF-6D. EQ-5D was more responsive to changes in physical function compared to SF-6D. CONCLUSIONS SF-6D and EQ-5D have both similarities and differences regarding sensitivity, domains covered and responsiveness to changes when evaluating a falls prevention intervention. Selecting the appropriate instrument depends on the characteristics of the participants and the intervention being evaluated.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Therese Brovold
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia Okanagan, Kelowna, Canada
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
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Valuing Health States in Russia: A First Feasibility Study. Value Health Reg Issues 2019; 19:75-80. [PMID: 31181452 DOI: 10.1016/j.vhri.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 12/15/2018] [Accepted: 01/31/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to explore the feasibility of different health-related quality-of-life valuation methods in a new setting. Based on a small feasibility study of 100 young Russians, we trialed different methodologies and identified key differences that have implications for the development of health technology assessment in Russia. METHODS In face-to-face interviews, respondents completed a series of health self-assessments based on a modified version of the EQ-5D-3L, visual analogue scale, time tradeoff, standard gamble, and best-worst scaling methodologies, covering actual and hypothetical health states. RESULTS We found that (1) the visual analogue scale produced lower health valuations and fewer logical inconsistencies than either time trade-off or standard gamble methodologies; (2) initial health states can be decisive in determining values assigned to health improvements; (3) respondents evaluate abstract health states more positively than their own actual health states; (4) there is evidence consistent with the hypothesis that actual and hypothetical health state valuation, using EQ-5D-3L, is an artifact of understanding rather than preference and that the incorporation of additional levels may therefore be no panacea if the dimensions themselves overlook important attributes; and (5) the country context is important in determining how respondents relate to the survey tools and how those survey tools are translated and delivered. CONCLUSIONS Russia is commencing its health technology assessment journey and should proceed cautiously as it moves toward the valuation of health benefits. These results suggest a useful framework for a more in-depth development of health valuation methodologies in Russia.
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Musaraj A, Musaraj A, Dervishi A. Pharmaco-economics analysis, as a strategy on facilitating choices between health and non-health programs in the establishment of the national health care system. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Adanela Musaraj
- Department of Medicine, Faculty of Professional Studies, University of Durres, Albania
| | - Arta Musaraj
- Deputy Minister of Defense, Minister of Defense, Albania
| | - Aida Dervishi
- Department of Biology, Faculty of Natural Science, University of Tirana, Albania
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D'Amico E, Chisari CG, Gitto L, Zanghì A, Toscano S, Patti F. Pharmacoeconomics of synthetic therapies for multiple sclerosis. Expert Opin Pharmacother 2019; 20:1331-1340. [PMID: 31090469 DOI: 10.1080/14656566.2019.1615880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Recently, the economic impact of multiple sclerosis (MS), which includes both direct and indirect costs, has been increasing. While direct costs comprise health-care costs, such as the cost of pharmaceuticals, additional treatments such as physiotherapy, and medical aids, indirect costs are triggered by the productivity loss of patients and caregivers. Although new drugs for MS have changed the therapeutic scenario, they have increased the direct costs of health-care services. Areas covered: This review describes the pharmacoeconomic aspects of synthetic therapies for MS. Additionally, it discusses the economic impact of the various classes of licensed disease-modifying treatments (DMTs) for relapsing forms of MS. Expert opinion: The emerging and more expensive DMTs for MS represent a considerable challenge for health-care systems and resource consumption. Future research should focus on the long-term efficacy of DMTs and the cost of treating MS in a real-life setting. Future biological and radiological biomarkers could help stratify patients at early stages of MS, helping physicians design a personalized therapeutic approach that could have a positive impact in economic terms.
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Affiliation(s)
- Emanuele D'Amico
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Clara G Chisari
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Lara Gitto
- b Department of Economy , University of Messina , Messina , Italy
| | - Aurora Zanghì
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Simona Toscano
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Francesco Patti
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
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Zhao L, Liu X, Liu D, He Y, Liu Z, Li N. Comparison of the psychometric properties of the EQ-5D-3L and SF-6D in the general population of Chengdu city in China. Medicine (Baltimore) 2019; 98:e14719. [PMID: 30882636 PMCID: PMC6426629 DOI: 10.1097/md.0000000000014719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The EQ-5D-3L and SF-6D are the most commonly used economic evaluation instruments. Data comparing the psychometric properties of the instruments are scarce in the Chinese population. This study compared the psychometric properties of these measures in the Chinese general population in Chengdu.From October to December 2012, 2186 respondents (age ≥18) were selected from urban and rural areas of Chengdu, China, via multistage stratified cluster sampling. Correlations, scatter plots and Bland-Altman plots were used to explore the relationships between the 2 measures. Ceiling and floor effects were used to analyze the score distribution. The known-groups method was used to evaluate discriminant validity.Among 2186 respondents, 2182 completed the questionnaire, and 2178 (18-82 years old, mean 46.09 ± 17.49) met the data quality requirement. The mean scores for the EQ-5D-3LCN, EQ-5D-3LUK, and SF-6DUK were 0.95 (Std: 0.11), 0.93 (Std: 0.15), and 0.79 (Std: 0.12), respectively. The correlations between domains ranged from 0.16 to 0.51. The correlation between the EQ-5D-3LCN and SF-6DUK and between the EQ-5D-3LUK and SF-6DUK was 0.46. The scatter plots and Bland-Altman plots demonstrated poor agreement between the EQ-5D-3L and SF-6D. The floor and ceiling effects were respectively 0.05% and 74.60% for the EQ-5D-3L and 0.05% and 2.53% for the SF-6DUK. The EQ-5D-3LCN, EQ-5D-3LUK and SF-6D have good discriminant validity in different sociodemographic and health condition groups. The SF-6D has higher level of discriminant validity in moderately healthy groups in the EQ-5D-3L full-health population.Both the EQ-5D-3L and SF-6D are valid economic evaluation instruments in the Chinese general population in Chengdu but do not seem to be interchangeable. The EQ-5D-3L has a higher ceiling effect and higher level of discriminant validity among different sociodemographic groups, and the SF-6D has a lower ceiling effect and higher level of discriminant validity in health condition groups. Users may consider the evidence in the choice of these instruments.
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Affiliation(s)
- Longchao Zhao
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Xiang Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Danping Liu
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
| | - Yan He
- Department of Social Medicine and Health Management, Public Health College, Zhengzhou University, Zhengzhou
| | - Zhijun Liu
- Applied Psychology Department, School of Management, Zunyi Medical University, Zunyi, China
| | - Ningxiu Li
- Department of Health Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu
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Kularatna S, Senanayake S, Gunawardena N, Graves N. Comparison of the EQ-5D 3L and the SF-6D (SF-36) contemporaneous utility scores in patients with chronic kidney disease in Sri Lanka: a cross-sectional survey. BMJ Open 2019; 9:e024854. [PMID: 30772857 PMCID: PMC6398797 DOI: 10.1136/bmjopen-2018-024854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare utility weights of EuroQoL-five-dimension-3 levels (EQ-5D-3L) and Short-Form six-dimension (SF-6D) in a representative cohort of patients with chronic kidney disease (CKD). A cost-utility analysis (CUA) is designed to report the change to costs required to achieve an estimated change to quality-adjusted life years (QALYs). The quality component of a QALY is measured by utility. Utility represents the preference of general population for a given health state. Classification systems of the multi-attribute utility instruments (MAUIs) are used to define these health states. Utility weights developed from different classification systems can vary and may affect the conclusions from CUAs. DESIGN A community-based cross-sectional study. SETTING Anuradhapura, a rural district in Sri Lanka. PARTICIPANTS A representative sample of 1096 patients with CKD, selected using the population-based CKD register, completed the EQ-5D-3L and SF-36. SF-6D was constructed from the SF-36 according to the published algorithm. The study assessed discrimination, correlation and differences across the two instruments. RESULTS Study participants were predominantly male (62.6%). Mean EQ-5D-3L utility score was 0.540 (SD 0.35) compared with 0.534 (SD 0.09) for the SF-6D (p=0.588). The correlation (r) between the scores was 0.40 (p<0.001). Utility scores were significantly different in both males and females between the two tools, but there was no difference in age and educational categories. Both MAUI scores were significantly lower (p<0.001) among those who were in more advanced stages of the disease and the corresponding utility scores of the two instruments in different CKD stages were also significantly different (p<0.05). The largest effect size was seen among the patients on dialysis. CONCLUSIONS The correlation between the scores was moderate. SF-6D had the lowest floor and ceiling effect and was better at detecting different stages of the disease. Thus, based on the evidence presented in this study, SF-6D appears to be more appropriate to be used among patients with CKD.
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Affiliation(s)
- Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | | | - Nicholas Graves
- Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Jørgensen J, Servos S, Kefalas P. The potential price and access implications of the cost-utility and budget impact methodologies applied by NICE in England and ICER in the US for a novel gene therapy in Parkinson's disease. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2018; 6:1500419. [PMID: 30364868 PMCID: PMC6198614 DOI: 10.1080/20016689.2018.1500419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 06/08/2023]
Abstract
Background: NICE in England, and ICER in the US both use cost-utility analyses (CUA) and budget impact analyses (BIA) to assess value for money and affordability, however the thresholds used differ greatly. Objective: To perform a cross-country comparison of the results of the CUA and BIA and detail the implications for reimbursed price and volumes, for a novel gene therapy for Parkinson's disease (PD). Methods: A Markov model was built to perform country-specific CUAs and BIAs Findings: The US ceiling price identified through CUA is ~ 1.8 times higher than in England (aligning to our previous US/UK price comparison analysis of high-cost drugs). However, the net budget impact corresponding to these price levels would limit number of patients treated in order not to exceed the BIA threshold. Performance-based annuity payments can increase patient access at launch without exceeding the thresholds while reducing payers' data uncertainty. Conclusion: Our cost-utility analysis in PD shows a difference in price potential between the US and England that aligns with what is observed in practice for other high-cost drugs. Furthermore, the budget impact threshold operational in England imposes a greater downwards pressure on price and/or volumes than the one applied by ICER in the US.
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Affiliation(s)
- Jesper Jørgensen
- Health Economics and Market Access Department, Cell and Gene Therapy Catapult, London, UK
| | - Spiros Servos
- Business Development Department, Oxford BioMedica (UK), Oxford, UK
| | - Panos Kefalas
- Health Economics and Market Access Department, Cell and Gene Therapy Catapult, London, UK
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Ghoshal A, Damani A, Salins N, Deodhar J, Muckaden MA. Economics of Palliative and End-of-Life Care in India: A Concept Paper. Indian J Palliat Care 2017; 23:456-461. [PMID: 29123355 PMCID: PMC5661351 DOI: 10.4103/ijpc.ijpc_51_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Only a few studies have assessed the economic outcomes of palliative care in India. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy compared to best supportive care. At present, there is no definite health-care system followed in India. Medical bankruptcy is common. In situations where patients bear most of the costs, medical decision-making might have significant implications on economics of health care. Game theory might help in deciphering the underlying complexities of decision-making when considered as a two person nonzero sum game. Overall, interdisciplinary communication and cooperation between health economists and palliative care team seem necessary. This will lead to enhanced understanding of the challenges faced by each other and hopefully help develop ways to create meaningful, accurate, and reliable health economic data. These results can then be used as powerful advocacy tools to convince governments to allocate more funds for the cause of palliative care. Eventually, this will save overall costs and avoid unnecessary health-care spending.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - M A Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
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Meregaglia M, Cairns J. A systematic literature review of health state utility values in head and neck cancer. Health Qual Life Outcomes 2017; 15:174. [PMID: 28865475 PMCID: PMC5581467 DOI: 10.1186/s12955-017-0748-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/24/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Health state utility values (HSUVs) are essential parameters in model-based economic evaluations. This study systematically identifies HSUVs in head and neck cancer and provides guidance for selecting them from a growing body of health-related quality of life studies. METHODS We systematically reviewed the published literature by searching PubMed, EMBASE and The Cochrane Library using a pre-defined combination of keywords. The Tufts Cost-Effectiveness Analysis Registry and the School of Health and Related Research Health Utilities Database (ScHARRHUD) specifically containing health utilities were also queried, in addition to the Health Economics Research Centre database of mapping studies. Studies were considered for inclusion if reporting original HSUVs assessed using established techniques. The characteristics of each study including country, design, sample size, cancer subsite addressed and demographics of responders were summarized narratively using a data extraction form. Quality scoring and critical appraisal of the included studies were performed based on published recommendations. RESULTS Of a total 1048 records identified by the search, 28 studies qualified for data extraction and 346 unique HSUVs were retrieved from them. HSUVs were estimated using direct methods (e.g. standard gamble; n = 10 studies), multi-attribute utility instruments (MAUIs; n = 13) and mapping techniques (n = 3); two studies adopted both direct and indirect approaches. Within the MAUIs, the EuroQol 5-dimension questionnaire (EQ-5D) was the most frequently used (n = 11), followed by the Health Utility Index Mark 3 (HUI3; n = 2), the 15D (n = 2) and the Short Form-Six Dimension (SF-6D; n = 1). Different methods and types of responders (i.e. patients, healthy subjects, clinical experts) influenced the magnitude of HSUVs for comparable health states. Only one mapping study developed an original algorithm using head and neck cancer data. The identified studies were considered of intermediate quality. DISCUSSION This review provides a dataset of HSUVs systematically retrieved from published studies in head and neck cancer. There is currently a lack of research for some disease phases including recurrent and metastatic cancer, and treatment-related complications. In selecting HSUVs for cost-effectiveness modeling purposes, preference should be given to EQ-5D utility values; however, mapping to EQ-5D is a potentially valuable technique that should be further developed in this cancer population.
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Affiliation(s)
- Michela Meregaglia
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,CeRGAS (Research Centre on Health and Social Care Management), Bocconi University, Via Roentgen 1, 20136, Milan, Italy.
| | - John Cairns
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.,CCBIO (Centre for Cancer Biomarkers), University of Bergen, Postboks 7804, N-5020, Bergen, Norway
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Endarti D, Riewpaiboon A, Thavorncharoensap M, Praditsitthikorn N, Hutubessy R, Kristina SA. A Comparison of EQ-5D-3L Index Scores Using Malaysian, Singaporean, Thai, and UK Value Sets in Indonesian Cervical Cancer Patients. Value Health Reg Issues 2017; 15:50-55. [PMID: 29474178 DOI: 10.1016/j.vhri.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To gain insight into the most suitable foreign value set among Malaysian, Singaporean, Thai, and UK value sets for calculating the EuroQol five-dimensional questionnaire index score (utility) among patients with cervical cancer in Indonesia. METHODS Data from 87 patients with cervical cancer recruited from a referral hospital in Yogyakarta province, Indonesia, from an earlier study of health-related quality of life were used in this study. The differences among the utility scores derived from the four value sets were determined using the Friedman test. Performance of the psychometric properties of the four value sets versus visual analogue scale (VAS) was assessed. Intraclass correlation coefficients and Bland-Altman plots were used to test the agreement among the utility scores. Spearman ρ correlation coefficients were used to assess convergent validity between utility scores and patients' sociodemographic and clinical characteristics. With respect to known-group validity, the Kruskal-Wallis test was used to examine the differences in utility according to the stages of cancer. RESULTS There was significant difference among utility scores derived from the four value sets, among which the Malaysian value set yielded higher utility than the other three value sets. Utility obtained from the Malaysian value set had more agreements with VAS than the other value sets versus VAS (intraclass correlation coefficients and Bland-Altman plot tests results). As for the validity, the four value sets showed equivalent psychometric properties as those that resulted from convergent and known-group validity tests. CONCLUSIONS In the absence of an Indonesian value set, the Malaysian value set was more preferable to be used compared with the other value sets. Further studies on the development of an Indonesian value set need to be conducted.
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Affiliation(s)
- Dwi Endarti
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia.
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Naiyana Praditsitthikorn
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Bangkok, Thailand; Bureau of AIDS, TB and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Raymond Hutubessy
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia
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Comparison of the EQ-5D-3L and the SF-6D (SF-12) contemporaneous utility scores in patients with cardiovascular disease. Qual Life Res 2017; 26:3399-3408. [DOI: 10.1007/s11136-017-1666-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
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Xin Y, McIntosh E. Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review. Qual Life Res 2016; 26:1-23. [DOI: 10.1007/s11136-016-1428-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Rautenberg T, Hulme C, Edlin R. Methods to construct a step-by-step beginner's guide to decision analytic cost-effectiveness modeling. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:573-581. [PMID: 27785080 PMCID: PMC5066562 DOI: 10.2147/ceor.s113569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although guidance on good research practice in health economic modeling is widely available, there is still a need for a simpler instructive resource which could guide a beginner modeler alongside modeling for the first time. AIM To develop a beginner's guide to be used as a handheld guide contemporaneous to the model development process. METHODS A systematic review of best practice guidelines was used to construct a framework of steps undertaken during the model development process. Focused methods review supplemented this framework. Consensus was obtained among a group of model developers to review and finalize the content of the preliminary beginner's guide. The final beginner's guide was used to develop cost-effectiveness models. RESULTS Thirty-two best practice guidelines were data extracted, synthesized, and critically evaluated to identify steps for model development, which formed a framework for the beginner's guide. Within five phases of model development, eight broad submethods were identified and 19 methodological reviews were conducted to develop the content of the draft beginner's guide. Two rounds of consensus agreement were undertaken to reach agreement on the final beginner's guide. To assess fitness for purpose (ease of use and completeness), models were developed independently and by the researcher using the beginner's guide. CONCLUSION A combination of systematic review, methods reviews, consensus agreement, and validation was used to construct a step-by-step beginner's guide for developing decision analytical cost-effectiveness models. The final beginner's guide is a step-by-step resource to accompany the model development process from understanding the problem to be modeled, model conceptualization, model implementation, and model checking through to reporting of the model results.
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Affiliation(s)
- Tamlyn Rautenberg
- Health Economics and HIV/AIDS Research Division (HEARD), University of Kwazulu Natal, KwaZulu Natal, South Africa
| | - Claire Hulme
- Leeds Institute of Health Sciences (LIHS), Academic Unit of Health Economics (AUHE), University of Leeds, West Yorkshire, United Kingdom
| | - Richard Edlin
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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de Kinderen RJ, Wijnen BF, van Breukelen G, Postulart D, Majoie MH, Aldenkamp AP, Evers SM. From clinically relevant outcome measures to quality of life in epilepsy: A time trade-off study. Epilepsy Res 2016; 125:24-31. [DOI: 10.1016/j.eplepsyres.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/16/2016] [Accepted: 05/17/2016] [Indexed: 11/24/2022]
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De Smedt D, Clays E, De Bacquer D. Measuring health-related quality of life in cardiac patients. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:149-150. [PMID: 29474613 DOI: 10.1093/ehjqcco/qcw015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Delphine De Smedt
- Department of Public Health, Ghent University, De Pintelaan 185 4K3, Gent 9000, Belgium
| | - Els Clays
- Department of Public Health, Ghent University, De Pintelaan 185 4K3, Gent 9000, Belgium
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, De Pintelaan 185 4K3, Gent 9000, Belgium
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Alouki K, Delisle H, Bermúdez-Tamayo C, Johri M. Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies. J Diabetes Res 2016; 2016:2159890. [PMID: 26885527 PMCID: PMC4738686 DOI: 10.1155/2016/2159890] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 01/29/2023] Open
Abstract
Objective. To summarize key findings of economic evaluations of lifestyle interventions for the primary prevention of type 2 diabetes (T2D) in high-risk subjects. Methods. We conducted a systematic review of peer-reviewed original studies published since January 2009 in English, French, and Spanish. Eligible studies were identified through relevant databases including PubMed, Medline, National Health Services Economic Evaluation, CINHAL, EconLit, Web of sciences, EMBASE, and the Latin American and Caribbean Health Sciences Literature. Studies targeting obesity were also included. Data were extracted using a standardized method. The BMJ checklist was used to assess study quality. The heterogeneity of lifestyle interventions precluded a meta-analysis. Results. Overall, 20 studies were retained, including six focusing on obesity control. Seven were conducted within trials and 13 using modeling techniques. T2D prevention by physical activity or diet or both proved cost-effective according to accepted thresholds, except for five inconclusive studies, three on diabetes prevention and two on obesity control. Most studies exhibited limitations in reporting results, primarily with regard to generalizability and justification of selected sensitivity parameters. Conclusion. This confirms that lifestyle interventions for the primary prevention of diabetes are cost-effective. Such interventions should be further promoted as sound investment in the fight against diabetes.
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Affiliation(s)
- Koffi Alouki
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
| | - Hélène Delisle
- TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, 2405 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada H3T 1A8
- *Hélène Delisle:
| | - Clara Bermúdez-Tamayo
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
| | - Mira Johri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, 850 Rue Saint-Denis, Montréal, QC, Canada H2X 0A9
- Department of Health Administration, School of Public Health (ESPUM), Faculty of Medicine, University of Montreal, 7101 Avenue du Parc, 3e Étage, Montréal, QC, Canada H3N 1X9
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Yang F, Lau T, Lee E, Vathsala A, Chia KS, Luo N. Comparison of the preference-based EQ-5D-5L and SF-6D in patients with end-stage renal disease (ESRD). THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:1019-26. [PMID: 25519850 DOI: 10.1007/s10198-014-0664-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/27/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVES The objective of this study was to compare the performance of the 5-level EuroQol 5-dimension (EQ-5D-5L) and the Short Form 6-dimension (SF-6D) instruments in assessing patients with end-stage renal disease (ESRD) in Singapore. METHODS In a cross-sectional study, ESRD patients attending a tertiary hospital were interviewed using a battery of questionnaires including the EQ-5D-5L, the kidney disease quality of life instrument (KDQOL-36), and questions assessing dialysis history and socio-demographic characteristics. We reviewed patients' medical records for their clinical information. We assessed the construct validity of the EQ-5D-5L and SF-6D index scores and compared their ability to distinguish between patients differing in health status and the magnitude of between-group difference they quantified. RESULTS One hundred and fifty ESRD patients on dialysis (mean age, 60.1 years; female, 48.7%) participated in the study. Both EQ-5D-5L and SF-6D demonstrated satisfactory known-groups validity; the EQ-5D-5L was more sensitive to differences in clinical outcomes and the SF-6D was more sensitive to differences in health outcomes measured by KDQOL scales. The intraclass correlation coefficient between the measures was 0.36. The differences in the EQ-5D-5L index score for patients in better and worse health status were greater than those measured by the SF-6D index score. CONCLUSIONS Both EQ-5D-5L and SF-6D are valid instruments for assessing ESRD patients. However, the two preference-based measures cannot be used interchangeably and it appears that EQ-5D-5L would lead to more favorable cost-effectiveness results than SF-6D if they are used in economic evaluations of interventions for ESRD.
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Affiliation(s)
- Fan Yang
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD 1, Singapore, 117549, Singapore
| | - Titus Lau
- Division of Nephrology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Evan Lee
- Division of Nephrology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - A Vathsala
- Division of Nephrology, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD 1, Singapore, 117549, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, MD 1, Singapore, 117549, Singapore.
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Grosse SD, Chaugule SS, Hay JW. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:267-83. [PMID: 25585817 DOI: 10.1586/14737167.2015.1001372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost-effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost-effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mail Stop E-64, Atlanta, GA 30333, USA
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Remenschneider AK, Scangas G, Meier JC, Gray ST, Holbrook EH, Gliklich RE, Metson R. EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis. Laryngoscope 2014; 125:1056-61. [PMID: 25431320 DOI: 10.1002/lary.25054] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Health utility value (HUV) is an index used to measure health-related quality of life for the valuation and comparison of treatments. The Euroqol 5-Dimension (EQ-5D) questionnaire is a widely used method for determining HUV, but it has not been applied for this purpose in patients with chronic rhinosinusitis (CRS) who undergo sinus surgery. STUDY DESIGN Prospective cohort study. METHODS Patients with CRS, who were recruited from 11 different otolaryngologic practices, completed the EQ-5D questionnaire at baseline, as well as 3, 12, and 24 months after surgery. HUVs calculated from the results of this questionnaire were compared to those reported in the general U.S. population and to patients suffering from other chronic diseases. RESULTS Baseline EQ-5D surveys were completed by 242 patients. Mean baseline HUV (standard deviation) was 0.81 (0.13). Female gender, revision surgery, and the use of intraoperative image guidance were associated was significantly lower baseline values. HUV rose at 3 months to 0.89 (0.12) and remained improved at 12 months 0.88 (0.10) and 24 months 0.89 (0.10) (P < 0.001). Baseline HUV in CRS (0.81[0.13]) is lower than the general U.S. population (0.85 [0.18]) and appears appropriately positioned among other common chronic conditions including asthma (0.82-0.92), migraine (0.81-0.91), and seasonal allergies (0.94). CONCLUSIONS Sinus surgery provides improvement in HUV in patients with CRS. These values may be paired with costs of care to perform cost-utility analysis on this group of patients. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Cuervo J, Castejón N, Khalaf KM, Waweru C, Globe D, Patrick DL. Development of the Incontinence Utility Index: estimating population-based utilities associated with urinary problems from the Incontinence Quality of Life Questionnaire and Neurogenic Module. Health Qual Life Outcomes 2014; 12:147. [PMID: 25288099 PMCID: PMC4196092 DOI: 10.1186/s12955-014-0147-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/15/2014] [Indexed: 01/18/2023] Open
Abstract
Background Generic utility instruments may not fully capture the impact and consequences of urinary problems. Condition-specific preference-based measures, developed from previously validated disease-specific patient-reported outcomes instruments, may add relevant information for economic evaluations. The aim of this study was to develop a condition-specific preference-based measure, the Incontinence Utility Index (IUI), for valuing health states associated with urinary problems. Methods A two-step process was implemented. First, an abbreviated health state classification system was developed from the Incontinence Quality of Life Questionnaire (I-QOL) and Neurogenic Module by applying Rasch modelling, classical psychometrical testing and expert criteria to data from two pivotal trials comprised of neurogenic detrusor overactivity (NDO) patients. Criterion, convergent validity and concordance with the original instrument was assessed in the abbreviated version. Then, a multi-attribute utility function (MAUF) was estimated from a representative sample of the UK non-institutionalized adult general population. Visual analogue and time-trade off (TTO) evaluations were applied in the elicitation process. Predictive validity of the MAUF was tested comparing estimated and direct utility scores. Results The abbreviated health state classification system generated from the NDO sample contained 5 attributes with 3 levels of response and had adequate psychometrical properties: significant differences in scores according to the reduction in the frequency of urinary incontinence episodes [UIE] (p < 0.001); Spearman correlation coefficient with number of daily UIE = −0.43; p < 0.01 and Intraclass Correlation Coefficient (ICC, 95% CI) with the original version = 0.90 (0.89-0.91; p < 0.001). Next, 442 participants were interviewed (398 cases were valid, generating 2,388 TTO evaluations) to estimate the social preferences for derived health states. Mean age was 44.75 years (interquartile range 33.5-55.5) and 60.1% were female. An overall algorithm for the IUI was estimated and transformed onto a dead = 0.00 and full health = 1.00 scale. Model fits were acceptable (R-squared = 0.923 and 0.978). Predictive validity was adequate: ICC (95% CI) = 0.928 (0.648-0.985) and Mean of Absolute Differences = 0.038. Conclusions The newly developed IUI is a preference-based measure for urinary problems related to NDO that provides general population-based utility scores with adequate predictive validity. Trial registration ClinicalTrials.gov: NCT00461292, NCT00311376. Electronic supplementary material The online version of this article (doi:10.1186/s12955-014-0147-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesús Cuervo
- LASER Analytica, C/Azcárraga 12 A, Oviedo, 33010, Asturias, Spain.
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Bergmo TS. Using QALYs in telehealth evaluations: a systematic review of methodology and transparency. BMC Health Serv Res 2014; 14:332. [PMID: 25086443 PMCID: PMC4132195 DOI: 10.1186/1472-6963-14-332] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/21/2014] [Indexed: 02/08/2023] Open
Abstract
Background The quality-adjusted life-year (QALY) is a recognised outcome measure in health economic evaluations. QALY incorporates individual preferences and identifies health gains by combining mortality and morbidity into one single index number. A literature review was conducted to examine and discuss the use of QALYs to measure outcomes in telehealth evaluations. Methods Evaluations were identified via a literature search in all relevant databases. Only economic evaluations measuring both costs and QALYs using primary patient level data of two or more alternatives were included. Results A total of 17 economic evaluations estimating QALYs were identified. All evaluations used validated generic health related-quality of life (HRQoL) instruments to describe health states. They used accepted methods for transforming the quality scores into utility values. The methodology used varied between the evaluations. The evaluations used four different preference measures (EQ-5D, SF-6D, QWB and HUI3), and utility scores were elicited from the general population. Most studies reported the methodology used in calculating QALYs. The evaluations were less transparent in reporting utility weights at different time points and variability around utilities and QALYs. Few made adjustments for differences in baseline utilities. The QALYs gained in the reviewed evaluations varied from 0.001 to 0.118 in implying a small but positive effect of telehealth intervention on patient’s health. The evaluations reported mixed cost-effectiveness results. Conclusion The use of QALYs in telehealth evaluations has increased over the last few years. Different methodologies and utility measures have been used to calculate QALYs. A more harmonised methodology and utility measure is needed to ensure comparability across telehealth evaluations.
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Affiliation(s)
- Trine S Bergmo
- Norwegian Centre for Telemedicine and Integrated Care, University Hospital of North Norway, N-9038 Tromsø Norway.
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Whitehurst DGT, Norman R, Brazier JE, Viney R. Comparison of contemporaneous EQ-5D and SF-6D responses using scoring algorithms derived from similar valuation exercises. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:570-577. [PMID: 25128050 DOI: 10.1016/j.jval.2014.03.1720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/19/2014] [Accepted: 03/27/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Poor agreement between preference-based health-related quality-of-life instruments has been widely reported across patient and community-based samples. This study compares index scores generated from contemporaneous EQ-5D (3-level version) and SF-6D (SF-36 version) responses using scoring algorithms derived from independently-conducted Australian population-representative discrete choice experiments (DCEs), providing the first comparative analysis of health state valuations using the same method of valuation across the full value sets. METHODS EQ-5D and SF-6D responses from seven patient data sets were transformed into health state valuations using published DCE-derived scoring algorithms. The empirical comparative evaluation consisted of graphical illustration of the location and spread of index scores, reporting of basic descriptive statistics, exploration of between-measure differences in mean index scores, and analysis of agreement. RESULTS Compared with previously published findings regarding the comparability of "conventional" EQ-5D and SF-6D index scores, health state valuations from the DCE-derived scoring procedures showed that agreement between scores remained "fair" (intraclass correlation coefficient values across the seven data sets ranged from 0.375 to 0.615). Mean SF-6D scores were significantly lower than the respective mean EQ-5D score across all patient groups (mean difference for the whole sample = 0.253). CONCLUSIONS The magnitude of disagreement previously reported between EQ-5D and SF-6D index scores is not ameliorated through the application of DCE-derived value sets; sizeable discrepancies remain. These findings suggest that differences between EQ-5D and SF-6D index scores persist because of their respective descriptive systems. Further research is required to explore the implications of variations in the descriptive systems of preference-based instruments.
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Affiliation(s)
- David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Richard Norman
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - John E Brazier
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Greenberg D, Neumann PJ. Does adjusting for health-related quality of life matter in economic evaluations of cancer-related interventions? Expert Rev Pharmacoecon Outcomes Res 2014; 11:113-9. [DOI: 10.1586/erp.11.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van den Hurk CJ, van den Akker-van Marle ME, Breed WP, van de Poll-Franse LV, Nortier JW, Coebergh JW. Cost-effectiveness analysis of scalp cooling to reduce chemotherapy-induced alopecia. Acta Oncol 2014; 53:80-7. [PMID: 24059270 DOI: 10.3109/0284186x.2013.794955] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alopecia is a frequently occurring side effect of chemotherapy that often can be prevented by cooling the scalp during the infusion. This study compared effects and costs of scalp cooling with usual general oncological care, i.e. purchasing a wig or head cover. MATERIAL AND METHODS Scalp-cooled patients (n = 160) were compared with non-scalp-cooled patients (n = 86) at 15 Dutch hospitals. Patients were enrolled prior to anthracycline and/or taxane-based chemotherapy for several types of cancer between 2007 and 2008. Cost-effectiveness of scalp cooling compared with that of usual care was determined by the ratio of costs to quality adjusted life years (QALYs). Costs for scalp cooling (machines and nursing time), hair dressers, wigs and head covers were estimated from a societal perspective. QALYs were measured using the Short Form-36. RESULTS Scalp cooling reduced the use of a wig or head cover by 40%, but wigs were still purchased unnecessarily by 38% of scalp-cooled patients. Average societal costs decreased therefore only by €269 per patient due to scalp cooling (p = 0.02). Given the eligibility for scalp cooling at the time, the insignificant difference in QALYs resulted from a balance of the benefits for those patients with successful scalp cooling and those without success. For the Dutch, given the generally accepted threshold of willingness to pay for a QALY (between €20 000 and €40 000), scalp cooling was cost-effective, therefore justifying the choice of scalp cooling or purchasing a wig or head cover. CONCLUSION Given the right indication, cost-effectiveness might be improved further by postponing wig and head cover purchases, by improving scalp cooling efficacy, as well as using the scalp cooling capacity more intensively.
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Affiliation(s)
- Corina J van den Hurk
- Research Department, Eindhoven Cancer Registry/Comprehensive Cancer Centre South , Eindhoven , The Netherlands
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De Smedt D, Clays E, Annemans L, De Bacquer D. EQ-5D versus SF-12 in coronary patients: are they interchangeable? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:84-89. [PMID: 24438721 DOI: 10.1016/j.jval.2013.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/03/2013] [Accepted: 10/30/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this study was to compare EuroQol five-dimensional (EQ-5D) utility scores and six-dimensional health state classification (SF-6D) utility scores (derived from the 12-Item Short-Form Health Survey [SF-12]) by using a large European sample of patients with stable coronary heart disease. Special attention was given to country-specific results. METHODS Data from the EURopean Action on Secondary and Primary Prevention by Intervention to Reduce Events III (EUROASPIRE III) survey were used. Patients hospitalized for a coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction, or myocardial ischemia were interviewed and examined at least 6 months after their acute event. Health-related quality of life was assessed by using the EQ-5D and the SF-12. SF-12 outcomes were converted to SF-6D utility values, allowing comparison between both measures. RESULTS Both EQ-5D and SF-6D results were available for 7472 patients with coronary heart disease from 20 European countries. The measures were significantly correlated (intraclass correlation coefficient = 0.536); however, large differences between the two measures remain. A total of 28.8% of the patients reported a ceiling effect on the EQ-5D instrument, whereas only 4.2% of the patients reported full health based on the SF-6D. Especially the mental component does not seem to be completely captured by the EQ-5D instrument. Furthermore, patients with worse EQ-5D outcomes were more likely to have better SF-6D results, whereas patients with better EQ-5D outcomes were more likely to have worse SF-6D results. CONCLUSIONS Both measures are not interchangeable. Whereas the main disadvantage of the EQ-5D questionnaire is its ceiling effect, the potential advantages of SF-12 might disappear when converting the outcomes into an SF-6D utility, because of the small differences between patients.
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Affiliation(s)
| | - Els Clays
- Department of Public Health, Ghent University, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Belgium; Faculty of Medicine and Pharmacy, Vrije University Brussel, Brussels, Belgium; I-CHER Interuniversity Center for Health Economics, Ghent and Brussels, Belgium
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Romero M, Vivas-Consuelo D, Alvis-Guzman N. Is Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation? SPRINGERPLUS 2013; 2:664. [PMID: 24353981 PMCID: PMC3866375 DOI: 10.1186/2193-1801-2-664] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/28/2013] [Indexed: 12/24/2022]
Abstract
The purpose of this review is to do a discussion about the use of the HRQoL as a health measure of the populations that enable to analyze its potential use as a measure of development and efficiency of health systems. The principal use of the HRQoL is in health technologies economics evaluation; however this measure can be use in public health when need to know the health state of population. The WHO recognizes its potential use but its necessary to do a discussion about your difficulties for its application and restrictions for its use as a performance indicator for the health systems. The review show the different aspects about the use of HRQoL how a measure of efficiency ot the health system, each aspect identified in the literature is analyzed and discussed, developing the pros and cons of their possible use, especially when it comes as a cardinal measure. The analysis allows recognize that measuring HRQoL in countries could serve as a useful indicator, especially when it seeks to measure the level of health and disease, as do most of the indicators of current use. However, the methodological constraints that do not allow comparability between countries especially when you have large socioeconomic differences have yet to be resolved to allow comparison between different regions.
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Affiliation(s)
- Martin Romero
- Fundación Salutia, Centro de investigación en Salud, Bogotá, Colombia ; Doctarado en Salud Publica - Universidad Nacional de Colombia, Bogotá, Colombia
| | - David Vivas-Consuelo
- Research Center for Health Economics and Management, Universitat Politècnica de València, Valencia, Spain
| | - Nelson Alvis-Guzman
- Research Group on Health Economics, Universidad de Cartagena, Cartagena, Colombia ; Research and Teaching Center, Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
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Carter JA, Ji X, Botteman MF. Clinical, economic and humanistic burdens of skeletal-related events associated with bone metastases. Expert Rev Pharmacoecon Outcomes Res 2013; 13:483-96. [PMID: 23862654 DOI: 10.1586/14737167.2013.820959] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite effective skeletal-related event (SRE)-limiting therapies such as zoledronic acid and denosumab, SREs continue to place a meaningful burden on patients, providers and payers. However, studies of SRE-related effects on clinical (i.e., survival), economic (i.e., cost per event) and humanistic (i.e., quality of life) outcomes often report results in a composite manner and frequently do not differentiate the effects by SRE-type (i.e., bone radiation, bone surgery, hypercalcemia, pathological fracture and spinal cord compression). Nevertheless, understanding the differential burdens of individual SRE types, which vary in severity and duration of effect, is an important consideration - particularly in pharmacoeconomic evaluations of SRE-limiting therapies. In this review of the clinical, economic and humanistic SRE burden, it was found that SRE types can be differentiated by these outcomes, although economic outcomes are far more frequently reported than clinical or humanistic.
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