Cancer population norms using a new value set for the SF-6Dv2 based on the preferences of patients with breast or colorectal cancer in Quebec

BACKGROUND

Because health resources are limited, health programs should be compared to allow the most efficient ones to emerge. To that aim, health utility instruments have been developed to allow the calculation of quality-adjusted life-year (QALY). However, generic instruments, which can be used by any individual regardless of their health profile, typically consider the preferences of the general population when developing their value set. Consequently, they are often criticized for lacking sensitivity in certain domains, such as cancer. In response, the latest version of the Short Form 6-Dimension (SF-6Dv2) has been adapted to suit the preferences of patients with breast or colorectal cancer in the Canadian province of Quebec. By extension, our study's aim was to determine cancer population norms of utility among patients with breast or colorectal cancer in Quebec using the SF-6Dv2.

METHOD

To determine the cancer population norms, we exploited the data that were used in the development of a new value set for the SF-6Dv2. This value set was developed considering the preferences of patients with breast or colorectal cancer. Stratification by time of data collection (i.e., T1 and T2), sociodemographic variables (i.e., age, sex, body mass index, and self-reported health problems affecting quality of life), and clinical aspects (i.e., cancer site, histopathological classification, cancer stage at diagnosis, modality, and treatment characteristics) was performed.

RESULTS

In 353 observations, patients were more likely to have negative utility scores at T1 than at T2. Males had higher mean utility scores than females considering type of cancer and comorbidities. Considering the SF-6Dv2's dimensions, more females than males reported having health issues, most which concerned physical functioning. Significant differences by sex surfaced for all dimensions except "Role Limitation" and "Mental health." Patients with multifocal cancer had the highest mean and median utility values in all cancer sites considered.

CONCLUSION

Cancer population norms can serve as a baseline for interpreting the scores obtained by a given population in comparison to the situation of another group. In this way, our results can assist in comparing utility scores among cancer patients with different sociodemographic groups to other patients/populations groups. To our knowledge, our identified utility norms are the first for patients with breast or colorectal cancer from Quebec.

Telehealth-Delivered Program and Accompanying Patients to Enhance the Clinical Condition of Patients Throughout a Liver Transplant: Protocol for a Mixed Methods Study

BACKGROUND

Liver transplantation (LT) is indicated in patients with severe acute or chronic liver failure for which no other therapy is available. With the increasing number of LTs in recent years, liver centers worldwide must manage their patients according to their clinical situation and the expected waiting time for transplantation. The LT clinic at the Centre hospitalier de l'Université de Montréal (CHUM) is developing a new health care model across the entire continuum of pre-, peri-, and posttransplant care that features patient monitoring by an interdisciplinary team, including an accompanying patient; a digital platform to host a clinical plan; a learning program; and data collection from connected objects.

OBJECTIVE

This study aims to (1) evaluate the outcomes following the implementation of a patient platform with connected devices and an accompanying patient, (2) identify implementation barriers and facilitators, (3) describe service outcomes in terms of health outcomes and the rates and nature of contact with the accompanying patient, (4) describe patient outcomes, and (5) assess the intervention's cost-effectiveness.

METHODS

Six types of participants will be included in the study: (1) patients who received transplants and reached 1 year after transplantation before September 2023 (historical cohort or control group), (2) patients who will receive an LT between December 2023 and November 2024 (prospective cohort/intervention group), (3) relatives of those patients, (4) accompanying patients who have received an LT and are interested in supporting patients who will receive an LT, (5) health care professionals, and (6) decision makers. To describe the study sample and collect data to achieve all the objectives, a series of validated questionnaires, accompanying patient logbooks, transcripts of interviews and focus groups, and clinical indicators will be collected throughout the study.

RESULTS

In total, 5 (steering, education, clinical-technological, nurse prescription, and accompanying patient) working committees have been established for the study. Recruitment of patients is expected to start in November 2023. All questionnaires and technological platforms have been prepared, and the clinicians, stakeholders, and accompanying patient personnel have been recruited.

CONCLUSIONS

The implementation of this model in the trajectory of LT recipients at the CHUM may allow for better monitoring and health of patients undergoing transplantation, ultimately reducing the average length of hospital stay and promoting better use of medical resources. In the event of positive results, this model could be transposed to all transplant units at the CHUM and across Quebec (potentially affecting 888 patients per year) but could also be applied more widely to the monitoring of patients with other chronic diseases. The lessons learned from this project will be shared with decision makers and will serve as a model for other initiatives involving accompanying patients, connected objects, or digital platforms.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/54440.

Canadian English translation and linguistic validation of the 13-MD to measure global health-related quality of life

BACKGROUND

The 13-MD is a new instrument designed to measure more globally the various aspects of the health-related quality of life. Its structure is balanced around physical, mental, and social aspects of health.

OBJECTIVE

To translate the 13-MD into Canadian English and to ensure that it is conceptually equivalent to the original version in Canadian French.

METHODS

Forward and back translations were conducted. A linguistic validation was performed in both Canadian French and Canadian English following an iterative process. This validation was conducted with 15 participants in each group (French and English speakers) using face-to-face cognitive debriefing interviews. This process was done in accordance with academic standards.

RESULTS

The two forward translations resulted in 35.8% of identical sentences (59/165). Back translation indicated that 83.6% of the sentences were identical or almost identical to the original Canadian French version. The review of the back translation led to a few changes in the reconciled forward translation (4/165) and the original version (11/165), while the linguistic validation process led to 24 changes over a possibility of 165 sentences in the Canadian English version and 6 over 165 in the Canadian French version. Most changes provided were minimal and were done to ensure a better understanding of the 13-MD.

CONCLUSION

The translation and linguistic validation processes were successful in creating a valid 13-MD in Canadian English (13-MD-CE) that is conceptually equivalent to the original version.

Associated criteria used in investigating suspected septic transfusion reactions: A scoping review

BACKGROUND AND OBJECTIVES

Septic transfusion reactions (STRs) occur as a result of bacterial contamination of blood or blood products, resulting in sepsis. This scoping review aimed to identify, explore and map the available literature on the STR criteria triggering the investigation of STR.

MATERIALS AND METHODS

Four electronic databases (MEDLINE, Web of Science, Science Direct, Embase) were searched to retrieve scientific literature reporting such criteria, published from 1 January 2000 to 5 May 2022. Grey literature was also searched from open web sources.

RESULTS

Of 1052 references identified, 43 (21 peer-reviewed and 22 grey literature) met the eligibility criteria for inclusion and data extraction after full article screening. Of them, most (27/43, 62.79%) were found to report a single set of criteria, and only two reported four or more sets of criteria. The analysis of 66 sets of criteria collected from the selected references revealed 57 different sets. A few sets of criteria used only one sign and symptom (s/s) (12.12%, n = 8), whereas 16 sets used 7-15 s/s (n = 16/66; 24.24%). Of the total 319 occurrences of s/s associated with the 66 sets of criteria, post-transfusion hyperthermia, body temperature increase and hypotension were the most common s/s categories. Of all the literature available, only one study tested the diagnostic accuracy of the STR criteria.

CONCLUSION

This scoping review revealed a substantial variation in criteria used to identify suspected STR. Consequently, conducting further studies to enhance the diagnostic accuracy of these criteria, which trigger STR investigations, is imperative for advancing clinical practice.

Estimating the monetary value of a Quality-Adjusted Life-Year in Quebec

BACKGROUND

The value of a Quality-Adjusted Life-Year (QALY) is of great importance for the healthcare system. It helps when it comes to defining a cost-effectiveness threshold for the evaluation of health technologies. No willingness-to-pay value for a QALY exists in the province of Quebec, Canada.

OBJECTIVES

In this paper, we empirically investigated the monetary value of a QALY for the population of Quebec.

METHODS

Based on the Short-Form 6-Dimension version 2 (SF-6Dv2), we conducted an online survey with a representative adult sample living in Quebec. We used a time trade-off (TTO) combined with contingent valuation (CV), and a discrete choice experiment (DCE) to assess both the population's willingness to pay (WTP) for one QALY and the marginal WTP for health attributes. A health utility algorithm using hybrid regression was developed to determine a preference-based value set for health states.

RESULTS

Main analysis was conducted on 993 answers for the CV and 2143 answers for the DCE. The willingness-to-pay per QALY varied from CA$ 47,048.84 (CI: 21,554.38; 72,543.30) for CV to CA$ 73,936.87 (CI: 63,105.40; 84,768.35) for DCE. Among the 6 dimensions of the SF-6Dv2, marginal WTP varied from CA$ 4499.15 (CI: 2975.06; 6023.25) for more role accomplishment in daily activities to CA$ 15,867.12 (CI: 13,825.75; 17,908.49) for less pain. Robustness check with multiple alternative samples, as well as alternative health utility algorithms, showed that the results were robust and the DCE method provided 50% larger results than the CV method, although confidence intervals overlap.

CONCLUSION

This paper provides useful information for decision-makers on the monetary value of a QALY in Quebec.

Impact of COVID-19 pandemic on the health-related quality of life of frontline workers: the case of seven low-income Eastern African countries

PURPOSE

This study aimed to explore the potential impact of the COVID-19 pandemic on the health-related quality of life (HRQoL) of humanitarian and healthcare workers and its related factors in seven Eastern African countries (EAC).

METHODS

A sample of frontline workers filled out an online cross-sectional survey questionnaire comprising socio-demographic, degree of symptoms of depression, anxiety, insomnia, and distress, alcohol and tobacco consumption, health-related quality of life (HRQoL) using Short Form 6-Dimension version 2 (SF-6Dv2) and Clinical Outcomes in Routine Evaluation 6-Dimension (CORE-6D), and fear of COVID-19 (FCV-19S) questionnaires. Multivariate regressions were conducted to identify independent factors associated with HRQoL.

RESULTS

Of total 721 study participants, mean (standard deviation) scores for SF-6Dv2 and CORE-6D were 0.87 (0.18) and 0.81 (0.14), respectively. Participants with an education level below a university degree, having chronic diseases, been tested positive to COVID-19, with traumatic memories, depression, insomnia, distress, and stress were found to have lower HRQoL likelihood in terms of SF-6Dv2 scores during the COVID-19 pandemic. Similarly, participants with chronic diseases, exposure to COVID-19 patients, depression, insomnia, distress, stress, tested positive with COVID-19, and high level of fear of COVID-19, had lower HRQoL likelihood in terms of CORE-6D scores. Participants who were married had higher HRQoL likelihoods in terms of SF-6Dv2 scores.

CONCLUSION

Some personal and mental health characteristics, and COVID-19 related factors, were predictors of lower HRQoL of frontline workers in EAC. These findings should be meaningful while designing sustainable interventions and guidelines aiming to improve the HRQoL of frontline workers during a pandemic situation.

Second Version of the Short Form 6-Dimension Value Set Elicited From Patients With Breast and Colorectal Cancer: A Hybrid Approach

BACKGROUND

Quality-adjusted life-year instruments help comparison among programs by capturing their effects in terms of utility. Generic instruments are applicable to everyone, and for this reason, they are known to lack sensitivity when measuring gains in some domains. Specific instruments tend to fill this gap but, in domains like cancer, existing instruments are either nonpreferences-based or based on the general population's preferences.

PATIENTS AND METHODS

This study describes the development of a new value set for a well-known and highly used generic instrument, the Second Version of the Short Form 6-Dimension, to better consider the preferences of patients with cancer. In this aim, a hybrid approach combining the time trade-off and the discrete choice experiment was used. The population of interest was the Quebec population, Canada, with breast or colorectal cancer. Their preferences were elicited in 2 periods: before (T1) and 8 days after the beginning of a chemotherapy procedure (T2).

RESULTS

A total of 2808 observations for the time trade-off and 2520 observations for the discrete choice experiment were used. The parsimonious model encompassing the 2 periods was the preferred model. The new value set allows a greater utility range than the EQ-5D-5L and the Second Version of the Short Form 6-Dimension reference value sets and helps in better considering patients experiencing severe health situations. A good correlation between these 2 instruments and other specific cancer instruments (ie, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, QLU-C10D, and Functional Assessment of Cancer Therapy-General) was observed. Significative differences in utility values were also noted within periods and types of cancer.

A systematic review of SF-6D health state valuation studies

BACKGROUND

The short-form 6-dimension (SF-6D) is a preference-based measure designed to calculate quality-adjusted life-year (QALY). Preference-based measures are standardized multidimensional health state classifications with preference or utility weights elicited from a sample of the population. There is a concern that valuations may differ between countries because of differences in culture, thus invalidating the use of values obtained from one country to another.

OBJECTIVE

To conduct a systematic review of elicitation methods and modelling strategies in SF-6D studies and to present a general comparison of dimensions' ordering among different countries.

METHODS

We performed a systematic review of studies that developed value sets for the SF-6D. The data search was conducted in PubMed, ScienceDirect, Embase, and Scopus up to September 8, 2022. Quality of studies was assessed with the CREATE checklist. Methodological differences were identified, and the dimensions' ordering of the selected studies was analyzed by cultural and economic factors.

RESULTS

From a total of 1369 entries, 31 articles were selected. This corresponded to 12 different countries and regions and 17 different surveys. Most studies used the standard gamble method to elicit health state preferences. Anglo-Saxon countries gave more importance to pain, while other countries have physical functioning as the highest dimension. As the economic level increases, people care less about physical functioning but more about pain and mental health.

CONCLUSIONS

Value sets for the SF-6D are different from one country to another and there is a need to develop value sets for more countries to consider cultural and economic differences.

Determination of a cost-effectiveness threshold for cancer interventions in Iran

Background and objectives

The estimation of a cost- Effectiveness (CE) threshold from the perspective of those who have experienced a life-threatening disease can provide empirical evidence for health policy makers to make the best allocation decisions on limited resources. The aim of the current study was to empirically determine the CE threshold for cancer interventions from the perspective of cancer patients in Iran.

Methods

A composite time trade-off (cTTO) task for deriving quality adjusted life-year (QALY) and a double-bounded dichotomous choice (DBDC) approach followed by open-ended question for examining patients' willingness-to-pay were performed. A nationally representative sample of 580 cancer patients was recruited from the largest governmental cancer centers in Iran between June 2021 and January 2022, and data were gathered using face-to-face interviews. The CE threshold was calculated using the nonparametric Turnbull model and parametric interval-censored Weibull regression model. Furthermore, the factors that affect the CE threshold were determined using the parametric model.

Results

The estimated CE threshold using the nonparametric Turnbull model and parametric interval-censored Weibull regression model was IRR 440,410,000 (USD 10,485.95) and IRR 595,280,000 (USD 14,173.33) per QALY, respectively. Gender, age, education, income, type of cancer, and current treatment status were significantly associated with the estimated CE threshold.

Conclusions

The value of parametric model-based threshold in this study was 1.98 times the Iranian GDP per capita, which was lower than the CE threshold value recommended by the WHO (i.e., 3 times the GDP per capita) for low-and middle-income countries.

Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran

Background and Objective

Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients.

Methods

Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability.

Results

Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79).

Conclusions

The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.

Preferences of patients with chronic low back pain about nonsurgical treatments: Results of a discrete choice experiment

INTRODUCTION

This study aimed to assess patients' preferences of nonsurgical treatments for chronic low back pain (CLBP).

METHOD

We conducted a discrete choice experiment (DCE) in Quebec, Canada, in 2018. Seven attributes were included: treatment modality, pain reduction, the onset of treatment efficacy, duration effectiveness, difficulties with daily activities, sleep problems, and knowledge of the patient's body and pain location. Treatment modalities were corticosteroid injections, supervised body-mind physical activities, supervised sports physical activities, physical manipulations, self-management courses, and psychotherapy. Utility levels were estimated using a logit model, a latent class model and a Bayesian hierarchical model.

RESULTS

Analyses were conducted on 424 $424$ individuals. According to the Bayesian hierarchical model, the conditional relative importance weights of attributes were as follows: (1) treatment modality (34.79%), (2) pain reduction (18.73%), (3) difficulties with daily activities (11.71%), (4) duration effectiveness (10.06%), (5) sleep problems (10.05%), (6) onset of treatment efficacy (8.60%) and (7) knowledge of the patient's body and pain location (6.06%). According to the latent class model that found six classes of respondents with different behaviours (using Akaike and Bayesian criteria), the treatment modality was the most important attribute for all classes, except for class 4 for which pain reduction was the most important. In addition, classes 2 and 5 refused corticosteroid injections, while psychotherapy was preferred only in class 3.

CONCLUSION

Given the preference heterogeneity found in the analysis, it is important that patient preferences are discussed and considered by the physicians. This will help to improve the patient care pathway in a context of a patient-centred model for a disease with growing prevalence.

PATIENT OR PUBLIC CONTRIBUTION

A small group of patients was involved in the conception, design and interpretation of data. Participants in the DCE were all CLBP patients.

Attributes Underlying Patient Choice for Telerehabilitation Treatment: A Mixed-Methods Systematic Review to Support a Discrete Choice Experiment Study Design

BACKGROUND

Across most healthcare systems, patients are the primary focus. Patient involvements enhance their adherence to treatment, which in return, influences their health. The objective of this study was to determine the characteristics (ie, attributes) and associated levels (ie, values of the characteristics) that are the most important for patients regarding telerehabilitation (TR) healthcare to support a future discrete choice experiment (DCE) study design.

METHODS

A mixed-methods systematic review was conducted from January 2005 to the end of July 2020 and the search strategy was applied to five different databases. The initial selection of articles that met the eligibility criteria was independently made by one researcher, two researchers verified the accuracy of the extracted data, and all researchers discussed about relevant variables to include. Reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the study. A qualitative synthesis was used to summarize findings.

RESULTS

From a total of 928 articles, 11 (qualitative [n = 5], quantitative [n = 3] and mixed-methods [n = 3] design) were included, and 25 attributes were identified and grouped into 13 categories: Accessibility, Distance, Interaction, Technology experience, Treatment mode, Treatment location, Physician contact mode, Physician contact frequency, Cost, Confidence, Ease of use, Feeling safer, and Training session. The attributes levels varied from two to five. The DCE studies identified showed the main stages to undertake these types of studies.

CONCLUSION

This study could guide the development of interview grid for individual interviews and focus groups to support a DCE study design in the TR field. By understanding the characteristics that enhance patients' preferences, healthcare providers can create or improve TR programs that provide high-quality and accessible care. Future research via a DCE is needed to determine the relative importance of the attributes.

Maternal and dietary behavior-related factors associated with preterm birth in Southeastern Terai, Nepal: A cross sectional study

Background

Preterm birth (PTB) is a global issue although its burden is higher in low- and middle-income countries. This study examined the risk factors of PTB in Southeastern Terai, Nepal.

Methods

In this community-based cross-sectional study, a total of 305 mothers having children under the age of 6 months were selected using systematic random sampling. Data were collected by structured interviewer-administered questionnaires and maternal antenatal cards from study participants for some clinical information. Predictors of PTB were identified using multi-level logistic regression analysis at a P-value < 0.05.

Results

Of the total 305 mother-live-born baby pairs, 13.77% (42/305) had preterm childbirth. Maternal socio-demographic factors such as mothers from Dalit caste/ethnicity [adjusted odds ratio (AOR) = 12.16, 95% CI = 2.2-64.61] and Aadibasi/Janajati caste/ethnicity (AOR = 3.83, 95% CI = 1.01-14.65), family income in the first tercile (AOR = 6.82, 95% CI = 1.65-28.08), than their counterparts, were significantly positively associated with PTB. Likewise, other maternal and dietary factors, such as birth order first-second (AOR = 9.56, 95% CI = 1.74-52.53), and birth spacing ≤ 2 years (AOR = 5.16, 95% CI = 1.62-16.42), mothers who did not consume additional meal (AOR = 9.53, 95% CI = 2.13-42.55), milk and milk products (AOR = 6.44, 95% CI = 1.56-26.51) during pregnancy, having <4 antenatal (ANC) visits (AOR = 4.29, 95% CI = 1.25-14.67), did not have intake of recommended amount of iron and folic acid tablets (IFA) (<180 tablets) (AOR = 3.46, 95% CI = 1.03-11.58), and not having adequate rest and sleep (AOR = 4.83, 95% CI = 1.01-23.30) during pregnancy had higher odds of having PTB than their counterparts.

Conclusion

Some socio-demographic, maternal, and dietary behavior-related factors were independently associated with PTB. These factors should be considered while designing targeted health interventions in Nepal. In addition, we recommend specific measures such as promoting pregnant women to use available antenatal care and counseling services offered to them, as well as having an adequate diet to a level that meets their daily requirements.

Group-based pelvic floor muscle training is a more cost-effective approach to treat urinary incontinence in older women: economic analysis of a randomised trial

QUESTION(S)

How cost-effective is group-based pelvic floor muscle training (PFMT) for treating urinary incontinence in older women?

DESIGN

Economic evaluation conducted alongside an assessor-blinded, multicentre randomised non-inferiority trial with 1-year follow-up.

PARTICIPANTS

A total of 362 women aged ≥ 60 years with stress or mixed urinary incontinence.

INTERVENTION

Twelve weekly 1-hour PFMT sessions delivered individually (one physiotherapist per woman) or in groups (one physiotherapist per eight women).

OUTCOME MEASURES

Urinary incontinence-related costs per woman were estimated from a participant and provider perspective over 1 year in Canadian dollars, 2019. Effectiveness was based on reduction in leakage episodes and quality-adjusted life years. Incremental cost-effectiveness ratios and net monetary benefit were calculated for each of the effectiveness outcomes and perspectives.

RESULTS

Both group-based and individual PFMT were effective in reducing leakage and promoting gains in quality-adjusted life years. Furthermore, group-based PFMT was ≥ 60% less costly than individual treatment, regardless of the perspective studied: -$914 (95% CI -970 to -863) from the participant's perspective and -$509 (95% CI -523 to -496) from the provider's perspective. Differences in effects between study arms were minor and negligible. Adherence to treatment was high, with low loss to follow-up and no between-group differences.

CONCLUSION

Compared with standard individual PFMT, group-based PFMT was less costly and as clinically effective and widely accepted. These results indicate that patients and healthcare decision-makers should consider group-based PFMT to be a cost-effective first-line treatment option for urinary incontinence.

TRIAL REGISTRATION

ClinicalTrials.govNCT02039830.

Quebec Health-related Quality of Life Population Norms in Adults Using the SF-6Dv2: Decomposition by Sociodemographic Data and Health Problems

OBJECTIVE

The Short-Form 6-Dimension version 2 (SF-6Dv2) is the newest version of the Short-Form 6-Dimension (SF-6D) that is widely used to calculate quality-adjusted life-years (QALYs). The aim of this study was to produce Quebec population norms from the SF-6Dv2.

METHODS

An online survey was conducted in the adult general population. Data was stratified by various sociodemographic characteristics, such as age, sex, body mass index, history of illness, and health problems.

RESULTS

A total of 4175 respondents completed the SF-6Dv2. Mean (95% confidence interval) and median (interquartile range) utility scores were 0.692 (0.684-0.700) and 0.780 (0.607-0.866), respectively. Floor and ceiling effect corresponded to 0.05% and 3.1%, respectively. Men, nonsmoker, higher education, and employed people had significantly higher scores, while lower scores were found for those with a history of illness and a lower life satisfaction. Those reporting a health problem presented significant lower mean utility scores ranging from 0.340 (nervous problem) to 0.623 (diabetes) for men and from 0.207 (genitourinary) to 0.578 (diabetes) for women as compared with those without health problem (0.793 for men and 0.750 for women).

CONCLUSION

This study is the first to provide utility score norms for SF-6Dv2 in the adult general population of Quebec. It also highlighted significant differences among various health problems that can be used to compare populations in studies that do not have a control group.

Mapping the Food Allergy Quality of Life Questionnaire Parent Form onto the Short-Form Six-Dimensions version 2

BACKGROUND

The Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) is the most widely used quality of life questionnaire in food allergy. The objective of this study was to develop a mapping algorithm to convert FAQLQ-PF scores into health state utilities.

METHODS

The Short-Form Six-Dimensions version 2 (SF-6Dv2) and FAQLQ-PF questionnaires were collected from an academic center oral immunotherapy referral cohort. Utility estimates were derived from the SF-6Dv2 using the food allergy preference set. Candidate mapping algorithm models were developed using seven regression methods starting from either the total average score, the average scores of each of the three domains or the individual item scores of FAQLQ-PF. The process was repeated twice, including only section A, common to all age groups, or including all age-applicable sections of the FAQLQ-PF. The mean absolute error (MAE) and root mean squared error (RMSE) were used to select the best fitting model. An independent cohort from a previous national online survey was used for external validation.

RESULTS

In the index cohort, 1000 of 1257 respondents had completed both questionnaires. The lowest MAE (0.0791) and RMSE (0.1020) were recorded when entering individual item scores in a categorical regression model. The model including only FAQLQ-PF section A was found to be most consistent when tested in the external validation cohort (n = 248) (MAE of 0.0898).

CONCLUSION

The FAQLQ-PF was mapped onto SF-6Dv2 utilities with good predictive accuracy in two independent cohorts. This will enable calculation of health utility for cost-effectiveness analyses in food allergy.

Building resilience in oncology teams: Protocol for a realist evaluation of multiple cases

Background

Teams caring for people living with cancer face many difficult clinical situations that are compounded by the pandemic and can have serious consequences on professional and personal life. This study aims to better understand how a multi-component intervention builds resilience in oncology teams. The intervention is based on a salutogenic approach, theories and empirical research on team resilience at work. This intervention research involves partnership between researchers and stakeholders in defining situations of adversity and solutions appropriate to context.

Methods

The principles of realist evaluation are used to develop context-mechanism-outcome configurations of a multi-component intervention developed by researchers and field partners concerned with the resilience of oncology teams. The multiple case study involves oncology teams in natural contexts in four healthcare establishments in Québec (Canada). Qualitative and quantitative methods are employed. Qualitative data from individual interviews, group interviews and observation are analyzed using thematic content analysis. Quantitative data are collected through validated questionnaires measuring team resilience at work and its effect on teaming processes and cost-effectiveness. Integration of these data enables the elucidation of associations between intervention, context, mechanism and outcome.

Discussion

The study will provide original data on contextual factors and mechanisms that promote team resilience in oncology settings. It suggests courses of action to better manage difficult situations that arise in a specialized care sector, minimize their negative effects and learn from them, during and after the waves of the pandemic. The mechanisms for problem resolution and arriving at realistic solutions to professional workforce and team effectiveness challenges can help improve practices in other settings.

Validation of the Canadian French version of the fear of COVID-19 scale in the general population of Quebec

BACKGROUND

The purpose of this study was to develop a Canadian French translation of the fear of COVID-19 scale (FCV-19S) and assess its psychometric characteristics.

METHODS

A forward and backtranslation process was conducted for the Canadian French version of the FCV-19S. The guidance of the ISPOR task force for translation and cultural adaptation was followed and cognitive debriefing interviews were conducted with six citizens. The final proofread Canadian French FCV-19S was then administered to a large sample of citizens from the province of Quebec in Canada through an online survey. A quota sampling was conducted in 2020. Respondents from the survey also completed the Clinical Outcomes in Routine Evaluation (CORE)-6D and the Sense of Coherence (SOC-3) questionnaires. Several psychometric tests were performed to investigate the reliability (internal consistency) and validity of the Canadian French FCV-19S, including construct validity, concurrent validity, and Rasch analysis.

RESULTS

The translation process was conducted without any major difficulties. The cognitive debriefing interviews led to no change in the reconciled translation. The survey collected answers from 3428 citizens. Results indicated that the factor structure of the Canadian French FCV-19S is a unidimensional factor fitting well with the data. The scale showed adequate reliability (Cronbach's alpha of .903) and concurrent validity, as indicated by significantly negative correlation with CORE-6D (r = -.410) and SOC-3 (r = -.233). The Canadian French FCV-19S properties tested using Rasch analysis was also very satisfactory.

CONCLUSIONS

The results of the present study indicated that the Canadian French version of FCV-19S is a unidimensional tool with robust psychometric properties in the adult's population of all ages residing in the province of Quebec, Canada.

Public Preferences for a COVID-19 Vaccination Program in Quebec: A Discrete Choice Experiment

OBJECTIVES

We aimed to elicit preferences of the French-speaking Quebec population regarding a COVID-19 vaccination program and to characterize individuals with respect to their vaccination behaviors.

METHODS

A discrete choice experiment was conducted in Autumn 2020 via a web-based survey. Its design included seven attributes: vaccine origin, vaccine effectiveness, side effects, protection duration, priority population, waiting time to get vaccinated, and recommender of the vaccine. Utilities were estimated using a mixed-logit model and a latent class logit model.

RESULTS

Our sample included 1599 individuals. From this total, 119 always chose the opt-out option (7.4%). According to the mixed-logit model, the relative weights of attributes were as follows: effectiveness (28.48%), side effects (23.68%), protection duration (17.41%), vaccine origin (12.75%), recommender (11.96%), waiting time to get vaccinated (3.62%), and priority population (2.11%). Five classes were derived from the latent class logit model. Class 1 (9.13%) wanted to get vaccinated as fast as possible and was composed of uncertain and more vulnerable individuals. Class 5 (25.14%) was similar to the full sample, mostly favoring vaccination. Classes 2 (7.69%) and 4 (15.82%) included "vaccine hesitant and demanding" individuals but were different in their sociodemographic profiles. Finally, "anti-vaccine" and other "vaccine hesitant" individuals were in class 3 (42.21%).

CONCLUSIONS

This study showed the vaccine characteristics that are likely to improve vaccine uptake, which may more easily lead to herd immunity. Different profiles of respondents also showed various levels of acceptance toward a COVID-19 vaccination program, which may help to better understand vaccine hesitancy behaviors.

Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression

The use of a threshold for cost-utility studies is of major importance to health authorities for making the best allocation decisions for limited resources. Regarding the increasing number of studies worldwide that seek to establish a value for a quality-adjusted life year (QALY), it is necessary to review these studies to provide a global insight into the literature. A systematic review on willingness to pay (WTP) studies focusing on QALY was conducted in eight databases up to June 26, 2020. From a total of 9991 entries, 39 studies were selected, and 511 observations were extracted for the meta-analysis using the ordinary least squares method. The results showed a predicted mean empirical value of $52,619.39 (95% CI 49,952.59; 55,286.19) per QALY in US dollars for 2018. A 1% increase in income led to an increase of 0.6% in the WTP value, while a 1-year increase in respondent age led to a decrease of 3.3% in the WTP value. Sex, education level and employment status had significant effects on WTP. Compared to face-to-face interviews, surveys conducted by the internet or telephone were more likely to have a significantly higher value of WTP per QALY, while out-of-pocket payment tended to lower the value. The prediction made for the province of Quebec, Canada, provided a QALY value of approximately USD $98,450 (CAD $127,985), which is about 2.3 times its gross domestic product (GDP) per capita in 2018. This study is consistent with the extant literature and will be useful for countries that do not yet have a preference-based survey for the value of a QALY.

Development and use of research vignettes to collect qualitative data from healthcare professionals: a scoping review

OBJECTIVES

To clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical studies involving healthcare professionals.

DESIGN

Scoping review according to the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.

DATA SOURCES

Electronic databases: Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO and SocINDEX (January 2000-December 2020).

ELIGIBILITY CRITERIA

Empirical studies in English or French with a qualitative design including an explicit methodological description of the development and/or use of vignettes to collect qualitative data from healthcare professionals. Titles and abstracts were screened, and full text was reviewed by pairs of researchers according to inclusion/exclusion criteria.

DATA EXTRACTION AND SYNTHESIS

Data extraction included study characteristics, definition, development and utilisation of a vignette, as well as strengths, limitations and recommendations from authors of the included articles. Systematic qualitative thematic analysis was performed, followed by data matrices to display the findings according to the scoping review questions.

RESULTS

Ten articles were included. An explicit definition of vignettes was provided in only half the studies. Variations of the development process (steps, expert consultation and pretesting), data collection and analysis demonstrate opportunities for improvement in rigour and transparency of the whole research process. Most studies failed to address quality criteria of the wider qualitative design and to discuss study limitations.

CONCLUSIONS

Vignette-based studies in qualitative research appear promising to deepen our understanding of sensitive and challenging situations lived by healthcare professionals. However, vignettes require conceptual clarification and robust methodological guidance so that researchers can systematically plan their study. Focusing on quality criteria of qualitative design can produce stronger evidence around measures that may help healthcare professionals reflect on and learn to cope with adversity.

Study protocol of associated criteria used in investigating septic transfusion reactions (STRs): A scoping review about available evidence

Background and objective

Assessment criteria for septic transfusion reactions (STRs) are variable around the world. A scoping review will be carried out to find out, explore and map existing literature on STRs associated criteria.

Methods

This scoping review will include indexed and grey literatures available in English or French language from January 1, 2000, to December 31, 2021. Literature search will be conducted using four electronic databases (i.e., MEDLINE via PubMed, Web of Science, Science Direct, and Embase via Ovid), and grey literatures accompanying the research questions and objectives. Based on the inclusion criteria, studies will be independently screened by two reviewers for title, abstract, and full text. Extracted data will be presented in tabular form followed by a narrative description of inputs corresponding to research objectives and questions.

Predictors of Vaccine Acceptance, Confidence, and Hesitancy in General, and COVID-19 Vaccination Refusal in the Province of Quebec, Canada

INTRODUCTION

A surge of COVID-19 variants is a major concern, and literatures that support developing an optimum level of herd immunity are meaningful. This study aimed to examine the factors associated with vaccine acceptance, confidence, and hesitancy in general, and COVID-19 vaccination refusal in the general population of Quebec, Canada.

METHODS

A web-based cross-sectional survey was conducted in October and November 2020 among French-speaking participants above 18 years of age employing quota sampling technique. The questionnaire included socio-demographic and attitudinal variables towards vaccination. Logistic regression analyses were conducted to examine the association between independent and outcome variables.

RESULTS

Of total 1599 participants, 88.9%, 87.5%, 78.5%, and 18.2%, respectively, indicated vaccine acceptance, high level of vaccine confidence, low level of vaccine hesitancy, and COVID-19 vaccination refusals. Participants having higher education, income, and fear of COVID-19 (FCV-19S) were more likely to get vaccinated, while smokers were less likely to get vaccinated. Similarly, age groups (40-59, and ≥60 years), higher education, income, permanent resident in Canada, country of parents from Canada, ever faced acute disease in the family, higher sense of coherence, and FCV-19S scores were predictors of high levels of vaccine confidence. Higher education, income, sense of coherence and FCV-19S scores, and higher health-related quality of life (CORE-6D) produced lower levels of vaccine hesitancy. Conversely, those acting as caretaker, other essential worker, smoker, and those with financial losses were more likely to have higher vaccine hesitancy. Additionally, ≥60 years of age, higher education and income, country of parents from Canada, higher scores of willingness to take risk and FCV-19S were less likely to have high level of COVID-19 vaccination refusal.

CONCLUSION

Over three quarters of the participants indicated positive attitudes toward vaccination. Some socio-demographic and health-related quality of life factors were associated with the outcome variables, and these should be sought while designing interventions to improve COVID-19 vaccination rates.

Development of a balanced instrument to measure global health-related quality of life: The 13-MD

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.

Development and Validation of an Instrument to Measure Health-Related Out-of-Pocket Costs: The Cost for Patients Questionnaire

OBJECTIVE

The growth of healthcare spending is a major concern for insurers and governments but also for patients whose health problems may result in costs going beyond direct medical costs. To develop a comprehensive tool to measure direct and indirect costs of a health condition for patients and their families to various outpatient contexts.

METHODS

We conducted a content and face validation including results of a systematic review to identify the items related to direct and indirect costs for patients or their families and an online Delphi to determine the cost items to retain. We conducted a pilot test-retest with 18 naive participants and analyzed data calculating intraclass correlation and kappa coefficients.

RESULTS

An initial list of 34 items was established from the systematic review. Each round of the Delphi panel incorporated feedback from the previous round until a strong consensus was achieved. After 4 rounds of the Delphi to reach consensus on items to be included and wording, the questionnaire had a total of 32 cost items. For the test-retest, kappa coefficients ranged from -0.11 to 1.00 (median = 0.86), and intraclass correlation ranged from -0.02 to 0.99 (median = 0.62).

CONCLUSIONS

A rigorous process of content and face development was implemented for the Cost for Patients Questionnaire, and this study allowed to set a list of cost elements to be considered from the patient's perspective. Additional research including a test-retest with a larger sample will be part of a subsequent validation strategy.

Validated Tools to Measure Costs for Patients: A Systematic Review

BACKGROUND

Increasing healthcare expenditures is a major concern to insurers and governments, but also to patients who must pay a greater proportion of their healthcare costs. The objective of this study was to identify validated tools for measuring the costs of a health condition for patients as well as the different elements to be considered when measuring costs from the patient's perspective.

METHODS

A systematic literature review was conducted from 1984 to December 2020. The search strategy was applied to seven different databases that had been identified prior as pertinent sources. Two authors independently extracted and compiled data. In case of disagreement, arbitration by two other researchers was conducted. The methodological quality of the included articles was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

RESULTS

Among the 679 retrieved articles, nine met the inclusion criteria. The types of costs evaluated in these studies included direct costs for patients as well as for caregivers, indirect costs, and intangible costs. The development and validation processes used in these articles included a literature search, a discussion with the involved stakeholders, the development of an initial questionnaire, the testing of the questionnaire on a sample of patients, and a critical review. Regarding the psychometric properties of the tool, only five studies tested the reliability and validity of the instrument.

CONCLUSIONS

There are very few validated tools available to measure the different health-related costs from a patient perspective. Further research is needed to develop and validate a versatile and generalizable tool using a rigorous methodological process.

Cost-Effectiveness Analysis of an Interdisciplinary Lifestyle Intervention Targeting Women With Obesity and Infertility in Comparison to Usual Care

Although lifestyle modification is considered as the first-line treatment for women with obesity and infertility, these women generally do not have access to a program supporting them in adopting healthy habits that is integrated to fertility care. Implementing such a program requires to demonstrate its efficiency. The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of an interdisciplinary lifestyle intervention (Fit-for-Fertility (FFF) program) for women with obesity and infertility, in comparison with the usual care protocol, i.e. fertility treatments. Methods: A CEA was conducted alongside a randomized controlled trial, recruiting women at the fertility clinic of the Centre hospitalier universitaire de Sherbrooke. Women were randomized to: i) the intervention group (IG): FFF program alone for 6 months (individual follow-ups every 6 weeks and 12 group sessions), and in combination with usual care for infertility after 6 months if not pregnant; or ii) control group (CG): usual care from the outset. Data were collected in both groups, during 18 months or until the end of the pregnancy for those who became pregnant. Costs related to the management of infertility, obesity, pregnancy and childbirth, and the FFF program were considered and collected by self-reported questionnaires, review of medical records and administrative databases. Live birth (LB) rate was used to assess effectiveness. The CEA’s parameter of interest was the incremental cost-effectiveness ratio (ICER), calculated by non-parametric bootstrap with 5,000 iterations. All costs are in Canadian dollars, 2019. Results: A total of 130 women were randomized (65 CG, 65 IG). We present results for the 108 women (57 CG, 51 IG) who completed at least 6 months in the study. We observed an absolute difference of 14.2% (p=0.328) in LB rate between groups (IG: 51.0%; CG: 36.8%). Total mean costs per patient were significantly higher in the IG vs the CG for healthcare system’s ($5,660 ± $3,200 vs $3,631 ± $3,389; p=0.002) and society’s ($9,745 ± $5,899 vs $6,898 ± 7,021; p=0.026) perspectives. We observed an ICER of $12,633 per additional LB [$5,319-$19,947] from the healthcare system’s perspective, and $5,980 [$3,086-$8 874] from the patients’ perspective. Overall, the ICER for the society’s perspective, which includes both previous perspectives, was estimated at $24,393 per additional LB [$15,509-$33,276]. Conclusion: According to our results, a lifestyle intervention may be clinically more effective than the usual protocol of care for women with obesity and infertility, but generates higher costs as well, resulting in a positive ICER (of $12,600 per additional life birth for the healthcare system). Such an intervention could be considered efficient compared to the usual standard of care, but studies are needed to assess the willingness to pay of stakeholders for this type of intervention.

Dimensions Used in Instruments for QALY Calculation: A Systematic Review

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.

Web-based early intervention for children with motor difficulties aged 3–8 years old using multimodal rehabilitation (WECARE): protocol of a patient-centred pragmatic randomised trial of paediatric telerehabilitation to support families

Introduction

Mild motor difficulties in children are underdiagnosed despite being highly prevalent, leaving such children often underserved and at higher risk for secondary consequences such as cardiovascular disease and anxiety. Evidence suggests that early patient-oriented interventions, coaching parents and providing children with early stimulation should be provided, even in the absence of a diagnosis. Such interventions may be effectively delivered via telerehabilitation.

Methods and analysis

A family-centred, pragmatic randomised controlled trial will be carried out to evaluate the real-world effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE). Families of children with motor difficulties, 3–8 years of age, living in Quebec, Canada, and receiving no public rehabilitation services (n=118) will be asked to determine up to 12 performance goals, evaluated using the Canadian Occupational Performance Measure (COPM, the primary outcome). Families will be randomised to receive either usual care or the WECARE intervention. The WECARE intervention will be delivered for 1 year via a web-based platform. Families will have access to videoconferences with an assigned rehabilitation therapist using a collaborative coaching approach, a private chat function, a forum open to all intervention arm participants and online resources pertaining to child development. Participants will be asked to re-evaluate the child’s COPM performance goals every 3 months up to 1 year post allocation. The COPM results will be analysed using a mixed Poisson regression model. Secondary outcomes include measures of the child’s functional ability, parental knowledge and skills and health-related quality of life, as well as qualitative outcomes pertaining to parental satisfaction and service delivery trajectories. Investigators and quantitative data analysts will be blinded to group allocation.

Ethics and dissemination

The CIUSSS de l’Estrie—CHUS ethics committee approved this trial (2020-3429). Study results will be communicated via peer-reviewed journal publications, conference presentations and stakeholder-specific knowledge transfer activities.

Trial registration number

NCT04254302.

Attributes Underlying Non-surgical Treatment Choice for People With Low Back Pain: A Systematic Mixed Studies Review

Background: The knowledge of patients’ preferences in the medical decision-making process is gaining in importance. In this article we aimed to provide an overview on the importance of attributes underlying the choice of non-surgical treatments in people with low back pain (LBP).

Methods: A systematic mixed studies review was conducted. Articles were retrieved from the search engines PubMed, ScienceDirect, and Scopus through June 21, 2018. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the study, and each step was performed by 2 reviewers.

Analysis: From a total of 390 articles, 13 were included in the systematic review, all of which were considered to be of good quality. Up to 40 attributes were found in studies using various methods. Effectiveness, ie, pain reduction, was the most important attribute considered by patients in their choice of treatment. This attribute was cited by 7 studies and was systematically ranked first or second in each. Other important attributes included the capacity to realize daily life activities, fit to patient’s life, and the credibility of the treatment, among others.

Discussion: Pain reduction was the most important attribute underlying patients’ choice for treatment. However, this was not the only trait, and future research is needed to determine the relative importance of the attributes.

Canadian French translation and linguistic validation of the health-related quality of life utility measure for pre-school children

BACKGROUND

There is a need to perform a Canadian French translation and linguistic validation of the health-related quality of life utility measure for pre-school children (HuPS) conceptually equivalent to the original Canadian English version.

RESEARCH DESIGN AND METHODS

The translation process consisted of forward and back translations. The linguistic validation was performed with the parents of preschool children during face-to-face cognitive debriefing interviews. The whole process was done in accordance with academic standards and the guidance of the Food and Drug Administration (FDA) for patient-reported outcome instruments.

RESULTS

The results of back translations indicated that 89% of the sentences were identical or almost identical to the original English-language wording. The review of the back translations led to a change in 13 sentences out of 91 from the reconciled forward translation, while the linguistic validation process with 13 parents led to 14 additional changes. Preliminary reliability validation results indicate a Cronbach's alpha of 0.73.

CONCLUSION

The translation and linguistic testing processes were successful in creating a valid HuPS in Canadian French (HuPS-CF). This translation should be the subject of reliability and validity studies in a wide variety of clinical and general populations before to use in research projects.

Sociodemographic factors and beliefs about medicines in the uptake of pharmacogenomic testing in older adults

Aim: To assess the impact of sociodemographic factors and beliefs about medicines on the uptake of pharmacogenomic testing in older adults in a public healthcare system. Materials & methods: Data are based on a sample of 347 primary care older adults. Results: Most respondents (90%) were willing to provide a saliva sample and 47% were willing to pay for it. Increased age (odds ratio: 0.91; p = 0.04) and negative beliefs about the harmfulness of medicines (odds ratio: 0.68; p = 0.02) were associated with a decreased willingness to provide a sample. Lower education (less than university, odds ratio: 0.54; p = 0.04) was associated with a decreased willingness to pay. Conclusion: Education and beliefs about medicines are important factors in the acceptability of pharmacogenomic testing in older adults.

The economic value of Canada's National Capital Green Network

The lack of information on the value of ecosystems contributing to human well-being in urban and peri-urban setting is known to contribute to the degradation of natural capital and ecosystem services (ES). The purpose of this study was to determine the economic value of ES in Canada's Capital Region (Ottawa-Gatineau region), so that these values can be integrated in future planning decisions. Using the valuation methods of market pricing, cost replacement, and two benefit transfer approaches (with adjustment and with meta-analysis), the value of 13 ES from five ecosystems (forests, wetlands, croplands, prairies and grasslands, and freshwater systems) was measured. The annual economic value of these 13 ES amounts to an average of 332 million dollars, and to a total economic value of over 5 billion dollars, annualized over 20 years. The largest part of this value is generated by nonmarket ES, indicating that much more emphasis should be put on the management, preservation, and understanding of processes that make up these types of ES. The work generated as part of this study is a first step towards operationalizing the concept of ES in planning. More specifically, these results can be used to raise awareness, but also as a stepping stone to improve ecosystem-wide planning in the Canada's Capital Region.

Underweight and Associated Factors Among Teenage Adolescent Girls in Resource-poor Settings: A Cross-sectional Study

Background and Purpose

Understanding the undernutrition status of teenage adolescent girls living in urban slums and its associated factors is meaningful to formulate customized health strategies. This study aimed to determine the prevalence of being underweight and associated factors among teenage adolescent girls in urban slums.

Materials and Methods

In this cross-sectional study, we enrolled a total of 418 teenage adolescent girls from five of 210 urban slums of Varanasi district, Uttar Pradesh, India employing two-stage probability sampling for the selection of households and subjects, between September 2016 and July 2017. The study of underwight subjects was assessed with BMI for age using standard criteria. Factors associated with being underweight were determined by multivariable logistic regression analysis.

Results

Of 418 study subjects, 49.76% (208/418) were underweight. Results revealed that sociodemographic factors such as teenage adolescent girls who were from SC/ST (schedule caste/schedule tribe) caste/ethnicity (adjusted odds ratio (AOR)=2.02, 95%CI: 1.00–4.23), subjects whose father’s education level was primary or lower (AOR=1.87, 95%CI: 1.12–3.11), and number of people in the family >4 (AOR=2.18, 95%CI: 1.18–4.03) were associated with being underweight. Likewise, dietary behavior-related factors such as vegetarian (AOR=2.21, 95%CI: 1.25–3.92), and <3 meals per day (AOR=2.36, 95%CI: 1.40–3.98) than their counterparts were associated with being underweight. In addition, teenage adolescent girls from food-insecure households (AOR=3.33, 95%CI: 2.01–5.51) were more likely to be underweight than those from food-secure households.

Conclusion

The higher burden of underweight among teenage adolescent girls in Indian urban slums needs to be addressed through specific public health interventions such as by improving education, providing education regarding dietary behavior, and having access to sufficient, safe, and nutritious foods.

SF-6Dv2 preference value set for health utility in food allergy

BACKGROUND

The lack of a value set allowing the calculation of QALY is an important limitation when establishing the value of emerging therapies to treat food allergy. The aim of this study was to develop a Short-Form Six-Dimension version 2 (SF-6Dv2) preference value set for the calculation of health utility from the Canadian food-allergic population.

METHODS

Two hundred ninety-five parents of patients aged 0-17 years old and 154 patients aged 12 years old and above with food allergy were recruited in clinic and online. Participants were asked to complete a self-administered online questionnaire including generic health-related quality of life questionnaires. Various health states described by the SF-6Dv2 were valued with time-trade-off and discrete choice experiments. Data from elicitation techniques were combined using the hybrid regression model.

RESULTS

A total of 241 parents and 125 patients performed 3904 time-trade-off and 5112 discrete choice experiments. Utility decrements were estimated for each level of each SF-6Dv2 dimension. Utility values calculated based on the validated preference set were in average 0.15 lower (95%CI: 0.12-0.18) and were poorly correlated (R²  = 0.46) with those derived from the EQ-5D-5L generic questionnaire in the same cohort.

CONCLUSION

A representative preference value set for patients with food allergy was determined using the SF-6Dv2 generic questionnaire. This adapted preference set will contribute to improve the validity of future utility estimates in this population for the appraisal of upcoming potentially impactful but sometimes costly therapies.

Translation and Cultural Adaptation of the Patient Self-Administered Financial Effects (P-SAFE) Questionnaire to Assess the Financial Burden of Cancer in French-Speaking Patients

People living with and beyond cancer (PLC) experience financial hardship associated with the disease and its treatment. Research demonstrates that the "economic toxicity" of cancer can cause distress and impair well-being, health-related quality of life and, ultimately, survival. The Patient Self-Administered Financial Effects (P-SAFE) questionnaire was created in Canada and tested in English. The objective of this study is to describe the processes of translation and cultural adaptation of the P-SAFE for use with French speaking PLC in Canada. The Canadian P-SAFE questionnaire was translated from English to French in collaboration with the developer of the initial version, according to the 12-step process recommended by the Patient-Reported Outcome (PRO) Consortium. These steps include forward and backward translation, a multidisciplinary expert committee, and cross-cultural validation using think-aloud, probing techniques, and clarity scoring during cognitive interviewing. Translation and validation of the P-SAFE questionnaire were performed without major difficulties. Minor changes were made to better fit with the vocabulary used in the public healthcare system in Quebec. The mean score for clarity of questions was 6.4 out of a possible 7 (totally clear) Cognitive interviewing revealed that lengthy questionnaire instructions could be confusing. Our team produced a Canadian-French version of the P-SAFE. After minor rewording in the instructions, the P-SAFE questionnaire appears culturally appropriate for use with French-speaking PLC in Canada. Further testing of the French version will require evaluation of psychometric properties of validity and reliability.

EQ-5D-5L and SF-6Dv2 utility scores in people living with chronic low back pain: a survey from Quebec

OBJECTIVE

To describe how chronic low back pain (CLBP) impacts on utility scores and which patients' characteristics most affect these scores in the province of Quebec.

SETTINGS

Province of Quebec, Canada.

PARTICIPANTS

569 adult patients with CLBP.

METHODS AND OUTCOMES

An online survey on low back pain was conducted between October 2018 and January 2019. The EuroQol Five Dimensions (EQ-5D-5L) and the Short Form Six Dimensions version 2 (SF-6Dv2) are two generic preference-based measures used to evaluate health-related quality of life (HRQoL) and provide quality-adjusted life-year utility values.

RESULTS

The number of subjects who agreed to participate was 610, but 41 were excluded because 8 had low back pain for less than 3 months and 33 did not start the survey. A total of 569 subjects were analysed, but only 410 completed the survey up to the EQ-5D-5L or SF-6Dv2 sections. Median (range) of EQ-5D-5L was 0.622 (-0.072 to 0.905), and mean (range) of SF-6Dv2 and EQ-Visual Analogue Scale was 0.561 (0.301-0.829) and 51.0 (0-100), respectively. In all multivariate models, health or life satisfaction increased the health utility score, while pain reduced it. Co-occurring health problems were present for a majority (68%) of participants, mainly fatigue/insomnia (57.4%), musculoskeletal disorder (56.2%) and mental disorder (44%).

CONCLUSION

This study provided utility scores with EQ-5D-5L and SF-6Dv2 in patients with CLBP in Quebec, and results were similar to other studies conducted in different settings. These values were well below those reported in the Quebec general population and highlight the association between CLBP and HRQoL.

Patients, users, caregivers and citizens’ involvement in local HTA unit in Quebec: a survey

Increasing emphasis is given on involving patients in health technology assessment (HTA). While this is mainly done at the level of regional and national HTA agencies, this tendency is also emerging in local HTA units. In this study we provide the results of a survey conducted in local HTA units in the province of Quebec, Canada. The aim of the survey was to provide a panorama of local HTA units practices to involve patients in their process, their interest in doing so, and their information needs for this. The survey was conducted in 2017 with a response rate of 11 units over a possibility of 12. Results indicate that only 3 units over 11 never involved patients or members of the public in their process and that all will involve them in the next few years. The three most important needs identified in the HTA units were: recruiting and selecting patients; integrating experiential knowledge; and knowing and implementing the winning conditions for partnership. To conclude, patient involvement in local HTA units is quickly evolving; that is why the latter urgently need tools to involve more effectively patients and members of the public in their process.

Key messages

There is a need to develop tools to involve patients in HTA process. Patient involvement in local HTA units is quickly evolving.

Experiences of using Cochrane systematic reviews by local HTA units

The aim of this study is to evaluate the utilisation of CSRs by Quebec's local health technology assessment (HTA) units to promote efficiency in hospital decision-making. A survey was conducted using a structured online questionnaire to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by two independent evaluators (TGP and CAB). Ten HTA units participated. Mean number of staff was 6.3 [2-18], producing about 4.7 reports per year [2-7.3]. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well known and HTA units were highly satisfied with CSRs (80-100%). However, only 24.7% (21/85) of topics were searched with success. As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (e.g. brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context (lack of contextualisation); Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. HTA units generally use other articles from the literature or produce an original systematic review in complement with CSRs. These results led to some suggestions to improve the use of CSRs by HTA units. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation.

Key messages

The main limit for the use of CRS in local HTA will remain its lack of contextualization. Context and scientific data are complementary.

Experiences of Using Cochrane Systematic Reviews by Local HTA Units

This study evaluated the use of Cochrane systematic reviews (CSRs) by Quebec’s local health technology assessment (HTA) units to promote efficiency in hospital decision-making. An online survey was conducted to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by 2 independent evaluators. Ten HTA units participated. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well-known and HTA units were highly satisfied with CSRs (80%-100%). As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (eg, brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context; Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. Since they generally used other articles from the literature or produce an original SR in complement with CSRs, this led to suggestions to improve their use of CSRs. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation. As such, this study reinforces the need to consider the notion of complementarity of experimental data informing us about causality and contextual data, allowing decision-making adapted to local issues.

Predicting SF-6Dv2 utility scores for chronic low back pain using the Oswestry Disability Index and Roland-Morris Disability Questionnaire

Background: Generic preference-based measures are used to evaluate disability and health-related quality of life (HRQoL). Objective: To evaluate if Short Form Six-Dimensions (SF-6Dv2) is correlated with specific current questionnaires used in chronic low back pain (CLBP) and if a predictive equation of SF-6Dv2 could be established. Methods: Between October 2018 and January 2019, an online survey on CLBP was conducted. HRQoL was measured with two specific questionnaires, i.e. Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ), and with the new version of the SF-6Dv2 as a generic preference-based measure. Results: 402 subjects completed at least two of the three HRQoL questionnaires. Mean (95% confidence interval) of SF-6Dv2, ODI, or RMDQ were, respectively, 0.561 (0.553-0.569), 43.7 (42.1-45.2), and 10.3 (9.8-10.8). SF-6Dv2 was moderately correlated with ODI and RMDQ (r = -0.635 and r = -0.542, p < 0.001). The best model to predict SF-6Dv2 explained 50.6% of variability and included ODI. The correlation between actual and predicted SF-6Dv2 was 0.71. Conclusion: This study demonstrated that SF-6Dv2 was moderately correlated with ODI and RMDQ and that ODI was a better predictor. There was a strong correlation between actual and predicted SF-6Dv2 from multivariate models. These results suggest that the model can be used in similar studies to estimate the SF-6Dv2 when it was not measured.

Predicting EQ-5D-5L Utility Scores from the Oswestry Disability Index and Roland-Morris Disability Questionnaire for Low Back Pain

BACKGROUND

Cost utility analysis is important for measuring the impact of chronic disease and helps clinicians and policymakers in patient management and policy decisions, but generic preference-based measures are not always considered in clinical studies.

OBJECTIVE

To evaluate if health-related quality-of-life (HRQoL)-specific questionnaires used in chronic low back pain (CLBP) can predict EQ-5D-5L utility scores.

METHODS

The data come from an online survey on low back pain conducted between October 2018 and January 2019. Health utility scores for EuroQol Five Dimensions Five Levels (EQ-5D-5L) were calculated with the recommended model of Xie et al. The EQ-5D-5L health states ranged from -0.148 for the worst (55555) to 0.949 for the best (11111). Univariate and multivariate linear regression were performed to predict EQ-5D-5L with Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ) and clinical variables.

RESULTS

Analyses were performed in 408 subjects who completed the questionnaires EQ-5D-5L, ODI or RMDQ. Median (range) of EQ-5D-5L was 0.622 (-0.072 to 0.905). There was high correlation between EQ-5D-5L and ODI (r=-0.78, p<0.001), while it was moderate with RMDQ (r=-0.62, p<0.001). The multivariate model to predict EQ-5D-5L with ODI explained 67.6% of variability, and the correlation between actual and predicted EQ-5D-5L was 0.82. Principal predictors were ODI, duration of LBP, invalidity, health satisfaction (0-10 cm), life satisfaction (0-10 cm), and intensity of pain today (0-10 cm).

CONCLUSION

Data from this study demonstrated that individual correlation between ODI and EQ-5D-5L was high, but moderate with RMDQ. Correlations between actual and predicted EQ-5D-5L from multivariate models were higher and very high. Considering these results, the multivariate model can be used in similar studies for patient with CLBP to estimate the utility scores from the ODI when the EQ-5D-5L was not measured.

Web Comparison of Three Contingent Valuation Techniques in Women of Childbearing Age: The Case of Ovulation Induction in Quebec

Background

In Canada, 11.5% to 15.7% of couples suffer from infertility. Anovulation, or failed ovulation, is one of the main causes of infertility in women. In Quebec, the treatment for ovulation induction and other services related to assisted reproductive technology (ART) have been partially reimbursed by the government since 2010.

Objective

This study aimed to compare the willingness to pay (WTP) of women of childbearing age to receive drug treatment in the event of failed ovulation according to 3 different contingent valuation methods.

Methods

The following elicitation techniques were used: simple bid price dichotomous choice (DC), followed by an open-ended question (DC-OE), and a simplified multiple-bounded discrete choice (MBDC). Each participant was randomly assigned to 1 of 3 elicitation techniques. Bid prices ranged from Can $200 to Can $5000. Of the 7 bid prices, 1 was randomly proposed to each participant in the DC and DC-OE groups. For the DC-OE group, if the answer to the DC bid price was no, respondents were asked what was the maximum amount they were willing to pay. For the MBDC group, each respondent was offered an initial bid price of Can $1500, and the subsequent bid price offer increased or decreased according to the answer provided. “Do not know” responses were considered as a “no”, and each individual was questioned as to their certainty after each choice. WTP values were estimated using probit and bivariate models; the Welsh and Poe model was also performed for the MBDC group.

Results

The survey was conducted from 2009 to 2010 with a total sample of 680 women. Analyses were performed on 610 respondents (199 DC, 230 DC-OE, and 181 MBDC). Of the 70 respondents who were excluded, 6 did not meet the age criterion, 45 had an annual income less than Can $2500, and 19 did not respond to the WTP question. Mean WTP values were Can $4033.26, Can $1857.90, and Can $1630.63 for DC, DC-OE, and MBDC, respectively. The WTP for MBDC “definitely yes” and “probably yes” values were Can $1516.73 and Can $1871.22, respectively. The 3 elicitation techniques provided WTP value differences that were statistically significant (P<.01). The MBDC was the most accurate method, with a lower confidence interval (Can $557) and a lower (CI/mean) ratio (0.34).

Conclusions

A positive WTP for ovulation induction was found in Quebec. Adding a follow-up question resulted in more accurate WTP values. The MBDC technique provided a more accurate estimate of the WTP with a smaller and, therefore, more efficient confidence interval. To help decision making and improve the effectiveness of the fiscal policy related to the ART program, the WTP value elicited with the MBDC technique should be used.

Quebec Health-Related Quality-of-Life Population Norms Using the EQ-5D-5L: Decomposition by Sociodemographic Data and Health Problems

OBJECTIVES

Population norms for the EQ-5D-5L were published in Canada but only for Alberta province. The purpose of this study was to derive Quebec population norms from the EQ-5D-5L.

METHODS

The data came from a larger study conducted between September 2016 and March 2018 using elicitation techniques for a quality-adjusted life-year project. The online survey was distributed randomly in the province of Quebec. To best describe the entire population, data were stratified by various sociodemographic characteristics such as age, gender, urban and rural populations, whether disadvantaged or not, immigrant or nonimmigrant, and health problems.

RESULTS

A total of 2704 (53.8%) respondents completed the EQ-5D-5L. Mean (95% confidence interval) and median (interquartile range) utility scores were 0.824 (0.818-0.829) and 0.867 (0.802-0.911), respectively. The EQ-VAS scores were estimated at 75.9 (75.2-76.6) and 80 (69-90). Subjects with lower scores were those who had a low or high body mass index; were smokers; were single, divorced, or widowed; had no children; were unemployed or sick; had lower education or lower annual income; and had a family or personal history of serious illness. Immigrants had higher scores. There was no difference in gender and urban or rural population. The score logically decreased with worsening health status, from a mean score of 0.896 (0.884-0.908) to 0.443 (0.384-0.501; P < .0001. Similar results were observed for subjects' satisfaction with their health or life. Subjects with lower scores were less willing to take risks. Subjects who declared they were affected by health problems presented significant lower utility scores, ranging from 0.554 (nervous problem) to 0.750 (cancer), compared with those without health problems (0.871; confidence interval: 0.867-0.876).

CONCLUSION

This is the first study to present utility score norms for EQ-5D-5L for the Quebec population. These results will be useful for comparison with quality-adjusted life-year studies to better interpret their results. Moreover, utility norms were provided for 21 health problems, which was rarely done.

Understanding the preferences of water users in a context of cyanobacterial blooms in Quebec

Algal blooms, whether they are harmful or more akin to a nuisance, do pose negative impacts on human well-being. In the province of Quebec, excessive phosphorus that contributes to the problem of cyanobacterial blooms comes mainly from non-point sources. Limited regulation on the management of this nutrient leads to its strong accumulation in soils and, combined to climate change effects, contributes to increasing the magnitude of the effects of algal blooms on humans and the environment. The presence of cyanobacteria in water has impacts on its colour, texture and odour, in addition to posing threats to the health of recreationists, as some cyanobacteria are known to release toxins during blooms. This research focuses on studying the impacts of algal bloom events on recreationists and people living close to affected waterbodies. More specifically, we explore the preferences of individuals for different ecosystem services (ES), mainly cultural ES, provided by waterbodies (i.e., recreational activities, aesthetic aspects, and ecological health). We also estimate the average willingness to pay, financed through an increase in municipal taxation, for mechanisms that would allow the resolution of this issue. To achieve these objectives, we use a choice experiment approach, enclosed in a questionnaire that was carried out in person to 252 people. Conditional logit with and without interactions, and a random parameter logit (mixed logit) are alternatively used. Results show that individuals value first their ability to perform recreational activities, followed by the ecological health of waterbodies, and the aesthetic aspects (i.e., odour and visual aspects). Interestingly, the fact that people reported taking part in fishing activities influenced the way they prioritized ES in the choice modelling exercises. Based on the most robust model, we estimate the average willingness to pay at CA$353/household per year to fund a suite of solutions aimed at improving overall water quality.

Economic impact of harmful algal blooms on human health: a systematic review

Harmful algal blooms (HABs) damage human activities and health. While there is wide literature on economic losses, little is known about the economic impact on human health. In this review, we systematically retrieved papers which presented health costs following exposure to HABs. A systematic review was conducted up to January 2019 in databases such as ScienceDirect and PubMed, and 16 studies were selected. Health costs included healthcare and medication expenses, loss of income due to illness, cost of pain and suffering, and cost of death. Two categories of illness (digestive and respiratory) were considered for health costs. For digestive illness cost, we found $86, $1,015 and $12,605, respectively, for mild, moderate and severe cases. For respiratory illness, costs were $86, $1,235 and $14,600, respectively, for mild, moderate and severe cases. We used Quality-Adjusted Life Years (QALYs) to access the loss of well-being due to illness caused by HABs. We found that breathing difficulty causes the most loss of QALYs, especially in children, with a loss of between 0.16 and 0.771 per child. Having gastroenteritis could cause a loss of between 2.2 and 7.1 QALYs per 1,000 children. Misleading symptoms of illness following exposure to HABs could cause bias in health costs estimations.