1
|
Kriit HK, Sommar JN, Åström S. Socioeconomic per-case costs of stroke, myocardial infarction, and preterm birth attributable to air pollution in Sweden. PLoS One 2024; 19:e0290766. [PMID: 38206924 PMCID: PMC10783732 DOI: 10.1371/journal.pone.0290766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Incident cases of stroke, myocardial infarction, and preterm birth have established exposure-response functions associated with air pollution. However, there are no studies reporting detailed costs per case for these health outcomes that are adapted to the cost-benefit tools that guide the regulation of air pollution. OBJECTIVES The primary objective was to establish non-fatal per-case monetary estimates for stroke, myocardial infarction, and preterm birth attributable to air pollution in Sweden, and the secondary objective was to ease the economic evaluation process of air pollution morbidity effects and their inclusion in cost-benefit assessments. METHODS Based on recommendations from the literature, the case-cost analysis considered direct and indirect medical costs, as well as production losses and informal costs relevant for the calculation of the net present value. A literature search was conducted to estimate the costs of each category for each incident case in Sweden. Informal costs were estimated using the quality-adjusted life-years approach and the corresponding willingness-to-pay in the Swedish population. The total average per-case cost was estimated based on specific health outcome durations and severity and was discounted by 3.5% per year. Sensitivity analysis included varying discount rates, severity of health outcome, and the range of societal willingness to pay for quality-adjusted life years. RESULTS The average net present value cost estimate was €2016 460k (185k-1M) for non-fatal stroke, €2016 24k (16k-38k) for myocardial infarction, and €2016 34k (19k-57k) for late preterm birth. The main drivers of the per-case total cost estimates were health outcome severity and societal willingness to pay for risk reduction. Varying the discount rate had the largest effect on preterm birth, with costs changing by ±30% for the discount rates analysed. RECOMMENDATION Because stroke, myocardial infarction, and preterm birth have established exposure-response functions linking these to air pollution, cost-benefit analyses should include the costs for these health outcomes in order to adequately guide future air pollution and climate change policies.
Collapse
Affiliation(s)
- Hedi Katre Kriit
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- Institute of Global Health, Health Economic and Financing Group, Heidelberg University, Heidelberg, Germany
- Interdisciplinary Center for Scientific Computing, Climate-Sensitive Infectious Disease Lab, Heidelberg University, Heidelberg, Germany
| | - Johan Nilsson Sommar
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | | |
Collapse
|
2
|
Carter HE, Waugh J, Chang AB, Shelton D, David M, Weir KA, Levitt D, Carty C, Frakking TT. Cost-Effectiveness of Care Coordination for Children With Chronic Noncomplex Medical Conditions: Results From a Multicenter Randomized Clinical Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)02063-0. [PMID: 35871140 DOI: 10.1016/j.jval.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of care coordination, compared with standard care, for children with chronic noncomplex medical conditions. METHODS A total of 81 children aged between 2 and 15 years newly diagnosed with a noncomplex chronic condition were randomized to either care coordination or standard care as part of a multicenter randomized controlled trial. Families receiving care coordination were provided access to an Allied Health Liaison Officer, who facilitated family-centered healthcare access across hospital, education, primary care, and community sectors. Costs were estimated over a 12-month period from the perspective of the Australian health system. Health outcomes were valued as quality-adjusted life-years (QALYs). Caregiver productivity costs were included in an alternative base-case analysis, and key assumptions were tested in a series of one-way sensitivity analyses. A probabilistic sensitivity analysis was conducted to investigate the overall impact of uncertainty in the data. RESULTS Children in the intervention arm incurred an average of $17 in additional health system costs (95% confidence interval -3861 to 1558) and gained an additional 0.031 QALYs (95% confidence interval -0.29 to 0.092) over 12 months, producing an incremental cost-effectiveness ratio of $548 per QALY. When uncertainty was considered, there was a 73% likelihood that care coordination was cost-effective from a health system perspective, assuming a willingness to pay of $50 000 per QALY. This increased to 78% when caregiver productivity costs were included. CONCLUSIONS Care coordination is likely to be a cost-effective intervention for children with chronic noncomplex medical conditions in the Australian healthcare setting.
Collapse
Affiliation(s)
- Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.
| | - John Waugh
- Department of Paediatrics, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; School of Clinical Medicine, The University of Queensland, Herston, QLD, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Doug Shelton
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, QLD, Australia
| | - Michael David
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW
| | - Kelly A Weir
- School of Health Sciences and Social Work and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Allied Health Research, Gold Coast Health, Southport, QLD, Australia
| | - David Levitt
- Department of Paediatrics, Queensland Children's Hospital, Children's Health Queensland, South Brisbane, QLD, Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD, Australia; Speech Pathology Department, Gold Coast University Hospital, Southport, QLD, Australia
| |
Collapse
|
3
|
A Systematic Review of the Effects of Skin-to-Skin Contact on Biomarkers of Stress in Preterm Infants and Parents. Adv Neonatal Care 2022; 22:223-230. [PMID: 34054011 PMCID: PMC9150851 DOI: 10.1097/anc.0000000000000905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Premature infants and their parents experience significant stress related to separation and lifesaving procedures. While evidence suggests that skin-to-skin contact (SSC) is a stress-reducing intervention for both neonates and parents, the mechanisms that underlie its efficacy are not well understood. OBJECTIVE Purpose of this systematic review is to summarize the current state of knowledge on changes in biomarkers (ie, oxytocin [OT], cortisol, hypoxanthine, xanthine, uric acid, and allantoin), associated with SSC in premature infants and parents, that may reflect physiologic responses to stress. METHODS A comprehensive literature search was conducted from 1990 to 2020. Studies were selected using prespecified inclusion and exclusion criteria. RESULTS Of the 175 studies identified, only 19 are included in this review. Ten studies evaluated only infants, 2 evaluated only parents, and 7 evaluated for changes in biomarkers in both infants and parents. Cortisol was the most common biomarker evaluated. While changes in infants' cortisol levels were highly variable, in 55% of the parent studies, parent cortisol levels decreased following SSC. In both parents and infants, OT levels decreased following SSC. Only 1 study found that allantoin levels were significantly lower in infants who received SSC. IMPLICATIONS FOR PRACTICE AND RESEARCH While evidence suggests the numerous benefits of SSC, additional research is needed to identify the optimal biomarker to determine the mechanisms that underlie these effects. The use of novel biomarkers (eg, gene expression changes microbiome) may provide new insights into the mechanisms that underlie the efficacy of SSC.Video Abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=48.
Collapse
|
4
|
Frakking TT, Teoh HJ, Shelton D, Moloney S, Ward D, Annetts K, David M, Levitt D, Chang AB, Carty C, Barber M, Carter HE, Mickan S, Weir KA, Waugh J. Effect of Care Coordination Using an Allied Health Liaison Officer for Chronic Noncomplex Medical Conditions in Children: A Multicenter Randomized Clinical Trial. JAMA Pediatr 2022; 176:244-252. [PMID: 34962514 PMCID: PMC8715383 DOI: 10.1001/jamapediatrics.2021.5465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of high-quality evidence on the effect of care coordination on health-related quality of life among children with chronic noncomplex medical conditions (non-CMCs). OBJECTIVE To examine whether care coordination delivered by an Allied Health Liaison Officer results in improved quality-of-life (QOL) outcomes for children with chronic non-CMCs and their families. DESIGN, SETTING AND PARTICIPANTS This multicenter, open label, randomized clinical trial was conducted in pediatric outpatient clinics at 3 Australian hospitals with tertiary- and secondary-level pediatric care facilities. A total of 81 children with chronic non-CMCs and their families participated in the trial for a period of up to 12 months between October 2017 to October 2020. Primary care reviews were offered at 1 week, 3 months, and 6 months after diagnosis. INTERVENTIONS Eligible children were randomized 1:1 to receive care coordination or standard care. Families of children receiving care coordination were provided access to an Allied Health Liaison Officer, who was responsible for facilitation of health care access across hospital, education, primary care, and community sectors. MAIN OUTCOMES AND MEASURES The primary outcomes were scores on the Pediatric Quality of Life Inventory (PedsQL), version 4.0, and the PedsQL Family Impact Module, version 2.0, measured at 6 and 12 months. An intent-to-treat approach was used to analyze the data. RESULTS Of 81 children (mean [SD] age, 8.2 [3.5] years; 55 [67.9%] male), 42 (51.9%) were randomized to care coordination and 39 (48.1%) to standard care. Compared with standard care, care coordination resulted in greater improvements in overall PedsQL scores (difference in score changes between groups, 7.10; 95% CI, 0.44-13.76; P = .04), overall PedsQL Family Impact Module scores (difference in score changes between groups, 8.62; 95% CI, 1.07-16.16; P = .03), and family functioning QOL (difference in score changes between groups, 15.83; 95% CI, 5.05-26.62; P = .004) at 12 months after diagnosis. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, care coordination improved the quality of life of children with chronic non-CMCs and their families. Further studies should explore specific non-CMCs that may benefit most from care coordination and whether an orientation among health services to provide such a coordination model could lead to longer-term improved clinical outcomes. TRIAL REGISTRATION http://anzctr.org.au Identifier: ACTRN12617001188325.
Collapse
Affiliation(s)
- Thuy Thanh Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia,Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, Queensland, Australia,Speech Pathology Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hsien-Jin Teoh
- Psychology Department, Redcliffe Hospital, Queensland Health, Queensland, Australia
| | - Doug Shelton
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, Queensland, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, Queensland, Australia,School of Medicine and Dentisry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Donna Ward
- Allied Health, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia
| | - Kylie Annetts
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia
| | - Michael David
- School of Medicine and Dentisry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - David Levitt
- Department of Paediatrics, Queensland Children’s Hospital, Queensland Health, South Brisbane, Queensland, Australia
| | - Anne B. Chang
- Queensland Children’s Respiratory Centre, Queensland Children’s Hospital, South Brisbane, Queensland, Australia,Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia,Centre for Children’s Health Research, Queensland University of Technology, Level 7, South Brisbane, Queensland Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | | | - Hannah E. Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Sharon Mickan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kelly A. Weir
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia,Allied Health Research, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John Waugh
- Department of Paediatrics, Caboolture Hospital, Queensland Health, Caboolture, Queensland, Australia,School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia,Department of Paediatrics, Ipswich Hospital, Queensland Health, Queensland, Australia
| |
Collapse
|
5
|
Shaw KA, Heboyan V, Fletcher ND, Murphy JS. Comparative cost-utility analysis of postoperative discharge pathways following posterior spinal fusion for scoliosis in non-ambulatory cerebral palsy patients. Spine Deform 2021; 9:1659-1667. [PMID: 34008146 DOI: 10.1007/s43390-021-00362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Accelerated postoperative discharge (AD) pathways have demonstrated numerous benefits for patients with adolescent idiopathic scoliosis undergoing PSF. Although early evidence supports the application of AD pathways over more traditional discharge (TD) approaches for patients with neuromuscular scoliosis, the economic impact of these pathways has not been investigated. METHODS A decision-analysis model was constructed using a hypothetical 15-year-old male with non-ambulatory CP with a 65-degree thoracolumbar scoliosis and pelvic obliquity undergoing operative treatment with PSF from T2-pelvis with pedicle screw fixation. The literature was reviewed to estimate costs, probabilities, and quality-adjusted life years (QALYs)) for identified complication profiles for discharge pathways. QALYs were constructed using age-matched values for US population average, applying a CP diagnosis corrective value. A probabilistic sensitivity analysis was performed using a second-order Monte Carlo simulations. Incremental cost-utility ratio and incremental net monetary benefit (NMB) were calculated. One-way sensitivity analyses were performed by selective variable variation. RESULTS AD pathway resulted in an average cost and effectiveness of $67,069 and 15.4 QALYs compared with $81,312 and 15.4 QALYs for TD. AD resulted in a 2.1% greater NMB with a cost-effectiveness ratio of $4361/QALY compared with $5290/QALY in the TD. The cost-effectiveness of TD was inversely sensitive to implant cost variation while the AD maintained effectiveness despite cost variations. CONCLUSION This cost-utility analysis demonstrated that the implementation of an AD pathway following PSF for non-ambulatory CP scoliosis is economically more effective, providing a 17.5% cost reduction with enhanced value of care evidenced by a 2.1% greater NMB over a TD pathway. The cost-effectiveness of the AD was maintained despite implant cost variations.
Collapse
Affiliation(s)
- K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA, 30905, USA.
| | - Vahé Heboyan
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, 1120 15th Street, Augusta, GA, USA
| | - Nicholas D Fletcher
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Emory University Atlanta, 1400 Tullie Rd NE, Atlanta, GA, USA
| | - Joshua S Murphy
- Department of Pediatric Orthopaedic Surgery, Children's Healthcare of Atlanta, Scottish Rite Campus, 5445 Meridian Mark Rd Suite 250, Atlanta, GA, USA
| |
Collapse
|
6
|
Forde D, Deming DD, Tan JC, Phillips RM, Fry-Bowers EK, Barger MK, Bahjri K, Angeles DM, Boskovic DS. Oxidative Stress Biomarker Decreased in Preterm Neonates Treated With Kangaroo Mother Care. Biol Res Nurs 2020; 22:188-196. [PMID: 31973579 DOI: 10.1177/1099800419900231] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Due to physiological and metabolic immaturity, prematurely born infants are at increased risk because of maternal separation in many neonatal intensive care units (NICUs). The stress induced from maternal-infant separation can lead to well-documented short-term physiologic instability and potentially lifelong neurological, sociological, or psychological sequelae. Based on previous studies of kangaroo mother care (KMC) that demonstrated improvement in physiologic parameters, we examined the impact of KMC on physiologic measures of stress (abdominal temperature, heart rate, oxygen saturation, perfusion index, near-infrared spectrometry), oxidative stress, and energy utilization/conservation in preterm infants. METHODS In this randomized, stratified study of premature neonates, we compared the effects on urinary concentrations of biomarkers of energy utilization and oxidative stress of 1 hr of KMC versus incubator care on Day 3 of life in intervention-group babies (n = 26) and control-group babies (n = 25), respectively. On Day 4, both groups received 1 hr of KMC. Urinary samples were collected 3 hr before and 3 hr after intervention/incubator care on both days. Energy utilization was assessed by measures of adenosine triphosphate (ATP) degradation (i.e., hypoxanthine, xanthine, and uric acid). Oxidative stress was assessed using urinary allantoin. Mixed-models analysis was used to assess differences in purine/allantoin. RESULTS Mean allantoin levels over Days 3 and 4 were significantly lower in the KMC group than in the control group (p = .026). CONCLUSIONS Results provide preliminary evidence that KMC reduces neonatal oxidative stress processes and that urinary allantoin could serve as an effective noninvasive marker for future studies.
Collapse
Affiliation(s)
- Dorothy Forde
- Hahn School of Nursing, University of San Diego, CA, USA
- School of Nursing, University of California, San Francisco, CA, USA
| | - Douglas D Deming
- Department of Pediatrics, Division of Neonatology, School of Medicine, Loma Linda University, Loma, CA, USA
| | - John C Tan
- Department of Basic Sciences, Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Raylene M Phillips
- Department of Pediatrics, Division of Neonatology, School of Medicine, Loma Linda University, Loma, CA, USA
| | | | - Mary K Barger
- Hahn School of Nursing, University of San Diego, CA, USA
| | - Khaled Bahjri
- School of Pharmacy, Loma Linda University, Loma Linda, CA, USA
| | - Danilyn M Angeles
- Department of Pediatrics, Division of Neonatology, School of Medicine, Loma Linda University, Loma, CA, USA
- Department of Basic Sciences, Division of Physiology, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Danilo S Boskovic
- Department of Basic Sciences, Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| |
Collapse
|
7
|
Kouakou CRC, Poder TG. Economic impact of harmful algal blooms on human health: a systematic review. JOURNAL OF WATER AND HEALTH 2019; 17:499-516. [PMID: 31313990 DOI: 10.2166/wh.2019.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Christian R C Kouakou
- Department of Economics, University of Sherbrooke, Sherbrooke, Montreal, Canada E-mail:
| | - Thomas G Poder
- Department of Economics, University of Sherbrooke, Sherbrooke, Montreal, Canada E-mail: ; Department of Management, Evaluation and Health Policy, School of Public Health of the University of Montreal, University of Montreal, Montreal, QC, Canada
| |
Collapse
|
8
|
Scott D, Ferguson GD, Jelsma J. The use of the EQ-5D-Y health related quality of life outcome measure in children in the Western Cape, South Africa: psychometric properties, feasibility and usefulness - a longitudinal, analytical study. Health Qual Life Outcomes 2017; 15:12. [PMID: 28103872 PMCID: PMC5248508 DOI: 10.1186/s12955-017-0590-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The EQ-5D-Y, an outcome measure of Health Related Quality of Life (HRQoL) in children, was developed by an international task team in 2010. The multinational feasibility, reliability and validity study which followed was undertaken with mainly healthy children. The aim of this study was to investigate the psychometric properties of the EQ-5D-Y when used to assess the HRQoL of children with different health states. METHOD A sample of 224 children between eight and twelve years were grouped according to their health state. The groups included 52 acutely ill children, 67 children with either a chronic health condition or disability and 105 mostly healthy, mainstream school children as a comparator. They were assessed at baseline, at three months and at six months. An analysis of the psychometric properties was performed to assess the reliability, validity and responsiveness of the EQ-5D-Y in the different groups of children. Cohen's kappa, the intraclass correlation coefficient, Pearson Chi-square, Kruskal-Wallis ANOVA and effect size of Wilcoxon Signed-rank test were used to determine the reliability, validity and responsiveness of the instrument. RESULTS The EQ-5D-Y dimensions were found to be reliable on test-retest (kappa varying from 0.365 to 0.653), except for the Usual Activities dimension (kappa 0.199). The Visual Analogue Scale (VAS) was also reliable (ICC = 0.77). Post-hoc analysis indicated that dimensions were able to discriminate between acutely ill and healthy children (all differences p < 0.001). The acutely ill children had the lowest ranked VAS (median 50, range 0-100), indicating worst HRQoL and was the only group significantly different from the other three groups (p < 0.001 in all cases). Convergent validity between all similar EQ-5D-Y and PedsQL, WeeFIM and Faces Pain Scale dimensions was only evident in the acutely ill children. As expected the largest treatment effect was also observed in these children (Wilcoxon Signed-rank test for VAS was 0.43). Six of the nine therapists who took part in the study, found the measure quick and easy to apply, used the information in the management of the child and would continue to use it in future. CONCLUSIONS The EQ-5D-Y could be used with confidence as an outcome measure for acutely-ill children, but demonstrated poorer psychometric properties in children with no health condition or chronic conditions. It appears to be feasible and useful to include the EQ-5D-Y in routine assessments of children.
Collapse
Affiliation(s)
- Des Scott
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa.
| | - Gillian D Ferguson
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| |
Collapse
|