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Kuharic M, Mulhern B, Sharp LK, Turpin RS, Pickard AS. Understanding caregiver burden from multiple perspectives: dyadic agreement between caregiver and care recipient. Qual Life Res 2024; 33:1719-1734. [PMID: 38632146 DOI: 10.1007/s11136-024-03643-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Caregiver burden (CB) is typically self-assessed by caregivers. However, an emerging concept is assessment of CB by the recipients of care, i.e., the patient. The specific objectives are (1) to assess the level of agreement between care recipients' and caregivers' view on CB, across financial, physical, emotional, and social domains; (2) to explore two care recipient perspectives: their self-perceived burden (CR-SPB), and their interpretation of the caregiver's view (Proxy-CB). METHODS Data were collected from 504 caregiver-care recipient dyads in the U.S. using an online Qualtrics panel. The survey assessed caregiver burden using CarerQol and newly developed items. The level of agreement between responses was quantified using weighted kappa (κ) coefficients for individual items and intraclass correlation coefficients (ICC) for index/summary scores. RESULTS The average age of caregivers was 49.2 years, and 62.7 years for care recipients. Dyads most commonly consisted of spouses/partners (34.5%); 68.3% lived together. Proxy-CB aligned more closely with caregiver's view, with moderate to substantial agreement across CB domains (from κ = 0.48 for emotional to κ = 0.66 for financial). In the same perspective, the CarerQol-7D Index showed moderate agreement (ICC = 0.58) and the summary score of CB items substantial agreement (ICC = 0.76). Care recipients generally overestimated CB in the Proxy-CB perspective, while they underestimated it in the CR-SPB perspective. CONCLUSION Results demonstrate there is a difference between perspectives. Strong agreement in Proxy-CB perspective suggests that care recipients can potentially substitute for caregivers depending on the domain. CR-SPB agrees less with caregivers and may provide complementary information.
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Affiliation(s)
- Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Chicago, IL, 60611, USA.
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Lisa K Sharp
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
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Widjaja E, Puka K, Smith ML. Trajectory of health-related quality of life in parents of children treated with epilepsy surgery versus medical therapy. Qual Life Res 2024; 33:1297-1305. [PMID: 38381280 DOI: 10.1007/s11136-024-03607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Child health-related quality of life (HRQOL) has been shown to improve after epilepsy surgery and is linked to parent HRQOL. We postulated that the HRQOL of parents whose children underwent epilepsy surgery would improve over two years compared to those treated with medical therapy. The aim of the study was to evaluate the trajectory of HRQOL of parents whose children received treatment with epilepsy surgery or medical therapy over two years. METHODS This multi-center study recruited parents whose children were evaluated for epilepsy surgery. Parents completed measures of care-related QOL (CarerQOL) at the time of their children's surgical evaluation, 6 months, 1 year, and 2 years later. Additional measures included parent anxiety and depression, satisfaction with family relationships, family resources and demands, and child clinical variables. A linear mixed model was used to compare the trajectories of parent HRQOL of surgical and medical patients, adjusting for baseline clinical, parent, and family characteristics. RESULTS There were 111 children treated with surgery and 154 with medical therapy. The trajectory of parent HRQOL was similar among parents of surgical and medical patients over the two-year follow-up. However, HRQOL of parents of surgical patients was 3.0 points higher (95%CI - 0.1, 6.1) across the follow-up period compared to parents of medical patients. Parents of seizure-free children reported 2.3 points (95%CI 0.2, 4.4) higher HRQOL relative to parents of non-seizure-free children across the two-year follow-up. CONCLUSION Parent HRQOL did not improve after their children were treated with epilepsy surgery, possibly related to ongoing comorbidities in children.
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Affiliation(s)
- Elysa Widjaja
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Ave, Chicago, IL, 60611, USA.
- Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
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Kuharic M, Mulhern B, Sharp LK, Turpin RS, Pickard AS. Comparison of EQ Health and Well-Being Long and Short With Other Preference-Based Measures Among United States Informal Caregivers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)00117-7. [PMID: 38492925 DOI: 10.1016/j.jval.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Several measures have been used or developed to capture the health and well-being of caregivers, including the EQ Health and Well-being (EQ-HWB) and its short form, EQ-HWB-S. This study aimed to evaluate the psychometric properties and construct validity of the EQ-HWB/EQ-HWB-S in a US caregiver population. METHODS A cross-sectional survey was conducted involving 504 caregivers. Eligible participants were 18+ years old, provided unpaid care to a relative/friend aged 18+ in the past 6 months, and spent on average of at least 1 hour per week caregiving. Survey included the following measures: EQ-HWB, Adult Social Care Outcomes Toolkit for Carers-Carer, CarerQol, and EQ-5D-5L. Psychometric properties were assessed using response distributions, floor/ceiling effects, Spearman's correlation for convergent validity, and effect sizes (ES) for known-group validity based on caregiving situations and intensity. RESULTS The average age of caregivers was 49.2 (SD = 15.4), with 57.5% being female. More than half (54.4%) reported high caregiving intensity, and 68.3% lived with the care recipient. The EQ-HWB-S index showed a strong positive correlation with the EQ-5D-5L (rs = 0.72), Adult Social Care Outcomes Toolkit for Carers (rs = 0.54), and CarerQol (rs = 0.54) indices. Notably, the EQ-HWB-S index showed the largest ES among measures in differentiating caregiving scenarios with a large ES for caregiver's general health (d = 1.00) and small ES for caregiving intensity (d = 0.39). CONCLUSIONS Results support construct validity of EQ-HWB and EQ-HWB-S as measures for assessing health and well-being of adult informal caregivers in comparison with other validated instruments. Differing levels of known-group validity across anchors emphasize the importance of selecting appropriate measures for caregivers, depending on research question and/or intervention aims.
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Affiliation(s)
- Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Lisa K Sharp
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
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Shah R, Salek MS, Finlay AY, Kay R, Nixon SJ, Otwombe K, Ali FM, Ingram JR. Mapping of Family Reported Outcome Measure (FROM-16) scores to EQ-5D: algorithm to calculate utility values. Qual Life Res 2024:10.1007/s11136-023-03590-z. [PMID: 38402530 DOI: 10.1007/s11136-023-03590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available. METHODS Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample. RESULTS The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance). CONCLUSIONS The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available.
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Affiliation(s)
- R Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.
| | - M S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - R Kay
- RK Statistics, Bakewell, UK
| | - S J Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - K Otwombe
- Statistics and Data Management Centre, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Tahami Monfared AA, Khachatryan A, Hummel N, Kopiec A, Martinez M, Zhang R, Zhang Q. Assessing Quality of Life, Economic Burden, and Independence Across the Alzheimer's Disease Continuum Using Patient-Caregiver Dyad Surveys. J Alzheimers Dis 2024; 99:191-206. [PMID: 38640156 DOI: 10.3233/jad-231259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Background Alzheimer's disease (AD) and mild cognitive impairment (MCI) have negative quality of life (QoL) and economic impacts on patients and their caregivers and may increase along the disease continuum from MCI to mild, moderate, and severe AD. Objective To assess how patient and caregiver QoL, indirect and intangible costs are associated with MCI and AD severity. Methods An on-line survey of physician-identified patient-caregiver dyads living in the United States was conducted from June-October 2022 and included questions to both patients and their caregivers. Dementia Quality of Life Proxy, the Care-related Quality of Life, Work Productivity and Activity Impairment, and Dependence scale were incorporated into the survey. Regression analyses investigated the association between disease severity and QoL and cost outcomes with adjustment for baseline characteristics. Results One-hundred patient-caregiver dyads were assessed with the survey (MCI, n = 27; mild AD, n = 27; moderate AD, n = 25; severe AD, n = 21). Decreased QoL was found with worsening severity in patients (p < 0.01) and in unpaid (informal) caregivers (n = 79; p = 0.02). Dependence increased with disease severity (p < 0.01). Advanced disease severity was associated with higher costs to employers (p = 0.04), but not with indirect costs to caregivers. Patient and unpaid caregiver intangible costs increased with disease severity (p < 0.01). A significant trend of higher summed costs (indirect costs to caregivers, costs to employers, intangible costs to patients and caregivers) in more severe AD was observed (p < 0.01). Conclusions Patient QoL and functional independence and unpaid caregiver QoL decrease as AD severity increases. Intangible costs to patients and summed costs increase with disease severity and are highest in severe AD.
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Faraji H, Soleymani F, Yaseri M, Sahraian MA, Abdollahiasl A, Meftah A, Nikfar S. Choosing the Best Instrument for Measuring Health Spillover Effect in Caregivers of Patients With Multiple Sclerosis. Value Health Reg Issues 2024; 39:49-56. [PMID: 37979543 DOI: 10.1016/j.vhri.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES To measure the health spillover effect in caregivers of patients with multiple sclerosis (MS), we aimed to select the best instrument from 2 common health-related quality of life (QoL) instruments, the 3-level EQ-5D (EQ-5D-3L) and the Health Utilities Index Mark 3 (HUI-3), by assessing them. METHODS Using consecutive sampling, 452 primary caregivers of patients with MS were asked to fill out a Care-related QoL instrument (CarerQol-7D), EQ-5D-3L, HUI-3, and the Center for Epidemiologic Studies Depression Scale between October 2019 and May 2020. Convergent and clinical validity were assessed to measure spillover effect in caregivers of patients with MS. RESULTS A strong correlation of health-utility scores between EQ-5D-3L and HUI-3 (r = 0.914, P < .01) was observed. The 95% limit of agreement (LoA) for CarerQol-7D and HUI-3 (-10.6 to 8.2) was narrower than the LoA for CarerQol-7D and EQ-5D-3L (-15.1 to 17.1). Both EQ-5D-3L and HUI-3 proved clinical validity for the QoL of caregivers. The CarerQoL-7D score was significantly lower in female (P < .001), single (P < .014), lower-educated (P < .001), parent's relatives (P < .001), and unemployed (P < .001) caregivers. CONCLUSIONS We found that both, EQ-5D-3L and HUI-3, were appropriate for measuring caregivers' QoL, although HUI-3 was a better choice because of its narrower LoA. Our findings suggest researchers should use HUI-3 to measure the quality-adjusted life-year of caregivers to aggregate with the QoL of patients in the denominator of an economic evaluation equation, such as the cost-effective ratio.
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Affiliation(s)
- Hoda Faraji
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Iran, Tehran
| | - Fatemeh Soleymani
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Iran, Tehran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran, Tehran
| | - Mohammad Ali Sahraian
- Neurology Department, MS Research Centre, Neuroscience institute, Tehran University of Medical Sciences, Iran, Tehran
| | - Akbar Abdollahiasl
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Iran, Tehran
| | - Azin Meftah
- Faculty of Health Sciences Pharmacy, University of Eastern Finland, Finland, Kuopio
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Iran, Tehran.
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Dückert S, Bart S, Gewohn P, König H, Schöttle D, Konnopka A, Rahlff P, Erik F, Vogeley K, Schulz H, David N, Peth J. Health-related quality of life in family caregivers of autistic adults. Front Psychiatry 2023; 14:1290407. [PMID: 38193135 PMCID: PMC10773769 DOI: 10.3389/fpsyt.2023.1290407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL. Methods N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL. Results Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05). Discussion Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.
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Affiliation(s)
- Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Bart
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Health Sciences, Faculty Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Petia Gewohn
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yoo HK, Porteous A, Ng A, Haria K, Griffiths A, Lloyd A, Yang X, Kazeem G, Barut V. Impact of neurofibromatosis type 1 with plexiform neurofibromas on the health-related quality of life and work productivity of adult patients and caregivers in the UK: a cross-sectional survey. BMC Neurol 2023; 23:419. [PMID: 37996843 PMCID: PMC10666383 DOI: 10.1186/s12883-023-03429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/07/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Plexiform neurofibromas (PN) are complex, benign nerve-sheath tumours that occur in 30-50% of patients with neurofibromatosis type 1 (NF1), a rare, genetic disorder. PN are associated with substantial, heterogeneous morbidities that impact health-related quality of life (HRQoL), including affecting motor function and causing pain, though HRQoL and work productivity data are scarce. This UK cross-sectional study explored HRQoL and work productivity in adult patients with NF1 PN and caregivers of paediatric patients. METHODS Adult patients and caregivers of paediatric patients self-enrolled in an online survey (March-April 2021). Outcomes included EQ-5D-5L, PROMIS® GH and INF1-QOL (adult patients only), and EQ-5D-5L, CarerQol and WPAI (caregivers only). Utilities were estimated from EQ-5D-5L responses using the UK crosswalk value set. Linear regression models explored univariable associations between adult patient characteristics and HRQoL. RESULTS Mean (± standard deviation) EQ-5D utility in adult patients with NF1 PN was 0.65 (± 0.29; n = 35; age-/sex-matched norm: 0.89 [± 0.04]). Moderate-extreme pain/discomfort and anxiety/depression were reported by 14/35 (40.0%) and 18/35 (51.4%) patients, respectively. Mean PROMIS® GH physical and mental health scores were 43.6 (± 9.19) and 41.7 (± 11.5; n = 35; matched norm: 50.0 [± 10.0]). Mean INF1-QOL score was 11.03 (± 6.02; n = 33). Chronic itching, at least one symptom, at least one comorbidity, PN location at extremities (arms/legs) and pain were associated with worse HRQoL scores. Mean caregiver EQ-5D utility was 0.72 (± 0.24; n = 8; age-/sex-matched norm: 0.88 [± 0.03]). Moderate pain/discomfort and moderate-severe anxiety/depression were reported by 4/8 (50.0%) and 2/8 (25.0%) caregivers, respectively. Mean CarerQol score was 69.3 (± 13.9; n = 8). Mean WPAI regular activity productivity loss was 36.3% (± 31.6%; n = 8). CONCLUSIONS NF1 PN worsens adult patient and caregiver HRQoL compared to the general population, notably affecting pain and discomfort, anxiety and depression and caregiver productivity.
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Affiliation(s)
| | | | - Alvin Ng
- Costello Medical, Singapore, Singapore
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Bucholc J, McCaffrey N, Ugalde A, Muldowney A, Rand S, Hoefman R, Mihalopoulos C, Engel L. How well do the adult social care outcomes toolkit for carers, carer experience scale and care-related quality of life capture aspects of quality of life important to informal carers in Australia? Qual Life Res 2023; 32:3109-3121. [PMID: 37356076 PMCID: PMC10522516 DOI: 10.1007/s11136-023-03459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Identify aspects of quality of life (QoL) important to Australian informal carers and explore how well the Adult Social Care Outcomes Toolkit for Carers, Care-related Quality of Life instrument and Carer Experience Scale capture these aspects in the Australian context. METHODS Online questionnaires were completed by Australian informal carers. Socio-demographics, open-ended questions: positive/negative aspects of caring and QoL aspects missing from the instruments, and ranking of the instrument domains was used to explore the content of the instruments. Instruments were scored using preference-weighted value sets (reported in another paper). Content analysis was used to analyse the open-ended responses. Chi-squared test looked at differences in domain importance. Descriptive analyses summarised all other information. RESULTS Eight themes were identified: Behaviour-mood of the care recipient, Caring responsibilities, Finances, Health, Own life, Perception of carers, Relationship with care recipient and Support. Many aspects of carer QoL mentioned as missing in the instruments appeared covered by the domains, of which all were reported as important. The highest ranked domain was relationship with the care recipient. The influence of the care recipient specific support, behaviour/mood and health on carer QoL appear absent in all instruments. CONCLUSION The content of the three instruments appears relevant in an Australian setting. The influence of care recipient's health and well-being on carer QoL should be considered, along with spillover effects. A content and/or face validity analysis is required to confirm differences in item interpretation in Australian informal carers.
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Affiliation(s)
- Jessica Bucholc
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Anna Ugalde
- Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | | | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), Cornwallis Building, University of Kent, Canterbury, UK
| | - Renske Hoefman
- The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands
| | - Cathrine Mihalopoulos
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Melbourne, VIC, Australia
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de Groot S, Santi I, Bakx P, Wouterse B, van Baal P. Informal Care Costs According to Age and Proximity to Death to Support Cost-Effectiveness Analyses. PHARMACOECONOMICS 2023; 41:1137-1149. [PMID: 36725787 PMCID: PMC10450016 DOI: 10.1007/s40273-022-01233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Costs of informal care are ignored in many cost-effectiveness analyses (CEAs) conducted from a societal perspective; however, these costs are relevant for lifesaving interventions targeted at the older population. In this study, we estimated informal care costs by age and proximity to death across European regions and showed how these estimates can be included in CEAs. METHODS We estimated informal care costs by age and proximity to death using generalised linear mixed-effects models. For this, we selected deceased singles from the Survey of Health, Ageing and Retirement, which we grouped by four European regions. We combined the estimates of informal care costs with life tables to illustrate the impact of including informal care costs on the incremental cost-effectiveness ratio (ICER) of a hypothetical intervention that prevents a death at different ages. RESULTS Informal care use, and hence informal care costs, increase when approaching death and with increasing age. The impact of including informal care costs on the ICER varies between €200 and €17,700 per quality-adjusted life-year gained. The impact increases with age and is stronger for women and in southern European countries. CONCLUSION Our estimates of informal care costs facilitate including informal care costs in CEAs of life-extending healthcare interventions. Including these costs may influence decisions as it leads to reranking of life-extending interventions compared with interventions improving quality of life.
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Affiliation(s)
- Saskia de Groot
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Irene Santi
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter Bakx
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Bram Wouterse
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Department of Health Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Gallop K, Pham N, Maclaine G, Saunders E, Black B, Hubig L, Acaster S. Health-related quality-of-life and burden for caregivers of individuals with neurogenic orthostatic hypotension. Neurodegener Dis Manag 2023; 13:35-45. [PMID: 36382590 DOI: 10.2217/nmt-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: This study explores the burden of caring for an individual with neurogenic orthostatic hypotension (nOH) and an underlying neurodegenerative disease (Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies). Materials & methods: A survey including several validated instruments was conducted with informal caregivers of individuals with Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies. Results: Caregivers of patients with nOH (n = 60) reported greater burden across all outcomes compared with those without nOH (n = 60). Receiving pharmacological treatment for nOH was the variable most consistently associated with significantly better caregiver health-related quality-of-life (p < 0.05). Conclusion: This study demonstrates the burden of nOH on informal caregivers and highlights the potential benefit of pharmacological treatment not only for patients but also indirectly, their caregivers.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
| | - Ngan Pham
- HEOR and Value Strategy, Theravance Biopharma US, Inc. San Francisco, CA 94080, USA
| | - Grant Maclaine
- HEOR and Value Strategy, Theravance Biopharma Ireland, Dublin, D04 N9W8, Ireland
| | | | - Bonnie Black
- Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lena Hubig
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
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12
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Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J, Govindasamy D. An economic incentive package to support the wellbeing of caregivers of adolescents living with HIV during the COVID-19 pandemic in South Africa: a feasibility study protocol for a pilot randomised trial. Pilot Feasibility Stud 2023; 9:3. [PMID: 36624520 PMCID: PMC9827020 DOI: 10.1186/s40814-023-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their ability to maintain their own wellbeing due to multiple factors (viz. poverty, stigma, lack of access to social support services) which have been exacerbated by the COVID-19 pandemic. Economic incentives, such as cash incentives combined with SMS reminders, have been shown to improve wellbeing. However, there is a lack of preliminary evidence on the potential of economic incentives to promote caregiver wellbeing in this setting, particularly in the context of a pandemic. This protocol outlines the design of a parallel-group pilot randomised trial comparing the feasibility and preliminary effectiveness of an economic incentive package versus a control for improving caregiver wellbeing. METHODS Caregivers of ALHIV will be recruited from public-sector HIV clinics in the south of the eThekwini municipality, KwaZulu-Natal, South Africa. Participants will be randomly assigned to one of the following groups: (i) the intervention group (n = 50) will receive three cash payments (of ZAR 350, approximately 23 USD), coupled with a positive wellbeing message over a 3-month period; (ii) the control group (n = 50) will receive a standard message encouraging linkage to health services. Participants will be interviewed at baseline and at endline (12 weeks) to collect socio-demographic, food insecurity, health status, mental health (stigma, depressive symptoms) and wellbeing data. The primary outcome measure, caregiver wellbeing, will be measured using the CarerQoL instrument. A qualitative study will be conducted alongside the main trial to understand participant views on participation in the trial and their feedback on study activities. DISCUSSION This study will provide scientific direction for the design of a larger randomised controlled trial exploring the effects of an economic incentive for improving caregiver wellbeing. The feasibility of conducting study activities and delivering the intervention remotely in the context of a pandemic will also be provided. TRIAL REGISTRATION PACTR202203585402090. Registry name: Pan African Clinical Trials Registry (PACTR); URL: https://pactr.samrc.ac.za/ ; Registration. date: 24 March 2022 (retrospectively registered); Date first participant enrolled: 03 November 2021.
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Affiliation(s)
- Stanley Carries
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zibuyisile Mkhwanazi
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lovemore Sigwadhi
- grid.11956.3a0000 0001 2214 904XBiostatistics Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Mosa Moshabela
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Makandwe Nyirenda
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa ,grid.415021.30000 0000 9155 0024Burden of Disease Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jane Goudge
- grid.11951.3d0000 0004 1937 1135Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Darshini Govindasamy
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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13
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Grazziotin LR, Currie G, Twilt M, IJzerman MJ, Kip MMA, Koffijberg H, Bonsel G, Benseler SM, Swart JF, Vastert SJ, Wulffraat NM, Yeung RSM, Armbrust W, van den Berg JM, Marshall DA. Factors associated with care- and health-related quality of life of caregivers of children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:51. [PMID: 35870932 PMCID: PMC9308305 DOI: 10.1186/s12969-022-00713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study investigates the relationship of child, caregiver, and caring context measurements with the care-related quality of life (CRQoL) and health-related quality of life (HRQoL) of caregivers of children with juvenile idiopathic arthritis (JIA). METHODS We performed a cross-sectional analysis of baseline data on caregivers of children with JIA from Canada and the Netherlands collected for the "Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases" study from June 2019 to September 2021. We used the CRQoL questionnaire (CarerQoL), adult EQ-5D-5L, and proxy-reported Youth 5-Level version of EuroQoL (EQ-5D-5L-Y) to assess caregiver CRQoL, caregiver HRQoL, and child HRQoL, respectively. We used a multivariate analysis to assess the relationship between both caregiver CRQoL and HRQoL and patient, caregiver, and caring context measurements. RESULTS A total of 250 caregivers were included in this study. Most of the caregivers were from the Netherlands (n = 178, 71%) and 77% were females (n = 193). The mean CarerQoL scores was 82.7 (standard deviation (SD) 11.4) and the mean EQ-5D-5L utility score was 0.87 (SD 0.16). Child HRQoL and employment had a positive relationship with both caregiver CarerQoL and EQ-5D-5L utility scores (p < 0.05), while receiving paid or unpaid help had a negative relationship with both scores (p < 0.05). CONCLUSION Our findings indicated that to understand the impact of JIA on families, we need to consider socio-economic factors, such as employment and support to carry caregiving tasks, in addition to child HRQoL.
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Affiliation(s)
- Luiza R. Grazziotin
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Gillian Currie
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marinka Twilt
- grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Maarten J. IJzerman
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Michelle M. A. Kip
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Hendrik Koffijberg
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Gouke Bonsel
- grid.478988.20000 0004 5906 3508EuroQol Research Foundation, Rotterdam, the Netherlands
| | - Susanne M. Benseler
- grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ,grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, Alberta Canada
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrecht, Utrecht, Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Sebastiaan J. Vastert
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrecht, Utrecht, Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrecht, Utrecht, Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Rae S. M. Yeung
- grid.17063.330000 0001 2157 2938Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Wineke Armbrust
- grid.4494.d0000 0000 9558 4598Wineke Armbrust University of Groningen, University Medical Center Groningen (UMCG), Beatrix Childrens Hospital, Dept Pediatric Rheumatology-Immunology, Groningen, Netherlands
| | - J. Merlijn van den Berg
- grid.7177.60000000084992262Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
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14
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Gumley AI, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Birchwood M, Briggs A, Bucci S, Cotton S, Engel L, French P, Lederman R, Lewis S, Machin M, MacLennan G, McLeod H, McMeekin N, Mihalopoulos C, Morton E, Norrie J, Reilly F, Schwannauer M, Singh SP, Sundram S, Thompson A, Williams C, Yung A, Aucott L, Farhall J, Gleeson J. Digital smartphone intervention to recognise and manage early warning signs in schizophrenia to prevent relapse: the EMPOWER feasibility cluster RCT. Health Technol Assess 2022; 26:1-174. [PMID: 35639493 DOI: 10.3310/hlze0479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. OBJECTIVE How feasible is a study to investigate the clinical effectiveness and cost-effectiveness of a digital intervention to recognise and promptly manage early warning signs of relapse in schizophrenia with the aim of preventing relapse? DESIGN A multicentre, two-arm, parallel-group cluster randomised controlled trial involving eight community mental health services, with 12-month follow-up. SETTINGS Glasgow, UK, and Melbourne, Australia. PARTICIPANTS Service users were aged > 16 years and had a schizophrenia spectrum disorder with evidence of a relapse within the previous 2 years. Carers were eligible for inclusion if they were nominated by an eligible service user. INTERVENTIONS The Early signs Monitoring to Prevent relapse in psychosis and prOmote Wellbeing, Engagement, and Recovery (EMPOWER) intervention was designed to enable participants to monitor changes in their well-being daily using a mobile phone, blended with peer support. Clinical triage of changes in well-being that were suggestive of early signs of relapse was enabled through an algorithm that triggered a check-in prompt that informed a relapse prevention pathway, if warranted. MAIN OUTCOME MEASURES The main outcomes were feasibility of the trial and feasibility, acceptability and usability of the intervention, as well as safety and performance. Candidate co-primary outcomes were relapse and fear of relapse. RESULTS We recruited 86 service users, of whom 73 were randomised (42 to EMPOWER and 31 to treatment as usual). Primary outcome data were collected for 84% of participants at 12 months. Feasibility data for people using the smartphone application (app) suggested that the app was easy to use and had a positive impact on motivations and intentions in relation to mental health. Actual app usage was high, with 91% of users who completed the baseline period meeting our a priori criterion of acceptable engagement (> 33%). The median time to discontinuation of > 33% app usage was 32 weeks (95% confidence interval 14 weeks to ∞). There were 8 out of 33 (24%) relapses in the EMPOWER arm and 13 out of 28 (46%) in the treatment-as-usual arm. Fewer participants in the EMPOWER arm had a relapse (relative risk 0.50, 95% confidence interval 0.26 to 0.98), and time to first relapse (hazard ratio 0.32, 95% confidence interval 0.14 to 0.74) was longer in the EMPOWER arm than in the treatment-as-usual group. At 12 months, EMPOWER participants were less fearful of having a relapse than those in the treatment-as-usual arm (mean difference -4.29, 95% confidence interval -7.29 to -1.28). EMPOWER was more costly and more effective, resulting in an incremental cost-effectiveness ratio of £3041. This incremental cost-effectiveness ratio would be considered cost-effective when using the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year gained. LIMITATIONS This was a feasibility study and the outcomes detected cannot be taken as evidence of efficacy or effectiveness. CONCLUSIONS A trial of digital technology to monitor early warning signs that blended with peer support and clinical triage to detect and prevent relapse is feasible. FUTURE WORK A main trial with a sample size of 500 (assuming 90% power and 20% dropout) would detect a clinically meaningful reduction in relapse (relative risk 0.7) and improvement in other variables (effect sizes 0.3-0.4). TRIAL REGISTRATION This trial is registered as ISRCTN99559262. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 27. See the NIHR Journals Library website for further project information. Funding in Australia was provided by the National Health and Medical Research Council (APP1095879).
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Affiliation(s)
- Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Ainsworth
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maximillian Birchwood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Paul French
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Reeva Lederman
- School of Computing and Information Systems, Melbourne School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Shôn Lewis
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matthew Machin
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathy Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Emma Morton
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Swaran P Singh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suresh Sundram
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chris Williams
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia.,NorthWestern Mental Health, Melbourne, VIC, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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15
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Sutherland CS, Hudson P, Mitchell S, Paracha N. Systematic Literature Review to Identify Utility Values in Patients with Spinal Muscular Atrophy (SMA) and Their Caregivers. PHARMACOECONOMICS 2022; 40:39-67. [PMID: 34907515 PMCID: PMC8994729 DOI: 10.1007/s40273-021-01115-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that has a substantial impact on health-related quality of life for patients with SMA and their caregivers. Utility values ('utilities') are used in health economic analyses to incorporate individual or societal perspectives regarding the desirability of health outcomes such as a certain health state or change in health states over time. OBJECTIVES The primary objective of this systematic literature review (SLR) was to identify published utilities associated with patients with SMA and their caregivers and to determine the extent to which Health Technology Assessment (HTA) requirements of methods used to generate utilities are met. A secondary objective was to broaden the scope to identify utilities associated with other (non-SMA) neuromuscular disorders. METHODS A comprehensive search to capture published utilities associated with patients with SMA and their caregivers was performed in 2019 and updated in 2021 using several electronic databases in addition to supplementary sources. As we anticipated that few published utilities associated with SMA would be identified, the search also captured utilities for other (non-SMA) neuromuscular disorders that may serve as useful surrogate values for studies of SMA and other rare diseases. Electronic searches were performed in Embase, MEDLINE, Evidence-Based Medicine Reviews, and EconLit via the Ovid platform and were supplemented by searches of the grey literature (reference lists, conference proceedings, global HTA body websites, and other relevant sources). Study eligibility criteria were based on the population, interventions, comparators, and outcomes (PICO) framework. The quality of the full-text publications was assessed using a checklist based on UK National Institute for Health and Care Excellence technical support documents. RESULTS In total, 14 publications that reported SMA-related patient or caregiver utilities or disutilities met the eligibility criteria to be included in the SLR; the included studies demonstrate the substantial health-related quality-of-life burden of SMA on both patients with SMA and their caregivers. A variety of preference-based measures were used to derive utilities for patients with SMA and their caregivers. Different methods for collecting utility data included patient and proxy assessment of health states using questionnaires, vignette methodologies, structured forms of expert elicitation, and mapped data from results of clinical trials. A range of utilities was reported from both patient- and proxy-reported data, which reflects the degree of disability associated with early- and later-onset SMA. Methods for deriving utilities were assessed with respect to three reference cases from HTA bodies in the UK, the USA, and Canada. None of the 14 publications met the requirements of all three HTA bodies because of differing tariff requirements between countries; one study met the requirements of HTA bodies in Canada and the UK. Also, six studies did not report the method of valuation, which precluded analysis with respect to the HTA reference cases. CONCLUSIONS This SLR provides a comprehensive repository of the currently available utilities relevant to patients with SMA and their caregivers. This SLR provides recommendations for establishing consensus on the approach to generating utility values for the SMA patient population and their caregivers for health economic decisions.
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Affiliation(s)
- C Simone Sutherland
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124 Building 001/OG13, CH 4070, Basel, Switzerland.
| | | | | | - Noman Paracha
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124 Building 001/OG13, CH 4070, Basel, Switzerland
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16
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Almojuela A, Xu Q, O'Carroll A, MacDonald C, Ritchie L, Serletis D. Development of a Pediatric Epilepsy Program: Analysis of Early Multidimensional Outcomes. JOURNAL OF PEDIATRIC EPILEPSY 2022. [DOI: 10.1055/s-0042-1742607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background A Pediatric Epilepsy Program was instituted in Manitoba in 2016. This report seeks to describe changes in the management of pediatric epilepsy patients in Manitoba since the inception of this Program, to provide an early analysis of local outcomes, and to present a framework for further program development.
Methods Data was collected for patients treated both before and after inception of the Program. Caregivers completed questionnaires on quality of life and program satisfaction. An online database was created to capture demographic information, seizure and quality of life outcomes, and caregiver satisfaction ratings. Descriptive statistics were used to summarize the results.
Results Prior to commencement of the Program, 16 patients underwent vagal nerve stimulator (VNS) insertion. At last follow-up, 6.25% of patients achieved Engel class I outcome, 75% achieved class III outcome, and 18.75% were classified as class IV. Following inception of the Program, 11 patients underwent resective procedures and 3 underwent VNS insertions. At last follow-up, 78.6% of patients achieved Engel class I outcome, 14.3% achieved class III outcome, and 7.1% were classified as class IV. Since inception of the Program, the average Quality of Life in Childhood Epilepsy Questionnaire-55 score measuring patient quality of life was (59.7 ± 23.2)/100. The average Care-Related Quality of Life-7D score measuring caregiver quality of life was (78.3 ± 18.6)/100. Caregiver satisfaction had an average rating of (9.4 ± 0.8)/10.
Conclusion Access to epilepsy surgery has significantly improved for children in Manitoba and has led to favorable, early multidimensional outcomes. Structural organization, funding, and multidisciplinary engagement are necessary for program sustainability and growth.
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Affiliation(s)
- Alysa Almojuela
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Aoife O'Carroll
- Department of Pediatrics and Child Health, Section of Pediatric Neurology, University of Manitoba, Winnipeg, Canada
| | - Carling MacDonald
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley Ritchie
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Demitre Serletis
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Charles Shor Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, United States
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17
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Mighiu C, O'Hara S, Ferri Grazzi E, Murray KF, Schattenberg JM, Ventura E, Karakaidos M, Taylor A, Brrang H, Dhawan A, Willemse J, Finnegan A. Impact of progressive familial intrahepatic cholestasis on caregivers: caregiver-reported outcomes from the multinational PICTURE study. Orphanet J Rare Dis 2022; 17:32. [PMID: 35109890 PMCID: PMC8809495 DOI: 10.1186/s13023-022-02177-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/16/2022] [Indexed: 01/01/2023] Open
Abstract
Background Progressive familial intrahepatic cholestasis (PFIC) is a spectrum of rare genetic diseases characterized by inadequate bile secretion that requires substantial ongoing care, though little research is published in this area. We report health-related quality of life (HRQoL) and work productivity outcomes from the retrospective, cross-sectional PICTURE study investigating the burden of PFIC on caregivers. Information from caregivers of patients with PFIC 1 or 2 in Germany, the United Kingdom and the United States from September 2020 to March 2021 was included.
Results The PICTURE study sample comprised HRQoL responses from 22 PFIC caregivers. Patients were on average 8.2 years old; most caregivers were 30–49 years old (68%) and mothers (77%). Median CarerQoL-7D score was 67.7/100; mean CarerQoL-VAS score for general happiness was 5.7/10 (SD 2.1). Most caregivers reported fulfilment in their caregiving responsibilities, but problems with mental and physical health, finances, and relationships. When stratified by patient’s PFIC type, mean CarerQoL-7D and CarerQoL-VAS scores suggested worse HRQoL outcomes with PFIC2 versus PFIC1 (59.4 vs. 71.2, and 5.3 vs. 6.5, respectively). Additionally, more caregivers reported impact on sleep in the PFIC2 versus PFIC1 subgroup (93% vs. 75%). When stratified by history of PFIC-related surgeries, mean CarerQoL-7D and VAS scores were higher among those whose children had no specified surgeries (67.7 vs. 59.0/100 and 6.2 vs. 5.2/10, respectively). Nearly all caregivers reported an impact of caregiving responsibilities on sleeping (86%) and on personal relationships (82%). No caregivers reported having formal care support. Most caregivers were employed (73%); a third reported mean productivity loss of 12.9 days (SD 19.3) over the last 3 months, and a mean of 2.8 (SD 9.5) missed years of employment during their career. A higher number of workdays were missed by PFIC 2 caregivers compared to PFIC1 over last 3 months (16 days vs. 3 days). Conclusions The PICTURE study has demonstrated the prevalent, comprehensive, and meaningful burden that caring for an individual with PFIC has on caregivers. Despite fulfilment from caregiving, the breadth and depth of these responsibilities reduced caregiver reported HRQoL including mental and physical health, productivity, career prospects, sleep, relationships and finances. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02177-0.
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Affiliation(s)
| | | | | | - Karen F Murray
- Pediatric Institute, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Jörn M Schattenberg
- University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Emily Ventura
- PFIC Advocacy and Resource Network, Stanton, KY, USA
| | | | | | | | - Anil Dhawan
- Pediatric Liver GI and Nutrition Center, King's College Hospital, London, UK
| | - Jose Willemse
- Dutch Liver Patient Association (NLV), Hoogland, The Netherlands
| | - Alan Finnegan
- Faculty of Health and Social Care, University of Chester, Chester, UK
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Soare IA, Flint I, Savic N, Puricelli F, Medjedovic J, O'Flaherty ED, James S, Longworth L. Quality of life study for caregivers of people with uncontrolled focal-onset seizures. J Med Econ 2022; 25:66-76. [PMID: 34906033 DOI: 10.1080/13696998.2021.2018871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to capture and measure the impact of caregiving for an adult with uncontrolled drug-resistant focal-onset seizures (FOS) on the caregivers' quality of life (QoL), and to quantify the costs of productivity losses associated with providing informal care in this patient population. METHODS An online survey, which included the EQ-5D-5L, CarerQol-7D and the Work Productivity and Activity Impairment: Specific-Health Problem (WPAI:SHP) questionnaires, was administered to caregivers of individuals with uncontrolled drug-resistant FOS in the United Kingdom (UK), France, Spain, Germany, Italy, and Sweden. RESULTS The study included 345 caregivers. Most were males, aged between 25 and 34 years old whose caring responsibilities took between 15 and 24 h per week. The caregivers' mean EQ-5D-5L score was 0.6, with 95% confidence intervals (CI) of [0.58, 0.63], whilst the mean CarerQol-7D score was 72.61 [70.46, 74.76]. Caregivers' mental health was the most substantially affected aspect of their QoL. In addition, most caregivers reported deriving some or a lot of fulfilment out of their caregiving tasks. The WPAI:SHP showed that the mean percentage of work impairment due to caregiving responsibilities was 63%, [59.75, 66.26]. The mean annualised costs of productivity losses per caregiver were estimated at €14,872 [€11,908; €17,888]. LIMITATIONS One limitation consisted in the use of an online survey instead of a face-to-face interview. However, the medical terms were clearly explained, and examples were provided to help participants to give accurate responses. Another limitation was that the respondents self-reported as caregivers. Efforts were made to mitigate this weakness by using screener questions. CONCLUSION This study found that providing informal care for people with uncontrolled drug-resistant FOS had a negative impact on caregivers' QoL, with mental health being affected the most. However, caregivers found their role fulfilling and had support with their caring tasks.
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Affiliation(s)
| | | | - Natasa Savic
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
| | | | - Jasmina Medjedovic
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
| | | | - Samuel James
- Arvelle Therapeutics GmbH, A company of Angelini Pharma, Zug, Switzerland
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Farkas M, Huynh E, Gulácsi L, Zrubka Z, Dobos Á, Kovács L, Baji P, Péntek M. Development of Population Tariffs for the ICECAP-A Instrument for Hungary and their Comparison With the UK Tariffs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1845-1852. [PMID: 34838283 DOI: 10.1016/j.jval.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The ICEpop CAPability measure for Adults (ICECAP-A) was developed to assess the capability well-being of adults for use in economic evaluations. Currently, ICECAP-A tariffs are available only for the UK population. The objectives of this study were to develop a Hungarian tariff set for the ICECAP-A instrument and to explore intercountry differences between the Hungarian and the UK value sets. METHODS A survey was conducted by computer-assisted personal interviews on a sample representative of the Hungarian adult population (N = 1000) to elicit their preferences regarding ICECAP-A attributes with the use of a best-worst scaling choice task. A latent class multinomial logit model with continuous variance scale was used to estimate the weights for each of the 4 capability levels of all 5 ICECAP-A attributes, namely, attachment, stability, achievement, enjoyment, and autonomy. RESULTS The model identified 2 preference classes with approximately equal share. The first class had a stronger relative preference for autonomy and achievement, whereas the second class had a strong preference for attachment. Multivariate analysis of the classes revealed that women, pensioners, people who are married or living in a partnership, and people with poorer health status are characteristics associated with the latter class membership (preference for attachment). Population tariffs were estimated from the model. Overall, attachment was found to be the most important attribute, followed by stability, enjoyment, achievement, and autonomy. CONCLUSIONS Hungarian tariffs are largely consistent with those found for the United Kingdom; nevertheless, autonomy seems to be less important in Hungary compared with the United Kingdom.
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Affiliation(s)
- Miklós Farkas
- School of Accounting and Finance, University of Bristol, Bristol, England, UK
| | - Elisabeth Huynh
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Acton, Australia
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Ágota Dobos
- Corvinus Center for Foreign Language Education and Research, Corvinus University of Budapest, Budapest, Hungary
| | - Levente Kovács
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
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Lin JL, Lipstein EA, Wittenberg E, Tay D, Lundstrom R, Lundstrom GL, Sediqzadah S, Wright DR. Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making. MDM Policy Pract 2021; 6:23814683211039468. [PMID: 34734118 PMCID: PMC8559218 DOI: 10.1177/23814683211039468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
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Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | | | - Saadia Sediqzadah
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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21
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Dhanji N, Brouwer W, Donaldson C, Wittenberg E, Al-Janabi H. Estimating an exchange-rate between care-related and health-related quality of life outcomes for economic evaluation: An application of the wellbeing valuation method. HEALTH ECONOMICS 2021; 30:2847-2857. [PMID: 34455657 DOI: 10.1002/hec.4411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/31/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
Quality of life outcomes for family carers and patients may be measured in different ways within the same economic evaluation. We used the wellbeing valuation method to calculate "exchange rates" between care-related outcomes (the Carer Experience Scale and CarerQoL-7D) and health-related (the EQ-5D-5L) outcomes. Data on quality of life outcomes were collected through a postal quality of life survey in the UK. A random effects model was used to estimate carers' wellbeing as a function of their EQ-5D-5L, Carer Experience Scale (or CarerQoL-7D) and a set of control variables. When life satisfaction was used as the measure of wellbeing, a one-point gain in the Carer Experience Scale (0-100 scale) was equivalent (in wellbeing terms) to a 0.014 gain in EQ-5D-5L value; and a one point gain in the CarerQoL-7D (0-100 scale) was equivalent to a 0.033 gain in EQ-5D-5L. The exchange rate values were reduced when capability was used as the measure of wellbeing. The exchange rates estimated in this study offer a means to place carer and patient outcomes, measured via different quality of life instruments, on a common scale, although there are important issues to consider in operationalising the technique.
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Affiliation(s)
- Nishit Dhanji
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| | - Cam Donaldson
- Yunus Centre for Social Business, Glasgow Caledonian University, Glasgow, UK
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard University, Boston, Massachusetts, USA
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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Kanters TA, Brugts JJ, Manintveld OC, Versteegh MM. Burden of Providing Informal Care for Patients with Atrial Fibrillation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:236-243. [PMID: 33518030 DOI: 10.1016/j.jval.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Patients with atrial fibrillation (AF) have rapid and irregular heart rates, increasing the risk of comorbidities and mortality. Next to formal medical care, many patients receive informal care from their social environment. The objective of this study was to examine the well-being and economic burden of providing informal care to patients with AF in the UK, Italy, and Germany. METHODS Caregivers of patients with AF completed an online survey based on the iMTA Valuation of Informal Care Questionnaire, with questions about their caregiving situation, perceived burden of caregiving, and absence from work due to health problems resulting from caregiving. Care-related quality-of-life utilities were calculated using the Care-related Quality of Life instrument and associated tariffs. Societal costs of caregiving were calculated based on the proxy good method. RESULTS A total of 585 caregivers participated in this study. On average, caregivers provided 33 hours of informal care per week to patients (SD 29 hours). On a scale from 0 to 10, their self-rated burden was 5.4. The average Care-related Quality of Life utility was 72. Caregivers primarily indicated problems with daily activities, mental health, and physical health. Still, the vast majority of caregivers (87%) derived fulfillment from providing care. Weekly societal costs of caregiving were on average €636. Comorbidities contributed substantially to the caregiver time and burden. CONCLUSIONS Caring for a patient with AF is associated with substantial objective and subjective burden, but also provides fulfillment from being able to care for a loved one.
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Affiliation(s)
- Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthijs M Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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McCaffrey N, Bucholc J, Rand S, Hoefman R, Ugalde A, Muldowney A, Mihalopoulos C, Engel L. Head-to-Head Comparison of the Psychometric Properties of 3 Carer-Related Preference-Based Instruments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1477-1488. [PMID: 33127019 DOI: 10.1016/j.jval.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the psychometric properties of the Adult Social Care Outcomes Toolkit for carers (ASCOT-Carer), the Carer Experience Scale (CES), and the Care-related Quality of Life (CarerQol) to inform the choice of instrument in future studies. METHODS Data were derived from a 2018 online survey of informal carers in Australia. Reliability was assessed via internal consistency (Cronbach alpha, α) and test-retest reliability (intraclass correlation coefficient, ICC) for respondents who self-reported no change in their quality of life as a carer over 2 weeks. Convergent validity was evaluated via predetermined hypotheses about associations (Spearman's rank correlation) with existing, validated measures. Discriminative validity was assessed based on the ability of the carer-related scores to distinguish between different informal care situations (Mann-Whitney U, Kruskal-Wallis one-way analysis of variance). RESULTS Data from 500 carers were analyzed. The ASCOT-Carer demonstrated a higher degree of internal consistency, possibly due to a unidimensional structure, and test-retest reliability than the CarerQol and CES (α = 0.87, 0.65, 0.59; ICC, 0.87, 0.67, 0.81, respectively). All 3 instruments exhibited convergent validity and detected statistically significant associations between carer-related scores and different informal care situations, except for the CarerQol-7D and sole carer status. CONCLUSIONS The ASCOT-Carer, CarerQol, and CES performed reasonably well psychometrically; the ASCOT-Carer exhibited the best psychometric properties overall in this sample of Australian informal carers. Findings should be used in conjunction with consideration of research goals, carer population, targeted carer-related constructs, and prevailing perspectives on the economic evaluation to inform choice of instrument in future studies.
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Affiliation(s)
- Nikki McCaffrey
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia.
| | - Jessica Bucholc
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), Cornwallis Building, University of Kent, Canterbury, UK
| | - Renske Hoefman
- The Netherlands Institute for Social Research (SCP), The Hague, The Netherlands
| | - Anna Ugalde
- Deakin University, School of Nursing and Midwifery, Quality and Patient Safety, Institute for Health Transformation, Burwood, Victoria, Australia
| | | | - Cathrine Mihalopoulos
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
| | - Lidia Engel
- Deakin University, School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Burwood, Victoria, Australia
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A validation study of the CarerQol instrument in informal caregivers of people with dementia from eight European countries. Qual Life Res 2020; 30:577-588. [PMID: 33113082 PMCID: PMC7886819 DOI: 10.1007/s11136-020-02657-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 10/29/2022]
Abstract
PURPOSE Informal care constitutes an important part of the total care for people with dementia. Therefore, the impact of the syndrome on their caregivers as well as that of health and social care services for people with dementia should be considered. This study investigated the convergent and clinical validity of the CarerQol instrument, which measures and values the impact of providing informal care, in a multi-country sample of caregivers for people with dementia. METHODS Cross-sectional data from a sample of 451 respondents in eight European countries, collected by the Actifcare project, were evaluated. Convergent validity was analysed with Spearman's correlation coefficients and multivariate correlations between the CarerQol-7D utility score and dimension scores, and other similar quality of life measures such as CarerQol-VAS, ICECAP-O, and EQ-5D. Clinical validity was evaluated by bivariate and multivariate analyses of the degree to which the CarerQol instrument can differentiate between characteristics of caregivers, care receivers and caregiving situation. Country dummies were added to test CarerQol score differences between countries. RESULTS The mean CarerQol utility score was 77.6 and varied across countries from 74.3 (Italy) to 82.3 (Norway). The scores showed moderate to strong positive correlations with the CarerQol-VAS, ICECAP-O, and EQ-5D health problems score of the caregiver. Multivariate regression analysis showed that various characteristics of the caregiver, care receiver and caregiving situation were associated with caregiver outcomes, but there was no evidence of a country-level effect. CONCLUSION This study demonstrates the convergent and clinical validity of the CarerQol instrument to evaluate the impact of providing informal care for people with dementia.
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25
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Validation of the Hungarian version of the CarerQol instrument in informal caregivers: results from a cross-sectional survey among the general population in Hungary. Qual Life Res 2020; 30:629-641. [PMID: 33037979 PMCID: PMC7886830 DOI: 10.1007/s11136-020-02662-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/12/2022]
Abstract
Purpose The CarerQol instrument has been designed and validated as an instrument able to measure both the positive and the negative impacts of caregiving on the quality of life of informal caregivers (CarerQol-7D), as well as their general happiness (CarerQol-VAS). The aim of this study was to assess the construct validity of the CarerQol in the Hungarian context. Methods The CarerQol was translated into Hungarian. Subsequently, in a cross-sectional online survey, representative for the general Hungarian population (N = 1000), informal caregivers were identified (N = 149, female 51.2%, mean age 53.2). Clinical, convergent and discriminant validity of the CarerQol were evaluated in relation to the caregivers’ and care recipients’ EQ-5D-5L health status, and caregiving situation characteristics. Results Average CarerQol-7D and CarerQol-VAS scores were 76.0 (SD 16.2) and 6.8 (SD 2.3), respectively. CarerQol-7D and CarerQol-VAS scores were significantly correlated with caregiving time (r = − 0.257; − 0.212), caregivers’ EQ-5D-5L scores (r = 0.453; 0.326) and the CarerQol-7D also with care recipients’ EQ-5D-5L scores (r = 0.247). CarerQol-7D scores differed significantly with relevant caregiving characteristics (e.g. nature and severity of care recipients’ health status, sharing household) and both the CarerQol-7D and CarerQol-VAS with the overall care experience. Conclusion Our findings confirmed the validity of the Hungarian language version of the CarerQol and support the cross-cultural validity of the instrument. CarerQol-7D scores performed better in distinguishing caregiving situation characteristics than the general happiness measure CarerQol-VAS. Care recipients’ health status was only weakly associated with informal caregivers’ care-related quality of life and happiness. Caregivers’ own health and caregiving circumstances were more strongly associated with these scores. Electronic supplementary material The online version of this article (10.1007/s11136-020-02662-8) contains supplementary material, which is available to authorized users.
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Webb EJD, Meads D, Al-Janabi H, Kind P, Torelli F, Horton M, Oyebode J, Wright P. UK General Population Utility Values for the SIDECAR-D Instrument Measuring the Impact of Caring for People With Dementia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1079-1086. [PMID: 32828221 PMCID: PMC7456787 DOI: 10.1016/j.jval.2020.04.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/26/2019] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Dementia affects many people, with numbers expected to grow as populations age. Many people with dementia receive informal/family/unpaid care, for example, from a spouse or child, which may affect carer quality of life. Measuring the effectiveness of health/social care interventions for carers requires a value measure of the quality-of-life impact of caring. This motivated development of the Scales Measuring the Impact of Dementia on Carers-D (SIDECAR-D) instrument. This study aimed to obtain general population values for SIDECAR-D to aid incorporating the impact of caring in economic evaluation. METHODS Members of the UK general public completed a best-worst scaling object case survey, which included the 18 SIDECAR-D items and EQ-5D-3L descriptions. Responses were analyzed using scale-adjusted finite mixture models. Relative importance scores (RISs) for the 18 SIDECAR-D items formed the SIDECAR-D relative scale measuring the relative impact of caring. The SIDECAR-D tariff, on the full health = 1, dead = 0 scale, was derived by rescaling EQ-5D-3L and SIDECAR-D RISs so the EQ-5D-3L RISs equaled anchored valuations of the EQ-5D-3L pits state from a visual analog scale task. RESULTS Five hundred ten respondents completed the survey. The model had 2 parameter and 3 scale classes. Additive utility decrements of SIDECAR-D items ranged from -0.05 to -0.162. Utility scores range from 0.95 for someone affirming 1 item to -0.297 for someone affirming all 18. CONCLUSION SIDECAR-D is a needs-based scale of the impact on quality of life of caring for someone with dementia, with a valuation tariff to support its use in economic evaluation.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Hareth Al-Janabi
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, UK
| | - Paul Kind
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Francesca Torelli
- Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Mike Horton
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, England, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK
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Engel L, Rand S, Hoefman R, Bucholc J, Mihalopoulos C, Muldowney A, Ugalde A, McCaffrey N. Measuring Carer Outcomes in an Economic Evaluation: A Content Comparison of the Adult Social Care Outcomes Toolkit for Carers, Carer Experience Scale, and Care-Related Quality of Life Using Exploratory Factor Analysis. Med Decis Making 2020; 40:885-896. [DOI: 10.1177/0272989x20944193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. To incorporate the spillover effects experienced by carers providing informal care in health policy decisions, new carer-related preference-based measures have been developed for use in economic evaluation, which include the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer), Carer Experience Scale (CES), and Care-Related Quality of Life (CarerQoL). The aim of this study was to investigate the extent to which these 3 instruments measure complementary or overlapping constructs. Methods. Data were derived from an online survey undertaken with carers residing in Australia. An exploratory factor analysis was conducted to ascertain the underlying latent constructs of the 3 measures. Results. Data from 351 informal carers yielded a 5-factor model describing general quality of life outside caring, problems due to caring, fulfilment from caring, social support with caring, and relationship with the care recipient. Most of the ASCOT-Carer and the CarerQol items loaded onto the first and second factors, respectively. The greatest overlap was observed between CarerQol and CES items loading onto the other 3 shared common factors. Limitations. Online data collection resulted in inconsistent responses, which had to be removed to yield logical data. A convenience sampling approach may have compromised the generalizability of study findings. Conclusion. Although some overlap was observed, the 3 carer-related preference-based measures seem to tap into different constructs of carer-related quality of life and caring experiences and cannot be used interchangeably.
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Affiliation(s)
- Lidia Engel
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Victoria, Australia
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, UK
| | - Renske Hoefman
- The Netherlands Institute for Social Research, The Hague, Netherlands
| | - Jessica Bucholc
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Victoria, Australia
| | | | - Anna Ugalde
- Deakin University, Geelong, Institute for Health Transformation, School of Nursing and Midwifery, Faculty of Health, Victoria, Australia
| | - Nikki McCaffrey
- Deakin University, Geelong, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Victoria, Australia
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Chambers GM, Settumba SN, Carey KA, Cairns A, Menezes MP, Ryan M, Farrar MA. Prenusinersen economic and health-related quality of life burden of spinal muscular atrophy. Neurology 2020; 95:e1-e10. [DOI: 10.1212/wnl.0000000000009715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo quantify the economic and health-related quality of life (HRQoL) burden incurred by households with a child affected by spinal muscular atrophy (SMA).MethodsHospital records, insurance claims, and detailed resource use questionnaires completed by caregivers were used to capture the direct and indirect costs to households of 40 children affected by SMA I, II, and III in Australia between 2016 and 2017. Prevalence costing methods were used and reported in 2017 US dollar (USD) purchasing power parity (PPP). The HRQoL for patients and primary caregivers was quantified with the youth version of the EQ-5D and CareQoL multiattribute utility instruments and Australian utility weights.ResultsThe average total annual cost of SMA per household was $143,705 USD PPP for all SMA types (SMA I $229,346, SMA II $150,909, SMA III $94,948). Direct costs accounted for 56% of total costs. The average total indirect health care costs for all SMA types were $63,145 per annum and were highest in families affected by SMA II. Loss of income and unpaid informal care made up 24.2% and 19.8% respectively, of annual SMA costs. Three of 4 (78%) caregivers stated that they experienced financial problems because of care tasks. The loss in HRQoL of children affected by SMA and caregivers was substantial, with average caregiver and patient scores of 0.708 and 0.115, respectively (reference range 0 = death and 1 = full health).ConclusionOur results demonstrate the substantial and far-ranging economic and quality of life burden on households and society of SMA and are essential to fully understanding the health benefits and cost-effectiveness associated with emerging disease-modifying therapies for SMA.
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McLoughlin C, Goranitis I, Al-Janabi H. Validity and Responsiveness of Preference-Based Quality-of-Life Measures in Informal Carers: A Comparison of 5 Measures Across 4 Conditions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:782-790. [PMID: 32540237 PMCID: PMC7532692 DOI: 10.1016/j.jval.2020.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/10/2019] [Accepted: 01/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Carer quality-of-life (QoL) effects are recommended for inclusion in economic evaluations, but little is known about the relative performance of different types of QoL measures with carers. This study evaluated the validity and responsiveness of 3 care-related QoL measures (the Carer Experience Scale [CES], CarerQoL-7D, and ASCOT-Carer), 1 health-related QoL measure (the EQ-5D-5L), and 1 generic QoL measure (the ICECAP-A). METHODS Validity and responsiveness were assessed in a UK sample of informal carers of adults with dementia, stroke, mental illness, or rheumatoid arthritis. A questionnaire containing the 5 QoL measures was posted to carers identified through the Family Resources Survey (N = 1004). Hypotheses regarding the anticipated associations between constructs related to the QoL of carers were tested to investigate construct validity and responsiveness. RESULTS Each measure exhibited some level of construct validity. In general, larger effect sizes and stronger associations were detected for the ASCOT-Carer and ICECAP-A measures in the pooled sample and across all conditions. The 5 measures did not exhibit clear responsiveness to changes over a 12-month period in care recipient health status or hours of care provided per week. CONCLUSION The results of this study provide initial evidence of the validity of care-related, health-related, and generic QoL (capability) measures in informal carers of adults with 4 highly prevalent conditions. Care-related measures were not always more sensitive to constructs associated with QoL of carers compared with generic measures. The performance of the ICECAP-A was comparable with that of the best-performing care-related measure, the ASCOT-Carer.
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Affiliation(s)
- Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, UK
| | - Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, UK; Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, England, UK.
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Baji P, Farkas M, Golicki D, Prevolnik Rupel V, Hoefman R, Brouwer WBF, van Exel J, Zrubka Z, Gulácsi L, Péntek M. Development of Population Tariffs for the CarerQol Instrument for Hungary, Poland and Slovenia: A Discrete Choice Experiment Study to Measure the Burden of Informal Caregiving. PHARMACOECONOMICS 2020; 38:633-643. [PMID: 32201921 DOI: 10.1007/s40273-020-00899-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND The CarerQol instrument can be used in economic evaluations to measure the care-related quality of life of informal caregivers. Tariff sets are available for Australia, Germany, Sweden, the Netherlands, the UK, and the USA. OBJECTIVE Our objective was to develop tariff sets for the CarerQol instrument for Hungary, Poland and Slovenia and to compare these with the existing value sets. METHODS Discrete-choice experiments were carried out in Hungary, Poland and Slovenia. Data were collected through an online survey between November 2018 and January 2019, using representative samples of 1000 respondents per country. Tariffs were calculated from coefficient estimates from panel mixed multinomial logit models with random parameters. RESULTS All seven CarerQol domains contributed significantly to the utility associated with different caregiving situations. Attributes valued highest were 'physical health' (tariffs for no problems were 15.6-21.8), 'mental health' (18.1-18.9) and 'fulfilment' (16.3-22.9). Value sets were comparable across the countries, although in Poland 'a lot of fulfilment' was valued higher (22.9) than in Hungary (16.3) and Slovenia (17.1). Compared with existing value sets, in the three Central European countries, 'fulfilment' was more important, whereas 'financial problems' were less important. CONCLUSION For the first time in the Central and Eastern European region, country-specific tariffs are now available for the Hungarian, Polish and Slovenian versions of the CarerQol instrument. This facilitates inclusion of the impact of informal care in economic evaluations. Our results can be used to develop and evaluate country-specific health policy strategies to support informal caregivers. The differences found in informal care preferences highlight the limited transferability of CarerQol tariffs across European regions.
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Affiliation(s)
- Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
| | - Miklós Farkas
- Department of Accounting and Finance, University of Bristol, Priory Road Complex, Bristol, BS8 1TU, UK
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, ul. Banacha 1b, 02-097, Warsaw, Poland
| | | | - Renske Hoefman
- The Netherlands Institute for Social Research, Den Haag, The Netherlands
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics (ESE), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics (ESE), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
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Mowforth OD, Davies BM, Kotter MR. Quality of Life Among Informal Caregivers of Patients With Degenerative Cervical Myelopathy: Cross-Sectional Questionnaire Study. Interact J Med Res 2019; 8:e12381. [PMID: 31697240 PMCID: PMC6914271 DOI: 10.2196/12381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 06/13/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Degenerative cervical myelopathy (DCM) is a common, chronic neurological condition that severely affects individuals by causing a range of disabling symptoms, frequently at a time around the peak of their careers. Subsequently, individuals with DCM often become dependent on informal care arrangements. The significant economic contribution of informal care and its burden on care providers are becoming increasingly recognized. Objective This study aimed to measure the quality of life of DCM informal caregivers and provide preliminary insight into possible contributing factors. Methods Carers of individuals with DCM completed a Web-based survey hosted by Myelopathy.org, an international DCM charity. Carer quality of life was assessed in the form of caregiver happiness and 7 dimensions of carer burden using the Care-Related Quality of Life (CarerQol) instrument. The relationships between patient disease severity, patient pain, and carer quality of life were investigated. Differences in carer quality of life were assessed across patient and carer demographic groups, including between UK and US carers. Results DCM caregivers experienced substantial burden as a result of their caregiving (mean CarerQol-7D=64.1; 95% CI 58.8-69.5) and low happiness (mean CarerQol-VAS [Visual Analog Scale]=6.3; 95% CI 5.7-6.9). Burden was high and happiness was low in DCM carers when compared with a large, mixed-disease study of adult informal carers where CarerQol-7D was 79.1 and CarerQol-VAS was 7.1. No significant relationship was found between DCM carer quality of life and patient disease severity and pain scores. DCM carer quality of life appeared uniform across all patient and carer demographic groups. Conclusions Caring for individuals with DCM is associated with reduced quality of life in the form of significant burden and reduced happiness. Reductions appear greater in DCM than in other diseases investigated. However, no simple relationship was identified between individual patient or carer factors and carer quality of life.
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Affiliation(s)
- Oliver Daniel Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Marshall Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mark Reinhard Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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McCabe C, Round J. Hard choices: Reflections from the tomb of the unknown patient. Healthc Manage Forum 2019; 32:288-292. [PMID: 31505957 DOI: 10.1177/0840470419871319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health Technology Assessment (HTA) has always sought to incorporate the evidence of all patients affected in the decision-making process. While health system budgets could increase to cover costs of new technologies, the relevant patients are those benefitting from access to the technology being appraised. More recently, with health system budgets effectively fixed, costs of new technologies are covered by displacing other, currently funded care. This reallocation means the patients affected by the decision include those whose healthcare is displaced. These patients are typically unidentified, however, and so HTA in this instance involves choosing between identified and unidentified patients. We argue that HTA should take account of identifiability bias in this decision-making, to avoid promoting inequitable and inefficient access to healthcare.
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Affiliation(s)
- Christopher McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, Alberta, Canada
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Wittenberg E, James LP, Prosser LA. Spillover Effects on Caregivers' and Family Members' Utility: A Systematic Review of the Literature. PHARMACOECONOMICS 2019; 37:475-499. [PMID: 30887469 DOI: 10.1007/s40273-019-00768-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND A growing body of research has identified health-related quality-of-life effects for caregivers and family members of ill patients (i.e. 'spillover effects'), yet these are rarely considered in cost-effectiveness analyses (CEAs). OBJECTIVE The objective of this study was to catalog spillover-related health utilities to facilitate their consideration in CEAs. METHODS We systematically reviewed the medical and economic literatures (MEDLINE, EMBASE, and EconLit, from inception through 3 April 2018) to identify articles that reported preference-based measures of spillover effects. We used keywords for utility measures combined with caregivers, family members, and burden. RESULTS Of 3695 articles identified, 80 remained after screening: 8 (10%) reported spillover utility per se, as utility or disutility (i.e. utility loss); 25 (30%) reported a comparison group, either population values (n = 9) or matched, non-caregiver/family member or unaffected individuals' utilities (n = 16; 3 reported both spillover and a comparison group); and 50 (63%) reported caregiver/family member utilities only. Alzheimer's disease/dementia was the most commonly studied disease/condition, and the EQ-5D was the most commonly used measurement instrument. CONCLUSIONS This comprehensive catalog of utilities showcases the spectrum of diseases and conditions for which caregiver and family members' spillover effects have been measured, and the variation in measurement methods used. In general, utilities indicated a loss in quality of life associated with being a caregiver or family member of an ill relative. Most studies reported caregiver/family member utility without any comparator, limiting the ability to infer spillover effects. Nevertheless, these values provide a starting point for considering spillover effects in the context of CEA, opening the door for more comprehensive analyses.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Lyndon P James
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Canaway A, Al-Janabi H, Kinghorn P, Bailey C, Coast J. Close-Person Spill-Overs in End-of-Life Care: Using Hierarchical Mapping to Identify Whose Outcomes to Include in Economic Evaluations. PHARMACOECONOMICS 2019; 37:573-583. [PMID: 30877637 DOI: 10.1007/s40273-019-00786-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Guidelines for economic evaluations often request that costs and outcomes beyond the patient are captured; this can include carers and also other affected parties. End-of-life care is one context where impacts of care spill over onto those other than patients, but there is little evidence about who should be included within economic evaluations. OBJECTIVE The purpose of this article was to examine (1) how many people are close to those at the end of life (2); their characteristics; and (3) what influences the network size at the end of life. METHODS In-depth interviews were conducted with 23 participants who were either recently bereaved or had somebody close to them currently receiving end-of-life care. Interviews were used in conjunction with hierarchical mapping to explore the network size and composition and influences upon these networks. Interviews were transcribed verbatim. Descriptive statistics were used to analyse the hierarchical maps and this information was combined with a constant comparative analysis of the qualitative data. RESULTS On average, close-person networks at the end of life contained eight individuals, three of whom were rated as being 'closest'. These were typically family members, although in a small number of cases non-family members were included amongst the closest individuals. There was variation in terms of network composition. Qualitative analyses revealed two key influences on network size: death trajectory (those with cognitive problems/diseases towards the end of life had smaller networks) and family size (larger families had larger networks). CONCLUSIONS The findings of this article have important implications for researchers wishing to include those affected by end-of-life care in an economic evaluation. Focussing on the three closest individuals would be a key starting point for economists seeking to capture spill-overs, whilst a truly societal perspective would require looking beyond proximal family members. This article further discusses the implications of including close persons in economic evaluations for decision makers.
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Affiliation(s)
- Alastair Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Philip Kinghorn
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Joanna Coast
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Brown CC, Tilford JM, Payakachat N, Williams DK, Kuhlthau KA, Pyne JM, Hoefman RJ, Brouwer WBF. Measuring Health Spillover Effects in Caregivers of Children with Autism Spectrum Disorder: A Comparison of the EQ-5D-3L and SF-6D. PHARMACOECONOMICS 2019; 37:609-620. [PMID: 30864066 PMCID: PMC6469595 DOI: 10.1007/s40273-019-00789-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Healthcare interventions that improve the health of children with autism spectrum disorder (ASD) have the potential to affect the health of caregivers. This study compares the three-level EuroQoL-5 Dimension (EQ-5D-3L) and the Short Form-6 Dimension (SF-6D) in their ability to value such spillover effects in caregivers. METHODS Clinical data collected from two Autism Treatment Network (ATN) sites was combined with survey data of caregivers of children diagnosed with ASD. Caregivers completed instruments by proxy describing child health and completed the EQ-5D-3L and SF-6D preference-weighted instruments to describe their own health. RESULTS There was a strong correlation between the health utility scores of the two preference-weighted instruments (ρ = 0.6172, p < 0.001) measuring caregiver health-related quality of life. There was a similar correlation between both the SF-6D and EQ-5D-3L scores with a previously validated care-related quality of life measure (Care-related Quality of Life instrument [CarerQol-7D]) (ρ = 0.569, p < 0.001 and ρ = 0.541, p < 0.001, respectively). The mean SF-6D scores for caregivers differed significantly in relation to four of the five child health or behavior measures whereas the EQ-5D-3L differed for only two of them. CONCLUSIONS Health utility values of caregivers for children with ASD vary by the health characteristics of the child, suggesting significant potential for spillover effects. The comparison of the EQ-5D-3L and SF-6D demonstrated that both instruments can be used to estimate spillover effects of interventions to improve child health, but the SF-6D exhibited greater sensitivity to child health among children with ASD.
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Affiliation(s)
- Clare C Brown
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR, 72205, USA
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 820, Little Rock, AR, 72205, USA.
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D Keith Williams
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Karen A Kuhlthau
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Center for Adolescent Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System and Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Renske J Hoefman
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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Hoefman RJ, van Exel J, Brouwer WBF. The Monetary Value of Informal Care: Obtaining Pure Time Valuations Using a Discrete Choice Experiment. PHARMACOECONOMICS 2019; 37:531-540. [PMID: 30298280 DOI: 10.1007/s40273-018-0724-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Interventions in health care often not only have an effect on patients, but also on their informal caregivers. Caregiving can have a profound impact on the health and wellbeing of carers. Ignoring these spillovers in economic evaluations risks labelling interventions mistakenly as cost-effective, at the expense of informal caregivers. OBJECTIVE This paper investigates willingness-to-accept (WTA) values for an hour of informal care, corrected for positive and negative impacts of informal care, to facilitate the inclusion of informal care hours on the cost side of economic evaluations without double-counting spillover effects. METHODS A discrete choice experiment (DCE) was conducted among a representative sample of the adult population in the Netherlands (n = 552) in September 2011. An experimental design minimizing the D-error was used to construct choice sets with two unlabelled alternatives with the attributes 'hours caregiving', 'monetary compensation for caregiving' and seven impacts of caregiving. To operationalize the random utility model, we used a panel mixed multinomial logit (MMNL) parameter model. For calculation of WTA, we used both population-level parameters and individual-level parameters. RESULTS The mean WTA for an additional hour of informal care, corrected for positive and negative impacts of informal care, was €14.57. The signs of the coefficients were all in the expected directions. CONCLUSIONS This study reports a preference-based monetary value for informal care, corrected for other impacts. This valuation facilitates the inclusion of informal care hours on the cost side in economic evaluations without double-counting any spillover effects included on the effects side.
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Affiliation(s)
- Renske J Hoefman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Brazier JE, Rowen D, Lloyd A, Karimi M. Future Directions in Valuing Benefits for Estimating QALYs: Is Time Up for the EQ-5D? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:62-68. [PMID: 30661635 DOI: 10.1016/j.jval.2018.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 05/25/2023]
Abstract
The widespread adoption of the EuroQol 5-dimensional questionnaire (EQ-5D) has been important for the comparability, transparency, and consistency of economic evaluations for informing resource allocation in healthcare. The objectives of this article were to (1) critically assess whether the widespread adoption of the EQ-5D and its time trade-off-based value sets to inform economic evaluation is likely to continue and (2) speculate about how benefits may be measured and valued to inform economic evaluation in the future. Evidence supports the use of the EQ-5D in many areas of health, but there are notable gaps. Furthermore, there has been interest among some policy makers in measuring changes in well-being, and in using common outcomes across sectors. Possibilities for measuring well-being alongside health can be achieved through bolt-on dimensions or an entirely new measure capturing both health and well-being. Nevertheless, there are significant concerns about the logic of estimating a common utility function. The development of online valuation methods has had a major impact on the field, which is likely to continue. We, however, recommend more allowance for respondents to consider their answers. There is an ongoing debate on the role of patient values or experience-based values. To date, this has seen limited take-up by decision makers and there are significant technical problems to obtaining representative and meaningful values. Policy makers and the general population must decide on the focus and scope of benefits that are incorporated into economic evaluation, and current evidence on this is mixed. In part, this will determine whether the widespread adoption will continue.
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Affiliation(s)
- John Edward Brazier
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Donna Rowen
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Milad Karimi
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK; Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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Mulhern B, Norman R, Street DJ, Viney R. One Method, Many Methodological Choices: A Structured Review of Discrete-Choice Experiments for Health State Valuation. PHARMACOECONOMICS 2019; 37:29-43. [PMID: 30194624 DOI: 10.1007/s40273-018-0714-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Discrete-choice experiments (DCEs) are used in the development of preference-based measure (PBM) value sets. There is considerable variation in the methodological approaches used to elicit preferences. OBJECTIVE Our objective was to carry out a structured review of DCE methods used for health state valuation. METHODS PubMed was searched until 31 May 2018 for published literature using DCEs for health state valuation. Search terms to describe DCEs, the process of valuation and preference-based instruments were developed. English language papers with any study population were included if they used DCEs to develop or directly inform the production of value sets for generic or condition-specific PBMs. Assessment of paper quality was guided by the recently developed Checklist for Reporting Valuation Studies. Data were extracted under six categories: general study information, choice task and study design, type of designed experiment, modelling and analysis methods, results and discussion. RESULTS The literature search identified 1132 published papers, and 63 papers were included in the review. Paper quality was generally high. The study design and choice task formats varied considerably, and a wide range of modelling methods were employed to estimate value sets. CONCLUSIONS This review of DCE methods used for developing value sets suggests some recurring limitations, areas of consensus and areas where further research is required. Methodological diversity means that the values should be seen as experimental, and users should understand the features of the value sets produced before applying them in decision making.
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Affiliation(s)
- Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology, 1-59 Quay St, Haymarket, Sydney, NSW, 2000, Australia.
| | - Richard Norman
- School of Public Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology, 1-59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology, 1-59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
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O'Hanlon CE, Walling AM, Okeke E, Stevenson S, Wenger NS. A Framework to Guide Economic Analysis of Advance Care Planning. J Palliat Med 2018; 21:1480-1485. [PMID: 30096252 DOI: 10.1089/jpm.2018.0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is fundamental to guiding medical care at the end of life. Understanding the economic impact of ACP is critical to implementation, but most economic evaluations of ACP focus on only a few actors, such as hospitals. OBJECTIVE To develop a framework for understanding and quantifying the economic effects of ACP, particularly its distributional consequences, for use in economic evaluations. DESIGN Literature review of economic analyses of ACP and related costs to estimate magnitude and direction of costs and benefits for each actor and how data on these costs and benefits could be obtained or estimated. RESULTS ACP can lead to more efficient allocation of resources by reducing low-value care and reallocating resources to high-value care, and can increase welfare by aligning care to patient preferences. This economic framework considers the costs and benefits of ACP that accrue to or are borne by six actors: the patient, the patient's family and caregivers, healthcare providers, acute care settings, subacute and home care settings, and payers. Program implementation costs and nonhealthcare costs, such as time costs borne by patients and caregivers, are included. Findings suggest that out-of-pocket costs for patients and families will likely change if subacute or home care is substituted for acute care, and subacute care utilization is likely to increase while primary healthcare providers and acute care settings may experience heterogeneous effects. CONCLUSIONS A comprehensive economic evaluation of ACP should consider how costs and benefits accrue to different actors.
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Affiliation(s)
- Claire E O'Hanlon
- 1 Pardee RAND Graduate School , RAND Corporation, Santa Monica, California
| | - Anne M Walling
- 2 Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.,3 Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles , Los Angeles, California.,4 RAND Health, RAND Corporation, Santa Monica, California
| | | | - Sharon Stevenson
- 6 Bellweather Care, Inc. and Okapi Venture Capital, Laguna Beach, California
| | - Neil S Wenger
- 3 Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles , Los Angeles, California.,4 RAND Health, RAND Corporation, Santa Monica, California
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Jain P, Subendran J, Smith ML, Widjaja E. Care-related quality of life in caregivers of children with drug-resistant epilepsy. J Neurol 2018; 265:2221-2230. [PMID: 30030620 DOI: 10.1007/s00415-018-8979-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/15/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Epilepsy in children negatively impacts on caregiver quality of life (QOL). The study aimed to evaluate the relationships between patient factors [demographics, clinical factors, health-related quality of life (HRQL)], contextual factors (socio-economic factors), caregiver mood, and caregiver QOL, and whether family factors mediate the relationship between patient HRQL and caregiver QOL. METHODS Children aged 4-18 years with medically intractable epilepsy were enrolled. Patient demographics, clinical data, patient HRQL [measured using Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)], socio-economic factors, caregiver anxiety and depression, and family factors (adaptation, resources and demands) were assessed. Caregiver QOL was measured using CarerQol, which evaluates care-related QOL, incorporating the negative and positive effects of caregiving. RESULTS One hundred and eighty-one children were studied. In bivariable regression analysis, higher patient HRQL (QOLCE) (β = 0.54, p < 0.001) and household income (β = 10.49, p = 0.019) were associated with higher caregiver QOL. Higher depression (β = - 2.48, p < 0.001) and anxiety (β = - 2.04, p < 0.001) were associated with lower caregiver QOL. Seizure severity and other socio-economic factors did not influence caregiver QOL (all p > 0.05). In multivariable regression analysis, higher QOLCE (β = 0.21, p = 0.001), lower depression (β = - 1.07, p < 0.001) and lower anxiety (β = - 1.19, p < 0.001) were associated with higher caregiver QOL. Family demands and resources moderated the relationship between patient HRQL and caregiver QOL. CONCLUSIONS Patient HRQL and caregiver mood were more important correlates of caregiver QOL than seizure severity in medically intractable epilepsy. The findings are significant in delineating variables (caregiver mood and family factors) that are potentially modifiable, and show promise for improving caregiver QOL.
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Affiliation(s)
- Puneet Jain
- Comprehensive Epilepsy Center, Division of Neurology, Hospital for Sick Children, Toronto, Canada
| | | | - Mary Lou Smith
- Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada.,Department of Psychology, University of Toronto, Toronto, Canada
| | - Elysa Widjaja
- Comprehensive Epilepsy Center, Division of Neurology, Hospital for Sick Children, Toronto, Canada. .,Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Canada. .,Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
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Rowen D, Azzabi Zouraq I, Chevrou-Severac H, van Hout B. International Regulations and Recommendations for Utility Data for Health Technology Assessment. PHARMACOECONOMICS 2017; 35:11-19. [PMID: 29052162 DOI: 10.1007/s40273-017-0544-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Recommendations and guidelines for the collection, generation, source and usage of utility data for health technology assessment (HTA) vary across different countries, with no international consensus. Many international agencies generate their own guidelines providing details on their preferred methods for HTA submissions, and there is variability in both what they recommend and the clarity and amount of detail provided in their guidelines. This article provides an overview of international regulations and recommendations for utility data in HTA for a selection of key HTA countries: Australia, Canada, France, Germany, the Netherlands, Spain (Catalonia), Sweden and the UK (England/Wales and Scotland). International guidelines are typically clear and detailed for the selection of countries assessed regarding the source description of health states (e.g. generic preference-based measure) and who should provide preference weights for these health states (e.g. general population for own country). Many guidelines specify the use of off-the-shelf generic preference-based measures, and some further specify a measure, such as EQ-5D. However, international guidelines are either unclear or lack detailed guidance regarding the collection (e.g. patients report own health), source (e.g. clinical trial) and usage (e.g. adjusting for comorbidities) of utility values. It is argued that there is a need for transparent and detailed international guidelines on utility data recommendations to provide decision makers with the best possible evidence. Where this is not possible it is recommended that best practice should be used to inform the collection, source and usage of utility values in HTA.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Ismail Azzabi Zouraq
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152, Glattpark-Opfikon (Zurich), Switzerland
| | - Helene Chevrou-Severac
- Takeda Pharmaceuticals International AG, Thurgauerstrasse 130, 8152, Glattpark-Opfikon (Zurich), Switzerland
| | - Ben van Hout
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Lamsal R, Zwicker JD. Economic Evaluation of Interventions for Children with Neurodevelopmental Disorders: Opportunities and Challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:763-772. [PMID: 28822113 PMCID: PMC5701958 DOI: 10.1007/s40258-017-0343-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Economic evaluation is a tool used to inform decision makers on the efficiency of comparative healthcare interventions and inform resource allocation decisions. There is a growing need for the use of economic evaluations to assess the value of interventions for children with neurodevelopmental disorders (NDDs), a population that has increasing demands for healthcare services. Unfortunately, few evaluations have been conducted to date, perhaps stemming from challenges in applying existing economic evaluation methodologies in this heterogeneous population. Opportunities exist to innovate methods to address key challenges in conducting economic evaluations of interventions for children with NDDs. In this paper, we discuss important considerations and highlight areas for future work. This includes the paucity of appropriate instruments for measuring outcomes meaningful to children with NDDs and their families, difficulties in the measurement of costs due to service utilization in a wide variety of sectors, complexities in the measurement of caregiver and family effects and considerations in estimating long-term productivity costs. Innovation and application of evaluation approaches in these areas will help inform decisions around whether the resources currently spent on interventions for children with NDDs represent good value for money, or whether greater benefits for children could be generated by spending money in other ways.
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Affiliation(s)
- Ramesh Lamsal
- School of Public Policy, University of Calgary, 906-8th Avenue SW, Calgary, AB T2P 1H9, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906-8th Avenue SW, Calgary, AB T2P 1H9, Canada.
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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Caregiver burden of parents of young children with cystic fibrosis. J Cyst Fibros 2017; 17:125-131. [PMID: 29150357 DOI: 10.1016/j.jcf.2017.08.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/20/2017] [Accepted: 08/31/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of research examining the impact of informal caregiving on parents of young children with cystic fibrosis (CF). The aim of this study was to examine caregiver burden and identify risk factors associated with high caregiver burden in mothers and fathers of young children with CF. METHODS This was a cross-sectional study of parents of young children with CF. A total of 213 families were invited to complete the CarerQoL questionnaire, a validated tool composed of two parts: (i) the CarerQol-7D which describes the care situation in terms of the negative and positive effects of caregiving and (ii) the visual analogue scale (VAS) which measures happiness on a scale from 0 to 10 (0=completely unhappy and 10=completely happy). The utility score (US) is a weighted average of the subjective burden derived from the CarerQol-7D (0-100); higher US indicates reduced burden. Differences in mother-father dyad median utility scores were examined using Wilcoxon signed rank test. Generalised linear mixed models were used to identify factors associated with high caregiver burden. RESULTS At least one parent from 195 families completed the questionnaire (130 mother-father dyads, 189 mothers and 137 fathers). Fathers had a significantly higher median utility score than mothers [(89.2 (IQR 79.6-96.5) vs. 84.7 (74.5-88.0) p<0.001]. Factors found to be significantly associated with higher caregiver burden were increasing child age (OR 1.02; CI: 1.00-1.04), having a child ever positive for Pseudomonas aeruginosa (Pa) (OR 2.48; CI: 1.30-4.73) and being a mother (OR 1.65; CI: 1.02-2.65). CONCLUSIONS This study contributes new findings to the sparse literature on caregiver burden of parents of young children with CF. Increasing child age and infection with Pa, associated with higher morbidity, were linked to greater parental burden.
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Hoefman RJ, Meulenkamp TM, De Jong JD. Who is responsible for providing care? Investigating the role of care tasks and past experiences in a cross-sectional survey in the Netherlands. BMC Health Serv Res 2017; 17:477. [PMID: 28697752 PMCID: PMC5505036 DOI: 10.1186/s12913-017-2435-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/05/2017] [Indexed: 11/16/2022] Open
Abstract
Background Many countries face substitution from formal to informal care. It is essential that a sufficient number of caregivers, such as family, friends or neighbors, are willing and able to lend care to address the needs of ill or elderly persons. We investigated whether the general public, who might become caregivers in the future, and current informal caregivers align with the shift to more informal caregiving. Methods We studied the views on the responsibility for care of the general public versus the government, and whether these views differed among groups with diverse past experiences with care in terms of own health problems or previous caregiving activities. Data (n = 1097) was collected among the Dutch Health Care Consumer Panel with a survey in October 2015. Multivariate analyses of the views on responsibility for care in general and for different types of care were performed using (i) health, (ii) informal care, and (iii) general background characteristics, among a sample of the general public and among a subgroup of current caregivers. Results The majority (67%) of the respondents would be willing to provide informal care in the future, when necessary. Respondents were more willing to provide support tasks than personal or nursing care activities. Among current caregivers, views on responsibility for care were associated with their past experience. Experiencing less burden of caregiving was associated with perceiving the general public as more responsible for personal or nursing care. Conclusions The results of this study show that substitution from formal to informal care is more in line with public views when support activities are concerned than personal or nursing care. In addition, burdened caregivers also consider the government more responsible for personal or nursing care. When handing over care tasks to the public domain a critical view is needed on which care tasks are most appropriate for this. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2435-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R J Hoefman
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Rotterdam, The Netherlands. .,Netherlands institute for health services research, PO Box 1568, 3500 BN Utrecht, Utrecht, The Netherlands.
| | - T M Meulenkamp
- Netherlands institute for health services research, PO Box 1568, 3500 BN Utrecht, Utrecht, The Netherlands
| | - J D De Jong
- Netherlands institute for health services research, PO Box 1568, 3500 BN Utrecht, Utrecht, The Netherlands.,Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, Maastricht, The Netherlands
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Philipson TJ, Kamal-Bahl S, Jena AB. Defining Value: The Need for a Longer, Broader View. PHARMACOECONOMICS 2017; 35:669-672. [PMID: 28337720 DOI: 10.1007/s40273-017-0503-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Tomas J Philipson
- Irving B. Harris Graduate School of Public Policy Studies, University of Chicago, 1155 E. 60th Street, Chicago, IL, 60637, USA.
| | - Sachin Kamal-Bahl
- Innovation Center, Global Health and Value, Pfizer Inc., 500 Arcola Road, Collegeville, PA, 19426, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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