1
|
Engel L, Chiotelis O, Papadopoulos N, Hiscock H, Howlin P, McGillivray J, Bellows ST, Rinehart N, Mihalopoulos C. Sleeping Sound Autism Spectrum Disorder (ASD): Cost-Effectiveness of a Brief Behavioural Sleep Intervention in Primary School-Aged Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06422-2. [PMID: 38833029 DOI: 10.1007/s10803-024-06422-2] [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: 05/22/2024] [Indexed: 06/06/2024]
Abstract
Disordered sleep is common in autistic children. This study aimed to evaluate the cost-effectiveness of a brief behavioural sleep intervention, the 'Sleeping Sound intervention', in primary school-aged autistic children in Australia. A cost-effectiveness analysis was undertaken alongside a randomised controlled trial over a 6-month follow-up period from both a societal and healthcare sector perspective. Resources used by participants were collected from a resource-use questionnaire and administrative data; intervention costs were determined from study records. Mean costs and quality-adjusted life-years (QALYs) were compared between the intervention and treatment as usual (TAU) groups. Uncertainty analysis using bootstrapping and sensitivity analyses were conducted. The sample included 245 children, with 123 participants randomised to the intervention group and 122 to TAU. The mean total costs were higher for the Sleeping Sound intervention with a mean difference of A$745 (95% CI 248; 1242; p = 0.003) from a healthcare sector perspective and A$1310 (95% CI 584; 2035, p < 0.001) from a societal perspective. However, the intervention also resulted in greater QALYs compared with TAU, with a mean difference of 0.038 (95% CI 0.004; 0.072; p = 0.028). The incremental cost-effectiveness ratio was A$24,419/QALY (95% CI 23,135; 25,703) from a healthcare sector perspective and A$41,922/QALY (95% CI 39,915; 43,928) from a societal perspective; with a probability of being cost-effective of 93.8% and 74.7%, respectively. Findings remained robust in the sensitivity analyses. The Sleeping Sound intervention offers a cost-effective approach in improving sleep in primary school-aged autistic children.Trial registration The trial was registered with the International Trial Registry (ISRCTN14077107).
Collapse
Affiliation(s)
- Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Oxana Chiotelis
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, Faculty of Education, Monash University, Notting Hill, VIC, Australia
- School of Educational Psychology & Counselling, Monash University, Melbourne, VIC, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Susannah T Bellows
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Nicole Rinehart
- Krongold Clinic, Faculty of Education, Monash University, Notting Hill, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
2
|
Xie S, Wu J, Chen G. Comparative performance and mapping algorithms between EQ-5D-5L and SF-6Dv2 among the Chinese general population. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:7-19. [PMID: 36709458 DOI: 10.1007/s10198-023-01566-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To explore the comparative performance and develop the mapping algorithms between EQ-5D-5L and SF-6Dv2 in China. METHODS Respondents recruited from the Chinese general population completed both EQ-5D-5L and SF-6Dv2 during face-to-face interviews. Ceiling/floor effects were reported. Discriminative validity in self-reported chronic conditions was investigated using the effect sizes (ES). Test-retest reliability was evaluated using intra-class correlation coefficient (ICC) and Bland-Altman plots in a subsample. Correlation and absolute agreements between the two measures were estimated with Spearman's rank correlation coefficient and ICC, respectively. Ordinary least squares (OLS), generalized linear model, Tobit model, and robust MM-estimator were explored to estimate mapping equations between EQ-5D-5L and SF-6Dv2. RESULTS 3320 respondents (50.3% males; age 18-90 years) were recruited. 51.1% and 12.2% of respondents reported no problems on all EQ-5D-5L and SF-6Dv2 dimensions, respectively. The mean EQ-5D-5L utility was higher than SF-6Dv2 (0.947 vs. 0.827, p < 0.001). Utilities were significantly different across all chronic conditions groups for both measures. The mean absolute difference of utilities between the two tests for EQ-5D-5L was smaller (0.033 vs. 0.043) than SF-6Dv2, with a slightly higher ICC (0.859 vs. 0.827). Fair agreement (ICC = 0.582) was observed in the utilities between the two measures. Mapping algorithms generated by the OLS models performed the best according to the goodness-of-fit indicators. CONCLUSIONS Both measures showed comparable discriminative validity. Systematic differences in utilities were found, and on average, the EQ-5D-5L generates higher values than the SF-6Dv2. Mapping algorithms between the EQ-5D-5L and SF-6Dv2 are reported to enable transformations between these two measures in China.
Collapse
Affiliation(s)
- Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
3
|
Zwack CC, Haghani M, de Bekker-Grob EW. Research trends in contemporary health economics: a scientometric analysis on collective content of specialty journals. HEALTH ECONOMICS REVIEW 2024; 14:6. [PMID: 38270771 PMCID: PMC10809694 DOI: 10.1186/s13561-023-00471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Health economics is a thriving sub-discipline of economics. Applied health economics research is considered essential in the health care sector and is used extensively by public policy makers. For scholars, it is important to understand the history and status of health economics-when it emerged, the rate of research output, trending topics, and its temporal evolution-to ensure clarity and direction when formulating research questions. METHODS Nearly 13,000 articles were analysed, which were found in the collective publications of the ten most specialised health economic journals. We explored this literature using patterns of term co-occurrence and document co-citation. RESULTS The research output in this field is growing exponentially. Five main research divisions were identified: (i) macroeconomic evaluation, (ii) microeconomic evaluation, (iii) measurement and valuation of outcomes, (iv) monitoring mechanisms (evaluation), and (v) guidance and appraisal. Document co-citation analysis revealed eighteen major research streams and identified variation in the magnitude of activities in each of the streams. A recent emergence of research activities in health economics was seen in the Medicaid Expansion stream. Established research streams that continue to show high levels of activity include Child Health, Health-related Quality of Life (HRQoL) and Cost-effectiveness. Conversely, Patient Preference, Health Care Expenditure and Economic Evaluation are now past their peak of activity in specialised health economic journals. Analysis also identified several streams that emerged in the past but are no longer active. CONCLUSIONS Health economics is a growing field, yet there is minimal evidence of creation of new research trends. Over the past 10 years, the average rate of annual increase in internationally collaborated publications is almost double that of domestic collaborations (8.4% vs 4.9%), but most of the top scholarly collaborations remain between six countries only.
Collapse
Affiliation(s)
- Clara C Zwack
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Milad Haghani
- School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Zhang A, Mao Z, Wang Z, Wu J, Luo N, Wang P. Comparing measurement properties of EQ-5D and SF-6D in East and South-East Asian populations: a scoping review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:449-468. [PMID: 36889006 DOI: 10.1080/14737167.2023.2189590] [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: 03/10/2023]
Abstract
INTRODUCTION Euro-Qol-5 Dimension (EQ-5D) and Short-Form 6-Dimension (SF-6D) are the most commonly used generic multi-attribute utility instruments (MAUI) to calculate quality-adjusted life-years (QALYs) in East and South-East Asia. This study aims to systematically review and summarize current evidence on comparing measurement properties of EQ-5D and SF-6D in East and South-East Asian populations. AREAS COVERED Guided by the PRISMA systematic review and meta-analysis guidelines, a systematic literature search was conducted in databases of PubMed, Web of Science, MEDLINE, EMBASE and CINAHL (until June 2022) to obtain studies which compared measurement properties (feasibility, reliability, validity, responsiveness, and sensitivity) and agreement of EQ-5D and SF-6D in the populations. EXPERT OPINION In general, both EQ-5D and SF-6D had good measurement properties in East and South-East Asian populations; but their utility scores cannot be used interchangeably. Compared to the 3-level EQ-5D, SF-6D had better sensitivity and lower ceiling effects, but the comparison results between the 5-level EQ-5D and SF-6D were inconsistent across populations. This scoping review found that most studies did not consider order effects, did not specify the versions of SF-6D, and ignored certain measurement properties (reliability, content validity, and responsiveness). These aspects need to be further explored in future studies.
Collapse
Affiliation(s)
- Aixue Zhang
- School of Public Health, Fudan University, Shanghai, Hong Kong, China.,KeyLaboratory of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, Hong Kong, China
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Zitong Wang
- School of Public Health, Fudan University, Shanghai, Hong Kong, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, Beijing, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, Hong Kong, China.,KeyLaboratory of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, Hong Kong, China
| |
Collapse
|
6
|
Benedetto V, Filipe L, Harris C, Tahir N, Doherty A, Clegg A. Outcome measures for economic evaluations and cost-effectiveness analyses of interventions for people with intellectual disabilities: A methodological systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:230-240. [PMID: 36448370 PMCID: PMC10099878 DOI: 10.1111/jar.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/12/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Mainstream economic evaluations methods may not be appropriate to capture the range of effects triggered by interventions for people with intellectual disabilities. In this systematic review, we aimed to identify, assess and synthesise the arguments in the literature on how the effects of interventions for people with intellectual disabilities could be measured in economic evaluations. METHOD We searched for studies providing relevant arguments by running multi-database, backward, forward citation and grey literature searches. Following title/abstract and full-text screening, the arguments extracted from the included studies were summarised and qualitatively assessed in a narrative synthesis. RESULTS Our final analysis included three studies, with their arguments summarised in different methodological areas. CONCLUSIONS Based on the evidence, we suggest the use of techniques more attuned to the population with intellectual disabilities, such sensitive preference-based instruments to collect health states data, and mapping algorithms to obtain utility values.
Collapse
Affiliation(s)
- Valerio Benedetto
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK.,Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK
| | - Luís Filipe
- Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK.,Department of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK.,Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK
| | - Naheed Tahir
- Public Advisers' Forum, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK
| | - Alison Doherty
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK.,Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Health Technology Assessment (HTA) Unit, Applied Health Research hub, University of Central Lancashire, Preston, UK.,Methodological Innovation, Development, Adaptation and Support (MIDAS) Theme, National Institute for Health and Care Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK
| |
Collapse
|
7
|
Xie S, Wang D, Wu J, Liu C, Jiang W. Comparison of the measurement properties of SF-6Dv2 and EQ-5D-5L in a Chinese population health survey. Health Qual Life Outcomes 2022; 20:96. [PMID: 35710429 PMCID: PMC9202323 DOI: 10.1186/s12955-022-02003-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/04/2022] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND SF-6Dv2, the latest version of SF-6D, has been developed recently, and its measurement properties remain to be evaluated and compared with the EQ-5D-5L. The aim of this study was to assess and compare the measurement properties of the SF-6Dv2 and the EQ-5D-5L in a large-sample health survey among the Chinese population. METHODS Data were obtained from the 2020 Health Service Survey in Tianjin, China. Respondents were randomly selected and invited to complete both the EQ-5D-5L and SF-6Dv2 through face-to-face interviews or self-administration. Health utility values were calculated by the Chinese value sets for the two measures. Ceiling and floor effects were firstly evaluated. Convergent validity and discriminate validity were examined using Spearman's rank correlation and effect sizes, respectively. The agreement was assessed using intraclass correlation coefficients (ICC). Sensitivity was compared using relative efficiency and receiver operating characteristic. RESULTS Among 19,177 respondents (49.3% male, mean age 55.2 years, ranged 18-102 years) included in this study, the mean utility was 0.939 (0.168) for EQ-5D-5L and 0.872 (0.184) for SF-6Dv2. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (72.8% vs. 36.1%). The Spearman's rank correlation (range: 0.30-0.69) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The SF-6Dv2 showed slightly better discriminative capacities than the EQ-5D-5L (ES: 0.126-2.675 vs. 0.061-2.256). The ICC between the EQ-5D-5L and SF-6Dv2 utility values of the total sample was 0.780 (p < 0.05). The SF-6Dv2 had 29.0-179.2% higher efficiency than the EQ-5D-5L at distinguishing between respondents with different external health indicators, while the EQ-5D-5L was found to be 8.2% more efficient at detecting differences in self-reported health status than the SF-6Dv2. CONCLUSIONS Both the SF-6Dv2 and EQ-5D-5L have been demonstrated to be comparably valid and sensitive when used in Chinese population health surveys. The two measures may not be interchangeable given the moderate ICC and the systematic difference in utility values between the SF-6Dv2 and EQ-5D-5L. Further research is warranted to compare the test-retest reliability and responsiveness.
Collapse
Affiliation(s)
- Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,School of Pharmaceutical Science and Technology, Tianjin University, Room 209, 24th Building, 92th Weijin Road, Nankai District, Tianjin, 300072, China
| | - Dingyao Wang
- School of Pharmaceutical Science and Technology, Tianjin University, Room 209, 24th Building, 92th Weijin Road, Nankai District, Tianjin, 300072, China.,Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Room 209, 24th Building, 92th Weijin Road, Nankai District, Tianjin, 300072, China. .,Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Chunyu Liu
- Tianjin Health Information Research Center (Tianjin Health Development Research Center), Tianjin, China
| | - Wenchen Jiang
- Tianjin Hospital of Integrated Traditional Chinese and Western Medicine, 6th Changjiang Road, Nankai District, Tianjin, 300100, China.
| |
Collapse
|
8
|
Acaster S, Williams K, Skrobanski H, Buesch K. Using the EQ-5D to measure caregiver health-related quality of life in rare pediatric disease: a study in aromatic L-amino acid decarboxylase deficiency. FUTURE NEUROLOGY 2022. [DOI: 10.2217/fnl-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: To evaluate how well the EQ-5D-5L, a generic preference-based measure of health-related quality of life, captures caregiver burden in a rare pediatric neurotransmitter disease. Materials & methods: Caregivers (n = 14) of individuals with aromatic L-amino acid decarboxylase (AADC) deficiency completed qualitative interviews on their experience as a caregiver, the EQ-5D-5L and a background questionnaire. Qualitative and quantitative data were compared to determine whether there was concordance or discordance in the findings. Results: No caregivers reported problems with mobility and self-care in either the qualitative interviews or on the EQ-5D-5L, and there was general concordance for pain/discomfort and anxiety/depression. However, discordance was found for usual activities, with 79% reporting no problems with this dimension on the EQ-5D-5L, compared with 100% describing substantial limitations during the interviews. Conclusion: The EQ-5D-5L may not be appropriate to evaluate caregiver burden in AADC deficiency, where caregivers' perceptions of “usual activities” differ substantially from the general population.
Collapse
Affiliation(s)
- Sarah Acaster
- Acaster Lloyd Consulting Ltd. 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | - Kate Williams
- Acaster Lloyd Consulting Ltd. 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | - Hanna Skrobanski
- Acaster Lloyd Consulting Ltd. 8th Floor, Lacon House, 84 Theobalds Road, London, WC1X 8NL, UK
| | - Katharina Buesch
- PTC Therapeutics Switzerland GmbH, Tower 2, Turmstrasse 28, CH-6312 Steinhausen/Zug, Switzerland
| |
Collapse
|
9
|
A Personalized Multidisciplinary Approach to Evaluating and Treating Autism Spectrum Disorder. J Pers Med 2022; 12:jpm12030464. [PMID: 35330464 PMCID: PMC8949394 DOI: 10.3390/jpm12030464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder without a known cure. Current standard-of-care treatments focus on addressing core symptoms directly but have provided limited benefits. In many cases, individuals with ASD have abnormalities in multiple organs, including the brain, immune and gastrointestinal system, and multiple physiological systems including redox and metabolic systems. Additionally, multiple aspects of the environment can adversely affect children with ASD including the sensory environment, psychosocial stress, dietary limitations and exposures to allergens and toxicants. Although it is not clear whether these medical abnormalities and environmental factors are related to the etiology of ASD, there is evidence that many of these factors can modulate ASD symptoms, making them a potential treatment target for improving core and associated ASD-related symptoms and improving functional limitation. Additionally, addressing underlying biological disturbances that drive pathophysiology has the potential to be disease modifying. This article describes a systematic approach using clinical history and biomarkers to personalize medical treatment for children with ASD. This approach is medically comprehensive, making it attractive for a multidisciplinary approach. By concentrating on treatable conditions in ASD, it is possible to improve functional ability and quality of life, thus providing optimal outcomes.
Collapse
|
10
|
Transdermal Electrical Neuromodulation for Anxiety and Sleep Problems in High-Functioning Autism Spectrum Disorder: Feasibility and Preliminary Findings. J Pers Med 2021; 11:jpm11121307. [PMID: 34945779 PMCID: PMC8704341 DOI: 10.3390/jpm11121307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is associated with anxiety and sleep problems. We investigated transdermal electrical neuromodulation (TEN) of the cervical nerves in the neck as a safe, effective, comfortable and non-pharmacological therapy for decreasing anxiety and enhancing sleep quality in ASD. Methods: In this blinded, sham-controlled study, seven adolescents and young adults with high-functioning ASD underwent five consecutive treatment days, one day of the sham followed by four days of subthreshold TEN for 20 min. Anxiety-provoking cognitive tasks were performed after the sham/TEN. Measures of autonomic nervous system activity, including saliva α-amylase and cortisol, electrodermal activity, and heart rate variability, were collected from six participants. Results: Self-rated and caretaker-rated measures of anxiety were significantly improved with TEN treatment as compared to the sham, with effect sizes ranging from medium to large depending on the rating scale. Sleep scores from caretaker questionnaires also improved, but not significantly. Performance on two of the three anxiety-provoking cognitive tasks and heart rate variability significantly improved with TEN stimulation as compared to the sham. Four of the seven (57%) participants were responders, defined as a ≥ 30% improvement in self-reported anxiety. Salivary α-amylase decreased with more TEN sessions and decreased from the beginning to the end of the session on TEN days for responders. TEN was well-tolerated without significant adverse events. Conclusions: This study provides preliminary evidence that TEN is well-tolerated in individuals with ASD and can improve anxiety.
Collapse
|
11
|
Lee D, Kim Y, Devine B. Spillover Effects of Mental Health Disorders on Family Members' Health-Related Quality of Life: Evidence from a US Sample. Med Decis Making 2021; 42:80-93. [PMID: 34378438 DOI: 10.1177/0272989x211027146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to characterize the spillover effects of selected mental health disorders (episodic mood disorder (EMD), anxiety, substance use disorder (SUD), schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and dementia) on family members' health-related quality of life and to compare the magnitude of spillover effects across these types. METHODS Using the 2000-2015 Medical Expenditure Panel Survey, households having individuals with mental health disorders were identified. The SF-12 and EQ-5D surveys were used to acquire utility and health status scores for household members. The outcomes in households including an individual with a mental health disorder were compared to those of the control group (absence of individuals with mental health disorders in the household). We also compared a total of 15 pairs of diseases based on the SF-6D scores. A beta generalized estimating equation model was employed. RESULTS Average scores of utility and health status among individuals living with a member with a mental health disorder in the household were statistically lower than those of the control group and; for the SF-6D, met the minimally important difference for SUD, schizophrenia, and dementia. Differences in the SF-6D scores were statistically significant for 5 pairs of the mental health disorders: EMD-anxiety, EMD-ADHD, dementia-anxiety, dementia-ADHD, and schizophrenia-ADHD. CONCLUSIONS This study provides evidence of family spillover effects in mental illness using both utility and health status measures from a US representative sample. Integrating this evidence into clinical and policy decision making as well as economic evaluations would allow for a more comprehensive valuation of the societal benefits of mental and behavioral health interventions.
Collapse
Affiliation(s)
- Donghoon Lee
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Yeonil Kim
- Merck Research Laboratories, Merck & Co Inc, Rahway, NJ, USA
| | - Beth Devine
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| |
Collapse
|
12
|
Henry E, Cullinan J. Mental health spillovers from serious family illness: Doubly robust estimation using EQ-5D-5L population normative data. Soc Sci Med 2021; 279:113996. [PMID: 33993007 DOI: 10.1016/j.socscimed.2021.113996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
People are interconnected and ill-health is rarely experienced in isolation. However, while there has been extensive research on health spillovers related to informal caregiving, there is comparatively little evidence on how ill-health may impact upon non-caregiving family members. This paper analyses EQ-5D-5L normative data from a nationally representative sample of adult residents of Ireland to estimate the independent relationship between serious family illness and five distinct dimensions of health. The empirical strategy combines inverse probability weighting and multivariate ordered probit regression in a doubly robust estimation. We find that experience of serious family illness is associated with large mental health decrements that are independent of caring responsibilities, while similar results are not evident for the four other health dimensions. Furthermore, stratified sub-sample analyses indicate considerable heterogeneity by sex and by income. In particular, we find evidence consistent with larger mental health spillovers for females than for males, as well as for low- and medium-income households relative to high-income households. The latter suggests that such spillovers may be substantially worse for those with fewer resources. Overall, the findings have a range of potential implications, including for the provision of mental health supports and services, for equity of health outcomes, as well as for health economic evaluation. For example, we calculate that our estimates of health spillovers are consistent with a 1.3% reduction in health utility for non-caregiving family members.
Collapse
Affiliation(s)
- Edward Henry
- Discipline of Economics, National University of Ireland Galway, Ireland.
| | - John Cullinan
- Discipline of Economics, National University of Ireland Galway, Ireland.
| |
Collapse
|
13
|
Carlton EF, Weiss SL, Prescott HC, Prosser LA. What's the Cost? Measuring the Economic Impact of Pediatric Sepsis. Front Pediatr 2021; 9:761994. [PMID: 34869119 PMCID: PMC8634593 DOI: 10.3389/fped.2021.761994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Sepsis, life-threatening organ dysfunction secondary to infection, hospitalizes nearly 75,000 children each year in the United States. Most children survive sepsis. However, there is increasing recognition of the longer-term consequences of pediatric sepsis hospitalization on both the child and their family, including medical, psychosocial, and financial impacts. Here, we describe family spillover effects (the impact of illness on caregivers) of pediatric sepsis, why measurement of family spillover effects is important, and the ways in which family spillover effects can be measured.
Collapse
Affiliation(s)
- Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hallie C Prescott
- Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, MI, United States.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
14
|
Beck E, Klint J, Neine M, Garcia S, Meszaros K. Cost-Effectiveness of 4CMenB Infant Vaccination in England: A Comprehensive Valuation Considering the Broad Impact of Serogroup B Invasive Meningococcal Disease. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:91-104. [PMID: 33431159 DOI: 10.1016/j.jval.2020.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This cost-effectiveness analysis (CEA) of 4CMenB infant vaccination in England comprehensively considers the broad burden of serogroup B invasive meningococcal disease (MenB IMD), which has not been considered, or was only partially considered in previous CEAs. METHODS A review of previous MenB vaccination CEAs was conducted to identify aspects considered in the evaluation of costs and health outcomes of the disease burden of MenB IMD. To inform the model structure and comprehensive analysis, the aspects were grouped into 5 categories. A stepwise analysis was conducted to analyze the impact of each category, and the more comprehensive consideration of disease burden, on the incremental cost-effectiveness ratio (ICER). RESULTS MenB IMD incidence decreased by 46.0% in infants and children 0-4 years old within 5 years after introduction of the program. Stepwise inclusion of the 5 disease burden categories to a conventional narrow CEA setting reduced the ICER from £360 595 to £18 645-that is, considering the impact of all 5 categories, 4CMenB infant vaccination is cost-effective at a threshold of £20 000 per QALY gained. CONCLUSIONS When considering comprehensively the MenB IMD burden, 4CMenB infant vaccination can be cost-effective, a finding contrary to previous CEAs. This analysis allows policy decision-makers globally to infer the impact of current disease burden considerations on the cost-effectiveness and the comprehensive assessment necessary for MenB IMD. Although this comprehensive CEA can help inform decision making today, it may be limited in capturing the full disease burden and complex interactions of health and economics of MenB IMD.
Collapse
|
15
|
McCarty P, Frye RE. Early Detection and Diagnosis of Autism Spectrum Disorder: Why Is It So Difficult? Semin Pediatr Neurol 2020; 35:100831. [PMID: 32892958 DOI: 10.1016/j.spen.2020.100831] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Autism spectrum disorder (ASD) affects approximately 2% of children in the United States (US). Therapeutic interventions are most effective if applied early, yet diagnosis often remains delayed, partly because the diagnosis is based on identifying abnormal behaviors that may not emerge until the disorder is well established. Universal screening has been recommended by the America Academy of Pediatrics at 18 and 24 months yet studies show low compliance by pediatricians and the US Preventive Services Task Force does not support universal screening. To better understand the limitations of universal screening this article looks at the performance of screening tests given the prevalence of ASD. Specifically, although the sensitivity and specificity of the Modified Checklist for Autism in Toddlers, Revised with Follow-up, the de facto screening tool, exceeds 90%, the relatively low prevalence of ASD in the general population (∼2%) results in a positive predictive value of about 33%, resulting in only 1 of 3 children identified by the Modified Checklist for Autism in Toddlers, Revised with Follow-up actually having ASD. To mitigate this issue, the America Academy of Pediatrics has recently recommended the use of a Level 2 screener after failing a Level 1 screener, before referring children on for a full comprehensive evaluation for ASD. In this way, a series of screening tools are used to enrich the population of children referred for further evaluation so fewer without an ASD diagnosis are evaluated. We have developed a program to train pediatricians to utilize these instruments as well as learn to diagnose ASD so children can effectively be referred for appropriate services at the front lines. Given the current burden on the medical system with the diagnosis and evaluation of children with ASD, it is important to create efficient systems for screening children which can best identify those most likely to have ASD. Developing methods to identify those children most at risk for developing ASD, either through consideration of medical or family history or through the use of biomarkers, may be helpful in identifying the children that require increased surveillance and those that do not need screening.
Collapse
Affiliation(s)
- Patrick McCarty
- Section on Neurodevelopmental Disorders, Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Richard E Frye
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ.
| |
Collapse
|
16
|
Bent S, Wahlberg J, Chen Y, Widjaja F, McDonald MG, Hendren RL. Quality of Life Among School-Age Children With Autism: The Oak Hill School Outcomes Study. Semin Pediatr Neurol 2020; 34:100808. [PMID: 32446439 DOI: 10.1016/j.spen.2020.100808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Prior studies have documented a lower quality of life (QOL) in children with autism spectrum disorder (ASD) compared to typically developing peers, but few studies have examined the trajectory of QOL over time in the same population. We conducted a 2-year cohort study in 29 children attending a specialized school for ASD with quarterly measures of parent-rated QOL as well as parent and teacher measures of behavior and social skills to determine the trajectory of change in QOL and predictors of change. The average change in QOL was constant (no change over time), but there was substantial variation with some students showing significant gains and others showing declines. Exploratory analyses revealed that improvements in behavior and social skills were greater (nonsignificantly) among children with improvements in QOL. Children with improved QOL were also younger and had a lower initial symptom burden. This study suggests that early intervention programs that provide social skills and behavioral management strategies may improve QOL in children with ASD. The study also highlights the need to develop and study novel, qualitative measures of QOL in this population.
Collapse
Affiliation(s)
- Stephen Bent
- Department of Psychiatry, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
| | - Jessica Wahlberg
- Department of Psychiatry, University of California, San Francisco, CA
| | - Yingtong Chen
- Department of Psychiatry, University of California, San Francisco, CA
| | - Felicia Widjaja
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - Robert L Hendren
- Department of Psychiatry, University of California, San Francisco, CA
| |
Collapse
|
17
|
Lindley LC, Keim-Malpass J, Svynarenko R, Cozad MJ, Mack JW, Hinds PS. Pediatric Concurrent Hospice Care: A Scoping Review and Directions for Future Nursing Research. J Hosp Palliat Nurs 2020; 22:238-245. [PMID: 32282559 PMCID: PMC7716801 DOI: 10.1097/njh.0000000000000648] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2010, forgoing curative therapies were removed as a hospice eligibility criterion for children through section 2302 of the Patient Protection and Affordable Care Act called Concurrent Care for Children. Given that concurrent care is a federally mandated option for children and their families, no review of the science has been conducted. The purpose of this study was to systematically collect the evidence on concurrent hospice care, critically appraise the evidence, and identify areas for future nursing research. Of the 186 articles identified for review, 14 met the inclusion and exclusion criteria. Studies in this review described concurrent hospice care from a variety of perspectives: policy, legal, and ethics. However, only 1 article evaluated the impact of concurrent hospice care on outcomes, whereas several studies explained clinical and state-level implementation. There is a need for further studies that move beyond conceptualization and generate baseline and outcomes data. Understanding the effectiveness of concurrent hospice care might provide important information for future nursing research. The approaches used to disseminate and implement concurrent hospice care at state, provider, and family levels should be explored.
Collapse
|
18
|
Wu Y, Al-Janabi H, Mallett A, Quinlan C, Scheffer IE, Howell KB, Christodoulou J, Leventer RJ, Lockhart PJ, Stark Z, Boughtwood T, Goranitis I. Parental health spillover effects of paediatric rare genetic conditions. Qual Life Res 2020; 29:2445-2454. [PMID: 32266555 DOI: 10.1007/s11136-020-02497-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The complexity and severity of rare genetic conditions pose substantial burden to families. While the importance of spillovers on carers' health in resource allocation decisions is increasingly recognised, there is significant lack of empirical evidence in the context of rare diseases. The objective of this study was to estimate the health spillovers of paediatric rare genetic conditions on parents. METHODS Health-related quality-of-life (HRQoL) data from children with rare genetic conditions (genetic kidney diseases, mitochondrial diseases, epileptic encephalopathies, brain malformations) and their parents were collected using the CHU9D and SF-12 measures, respectively. We used two approaches to estimate parental health spillovers. To quantify the 'absolute health spillover', we matched our parent cohort to the Australian general population. To quantify the 'relative health spillover', regression models were applied using the cohort data. RESULTS Parents of affected children had significantly lower HRQoL compared to matched parents in the general public (- 0.06; 95% CIs - 0.08, - 0.04). Multivariable regression demonstrated a positive association between parental and child health. The mean magnitude of HRQoL loss in parents was estimated to be 33% of the HRQoL loss observed in children (95% CIs 21%, 46%). CONCLUSION Paediatric rare genetic conditions appear to be associated with substantial parental health spillovers. This highlights the importance of including health effects on family members and caregivers into economic evaluation of genomic technologies and personalised medicine. Overlooking spillover effects may undervalue the benefits of diagnosis and management in this context. This study also expands the knowledge of family spillover to the rare disease spectrum.
Collapse
Affiliation(s)
- You Wu
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Hareth Al-Janabi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Mallett
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Kidney Health Service and Conjoint Renal Research Laboratory, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Catherine Quinlan
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatric Nephrology, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Ingrid E Scheffer
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
- Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Katherine B Howell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - John Christodoulou
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Disciplines of Genetic Medicine and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Richard J Leventer
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Paul J Lockhart
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ilias Goranitis
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia.
- Australian Genomics Health Alliance, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| |
Collapse
|
19
|
Frye RE, Vassall S, Kaur G, Lewis C, Karim M, Rossignol D. Emerging biomarkers in autism spectrum disorder: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:792. [PMID: 32042808 DOI: 10.21037/atm.2019.11.53] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Autism spectrum disorder (ASD) affects approximately 2% of children in the United States (US) yet its etiology is unclear and effective treatments are lacking. Therapeutic interventions are most effective if started early in life, yet diagnosis often remains delayed, partly because the diagnosis of ASD is based on identifying abnormal behaviors that may not emerge until the disorder is well established. Biomarkers that identify children at risk during the pre-symptomatic period, assist with early diagnosis, confirm behavioral observations, stratify patients into subgroups, and predict therapeutic response would be a great advance. Here we underwent a systematic review of the literature on ASD to identify promising biomarkers and rated the biomarkers in regards to a Level of Evidence and Grade of Recommendation using the Oxford Centre for Evidence-Based Medicine scale. Biomarkers identified by our review included physiological biomarkers that identify neuroimmune and metabolic abnormalities, neurological biomarkers including abnormalities in brain structure, function and neurophysiology, subtle behavioral biomarkers including atypical development of visual attention, genetic biomarkers and gastrointestinal biomarkers. Biomarkers of ASD may be found prior to birth and after diagnosis and some may predict response to specific treatments. Many promising biomarkers have been developed for ASD. However, many biomarkers are preliminary and need to be validated and their role in the diagnosis and treatment of ASD needs to be defined. It is likely that biomarkers will need to be combined to be effective to identify ASD early and guide treatment.
Collapse
Affiliation(s)
- Richard E Frye
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Deparment of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Sarah Vassall
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gurjot Kaur
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Christina Lewis
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mohammand Karim
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.,Deparment of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Prosser LA, Wittenberg E. Advances in Methods and Novel Applications for Measuring Family Spillover Effects of Illness. PHARMACOECONOMICS 2019; 37:447-450. [PMID: 30915632 DOI: 10.1007/s40273-019-00794-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Lisa A Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, USA.
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, USA.
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, USA
| |
Collapse
|