1
|
Barbosa C, Bray JW, Dowd WN, Barnosky A, Wittenberg E. SF-6D utility scores for alcohol use disorder status and alcohol consumption risk levels in the US population. Addiction 2021; 116:1034-1042. [PMID: 33448504 PMCID: PMC7882636 DOI: 10.1111/add.15224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/26/2020] [Accepted: 08/07/2020] [Indexed: 01/12/2023]
Abstract
AIMS To estimate US population health utilities for subgroups defined by alcohol use disorder (AUD) status and consumption level. DESIGN Cross-sectional survey. SETTING Community settings in the United States (i.e. excluding institutional settings). PARTICIPANTS A total of 36,042 adults (age 18+) in non-institutional settings in the United States. MEASUREMENTS We used 12-item Short Form Survey (SF-12) data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to calculate mean Short Form-6 dimension (SF-6D) utility scores across World Health Organization alcohol consumption risk levels-very high risk, high risk, medium risk, low risk and an additional abstinent level-for three groups: (1) the general population (n = 36,042), (2) individuals with life-time AUD (n = 9925) and (3) individuals with current AUD (n = 5083), and assessed minimally important differences (MIDs) between consumption levels. Each group is a subset of the previous group. FINDINGS The general population's mean SF-6D utility was higher than that of individuals with life-time or current AUD across all consumption risk levels (0.79 versus 0.76 for both AUD groups). For all groups, SF-6D utilities increased as consumption risk level decreased to non-abstinent levels, and reducing consumption from very high risk to any lower level was associated with a statistically significant and meaningful improvement in utility. For individuals with life-time or current AUD, becoming abstinent from high-, medium- and low-risk levels was associated with significantly and meaningfully worse utilities. CONCLUSIONS Higher alcohol consumption risk levels appear to be associated with lower health index scores for the general population and individuals with a history of alcohol use disorder, meaning that higher alcohol consumption is associated with worse health-related quality of life.
Collapse
Affiliation(s)
| | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina, Greensboro, NC, USA
| | | | | | - Eve Wittenberg
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Whitham HK, Hutchinson AB, Shrestha RK, Kuppermann M, Grund B, Shouse RL, Sansom SL. Health Utility Estimates and Their Application to HIV Prevention in the United States: Implications for Cost-Effectiveness Modeling and Future Research Needs. MDM Policy Pract 2020; 5:2381468320936219. [PMID: 32864453 PMCID: PMC7432967 DOI: 10.1177/2381468320936219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 05/06/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives. Health utility estimates from the current era of HIV
treatment, critical for cost-effectiveness analyses (CEA) informing HIV health
policy, are limited. We examined peer-reviewed literature to assess the
appropriateness of commonly referenced utilities, present previously unreported
quality-of-life data from two studies, and discuss future implications for
HIV-related CEA. Methods. We searched a database of
cost-effectiveness analyses specific to HIV prevention efforts from 1999 to 2016
to identify the most commonly referenced sources for health utilities and to
examine practices around using and reporting health utility data. Additionally,
we present new utility estimates from the Centers of Disease Control and
Prevention’s Medical Monitoring Project (MMP) and the INSIGHT Strategies for
Management of Anti-Retroviral Therapy (SMART) trial. We compare data collection
time frames, sample characteristics, assessment methods, and key estimates.
Results. Data collection for the most frequently cited utility
estimates ranged from 1985 to 1997, predating modern HIV treatment. Reporting
practices around utility weights are poor and lack details on participant
characteristics, which may be important stratifying factors for CEA. More recent
utility estimates derived from MMP and SMART were similar across CD4+ count
strata and had a narrower range than pre–antiretroviral therapy (ART) utilities.
Conclusions. Despite the widespread use of ART,
cost-effectiveness analysis of HIV prevention interventions frequently apply
pre-ART health utility weights. Use of utility weights reflecting the current
state of the US epidemic are needed to best inform HIV research and public
policy decisions. Improved practices around the selection, application, and
reporting of health utility data used in HIV prevention CEA are needed to
improve transparency.
Collapse
Affiliation(s)
- Hilary K Whitham
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela B Hutchinson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ram K Shrestha
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Miriam Kuppermann
- Departments of Obstetrics, Gynecology, and Reproductive Sciences; and Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, Minnesota (BG)
| | - R Luke Shouse
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie L Sansom
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
3
|
Convergent validity of the EQ-5D-3L in a randomized-controlled trial of the Housing First model. BMC Health Serv Res 2019; 19:482. [PMID: 31300051 PMCID: PMC6626335 DOI: 10.1186/s12913-019-4310-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health utility assessments are important for economic evaluations but few instruments have been validated in homeless people with mental illness. We examined the convergent validity of the EuroQol-5 Dimension 3-level questionnaire (EQ-5D-3L) as a measure of quality of life in homeless adults with mental illness. METHODS Data were from Toronto participants in At Home/Chez Soi, a 24-month randomized controlled trial of Housing First (immediate access to scattered site housing and mental health support services) compared to treatment as usual for homeless adults with a mental disorder (n = 575). Participants completed the EQ-5D-3L at 6 month intervals. We tested convergent validity, hypothesizing strong correlation (r > 0.6) with the Lehman Quality of Life Interview 20 (QOLI-20) index and moderate correlations (r > 0.3) with the Colorado Symptom Index (CSI), Recovery Assessment Scale (RAS), and number of comorbidities. We also examined correlations between EQ-5D-3L scores and the QOLI-20 over time using a linear mixed-effects model. RESULTS The EQ-5D-3L was not strongly correlated with the QOLI-20 (r ranged from 0.31-0.52 at various time points). The EQ-5D-3L was moderately correlated with the CSI, RAS, and number of comorbidities. The Snijders/Bosker r2 for longitudinal validity between the EQ-5D-3L and QOLI-20 within subjects over time was 0.2094 (square-root r = 0.4576). CONCLUSIONS The EQ-5D-3L did not demonstrate strong convergent validity in homeless people with mental illness but was moderately correlated with several instruments. Further research is warranted to determine the optimal method for measuring health utilities in this population. TRIAL REGISTRATION International Standard Randomised Control Trial Registry ISRCTN42520374 assigned on August 18, 2009.
Collapse
|
4
|
Al-Janabi H, McLoughlin C, Oyebode J, Efstathiou N, Calvert M. Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery. Soc Sci Med 2019; 235:112382. [PMID: 31326132 DOI: 10.1016/j.socscimed.2019.112382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/26/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
Abstract
Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic 'IMPACT'. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
Collapse
Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP, UK
| | - Nikolaos Efstathiou
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
| |
Collapse
|
5
|
Bae G, Kim E, Kwon HY, An J, Park J, Yang H. Health state utility values of osteoporotic fractures among Korean women. Expert Rev Pharmacoecon Outcomes Res 2019; 20:177-183. [PMID: 31092075 DOI: 10.1080/14737167.2019.1617703] [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: 10/26/2022]
Abstract
Objectives: This study aimed to investigate health state utility values in eight health states related to osteoporosis and osteoporotic fractures using time trade-off (TTO) technique among postmenopausal Korean women.Methods: Scenarios describing eight health states including osteoporosis and hip, vertebral, post-hip, post-vertebral, ankle, humerus, and wrist fractures were developed and presented to 500 female participants aged 45 to 59 years who were selected with probability proportionate to age group and region for this investigation. Each health states valuation was derived using the trade-off (TTO) technique. Ten years of a given health state was traded off with a shorter length of time in full health.Results: Mean scores of each state were calculated. Osteoporosis scored the highest (0.669 ± 0.155), followed by wrist fracture (0.656 ± 0.151). Hip (0.298 ± 0.158) and vertebral (0.298 ± 0.160) fractures were found to be the worst health states. Post-hip (0.446 ± 0.159) and post-vertebral fractures (0.455 ± 0.160) were also considered undesirable states. All fractures were associated with disutilities, ranging from a mean of -0.013 to -0.371. These values were statistically significant (p < 0.0001). Hip and vertebral fractures are among the most serious consequences of osteoporotic fractures.Conclusions: The vertebral and hip fractures marked the lowest utility scores among post-menopausal women in Korea.
Collapse
Affiliation(s)
- Green Bae
- College of Pharmacy, Ewha Womans University, Seoul, South Korea
| | - Eugene Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Hye-Young Kwon
- Division of Biology & Public Health, Mokwon University, Daejeon, Korea
| | | | | | | |
Collapse
|
6
|
Disher T, Beaubien L, Campbell-Yeo M. Are guidelines for measurement of quality of life contrary to patient-centred care? J Adv Nurs 2018; 74:2677-2684. [PMID: 30109711 DOI: 10.1111/jan.13820] [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: 03/19/2018] [Revised: 06/22/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
AIMS A discussion of how quality-adjusted life years are used to inform resource allocation decisions and highlight how assumptions underpinning the measurement of quality of life are contrary to the principles of patient-centred care. BACKGROUND Cost-effectiveness analyses (CEAs) can provide influential guidance for health resource allocation, particularly in the context of a budget-constrained public health insurance plan. Most national economic guideline bodies recommend that quality-adjusted life year weights for CEA be elicited indirectly (public preferences). This has potentially important implications for healthcare provision and research, as it discounts the ability of a person experiencing an illness to describe how it affects their quality of life. DESIGN Discussion paper. DATA SOURCES Guidelines for the conduct of health economic evaluations, influential methodological and theoretical texts, and a review of PubMed conducted in April 2017. IMPLICATIONS FOR NURSING Nurses are increasingly interested in leveraging methods from health economics to aid in decision-making and advocacy. In this analysis, we highlight how taken-for-granted approaches to the measurement of quality of life may discount the experience of patients and lead to decisions that are contrary to the principles of patient-centred care. Nurses conducting or reading research using these methods should consider whether the approach used to measure the quality of life are appropriate for the population under consideration. CONCLUSION Since patient and public health preferences can differ in both magnitude and direction, guideline bodies should re-evaluate their partiality for public preferences in the reference case.
Collapse
Affiliation(s)
- Timothy Disher
- Faculty of Health, School of Nursing, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Louis Beaubien
- Faculty of Management, Rowe School of Business, Dalhousie University, Halifax, NS, Canada.,Faculty of Medicine, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- Faculty of Health, School of Nursing, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.,Faculty of Medicine, Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.,Faculty of Science, Department of Psychology & Neuroscience, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| |
Collapse
|
7
|
Hagiwara Y, Shiroiwa T, Shimozuma K, Kawahara T, Uemura Y, Watanabe T, Taira N, Fukuda T, Ohashi Y, Mukai H. Impact of Adverse Events on Health Utility and Health-Related Quality of Life in Patients Receiving First-Line Chemotherapy for Metastatic Breast Cancer: Results from the SELECT BC Study. PHARMACOECONOMICS 2018; 36:215-223. [PMID: 29043567 PMCID: PMC5805818 DOI: 10.1007/s40273-017-0580-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of adverse events (AEs) on health utility and health-related quality of life (HRQOL) in patients with metastatic breast cancer undergoing first-line chemotherapy. METHODS We analyzed the data from the SELECT BC study, a multicenter, open-label, randomized, phase III study conducted in Japan, which compared first-line S-1 with taxane therapies. Heath utility and HRQOL were assessed using the EQ-5D-3L and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) at baseline and 3, 6, and 12 months after treatment initiation. Health utility was calculated based on societal preferences, and AEs were reported at each cycle of the study treatment. Linear marginal mean models were used to quantify the impact of the last AEs (with 10 or more incidences) observed before HRQOL assessment on health utility and HRQOL. RESULTS Analysis included 380 patients and 12 (of 15) AEs. Grade 1 nausea and oral mucositis, grade 1 and 2 edema, and grade 2 fatigue, motor and sensory neuropathy, and myalgia were significantly associated with disutility, measured using the EQ-5D-3L. Grade 1 oral mucositis, grade 1 and 2 fatigue, and grade 2 sensory neuropathy were significantly associated with impaired global health status in the EORTC QLQ-C30. AEs associated with decrements in the five functioning scales included fatigue, oral mucositis, nausea, edema, motor and sensory neuropathy, and myalgia. CONCLUSIONS We reported disutilities caused by AEs in patients with metastatic breast cancer under chemotherapy. These findings can be applied to future model-based cost-effectiveness analyses. TRIAL REGISTRATION NUMBER C000000416.
Collapse
Affiliation(s)
- Yasuhiro Hagiwara
- Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Takeru Shiroiwa
- Department of Health and Welfare Services, National Institute of Public Health, Wako, Japan
| | - Kojiro Shimozuma
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Kusatsu, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Naruto Taira
- Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
| | - Takashi Fukuda
- Department of Health and Welfare Services, National Institute of Public Health, Wako, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Hirofumi Mukai
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
8
|
Sacchi L, Rubrichi S, Mazzanti A, Quaglini S, Parimbelli E. UceWeb: a Web-based Collaborative Tool for Collecting and Sharing Quality of Life Data. Methods Inf Med 2018; 54:156-63. [DOI: 10.3414/me14-01-0021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 10/01/2014] [Indexed: 11/09/2022]
Abstract
SummaryObjectives: This work aims at building a platform where quality-of-life data, namely utility coefficients, can be elicited not only for immediate use, but also systematically stored together with patient profiles to build a public repository to be further exploited in studies on specific target populations (e.g. cost/utility analyses).Methods: We capitalized on utility theory and previous experience to define a set of desirable features such a tool should show to facilitate sound elicitation of quality of life. A set of visualization tools and algorithms has been developed to this purpose. To make it easily accessible for potential users, the software has been designed as a web application. A pilot validation study has been performed on 20 atrial fibrillation patients.Results: A collaborative platform, UceWeb, has been developed and tested. It implements the standard gamble, time trade-off and rating-scale utility elicitation methods. It allows doctors and patients to choose the mode of interaction to maximize patients’ comfort in answering difficult questions. Every utility elicitation may contribute to the growth of the repository.Conclusion: UceWeb can become a unique source of data allowing researchers both to perform more reliable comparisons among healthcare interventions and build statistical models to gain deeper insight into quality of life data.
Collapse
|
9
|
Wittenberg E, Bray JW, Gebremariam A, Aden B, Nosyk B, Schackman BR. Joint Utility Estimators in Substance Use Disorders. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:458-465. [PMID: 28292491 PMCID: PMC5356490 DOI: 10.1016/j.jval.2016.09.2404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although co-occurring conditions are common with substance use disorders (SUDs), estimation methods for joint health state utilities have not yet been tested in this context. OBJECTIVES To compare joint health state utility estimators in SUD to inform economic evaluation. METHODS We conducted two Internet-based surveys of US adults to collect community perspective standard gamble utilities for SUD and common co-occurring conditions. We evaluated six conditions as they occur individually and four combinations of these as they occur in tandem. We applied joint utility estimators using the six individual conditions' utilities to compare their performance relative to the observed combination states' utilities. We assessed performance with bias (estimated utility minus observed utility) and root mean square error (RMSE). RESULTS Using 3892 utilities from 1502 respondents, the minimum estimator was statistically unbiased (i.e., the 95% confidence interval included 0) for all combination states that we measured. The maximum estimator was unbiased for two states and the linear index and adjusted decrement estimators were unbiased for one state. The maximum estimator had the smallest RMSE for two combination states (back pain and prescription opioid misuse [0.0004] and injection crack and injection opioid use [0.0007]); the linear index and minimum estimators had the smallest RMSE for one combination state each. The additive and multiplicative estimators had the largest RMSE for all states. CONCLUSIONS Our results demonstrate the usefulness of the minimum estimator in this context, and confirm the inadequacy of the additive and multiplicative estimators. Further research is needed to extend these results to other SUD states.
Collapse
Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jeremy W Bray
- Department of Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | - Brandon Aden
- Department of Healthcare Policy & Research and Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bruce R Schackman
- Department of Healthcare Policy & Research and Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
10
|
Wittenberg E, Bray JW, Aden B, Gebremariam A, Nosyk B, Schackman BR. Measuring benefits of opioid misuse treatment for economic evaluation: health-related quality of life of opioid-dependent individuals and their spouses as assessed by a sample of the US population. Addiction 2016; 111:675-84. [PMID: 26498740 PMCID: PMC5034732 DOI: 10.1111/add.13219] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/16/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Abstract
AIMS To understand how the general public views the quality of life effects of opioid misuse and opioid use disorder on an individual and his/her spouse, measured in terms used in economic evaluations. DESIGN Cross-sectional internet survey of a US population-representative respondent panel conducted December 2013-January 2014. SETTING United States. PARTICIPANTS A total of 2054 randomly selected adults; 51.1% male (before weighting). MEASUREMENTS Mean (95% confidence interval) and median health 'utility' for six opioid misuse and treatment outcomes: active injection misuse; active prescription misuse; methadone maintenance therapy at initiation and when stabilized in treatment; and buprenorphine therapy at initiation and when stabilized. Utility is a numerical representation of health-related quality of life used in economic evaluations to 'adjust' estimated survival to include peoples' preferences for health states. Utilities are determined by surveying the general population to estimate the value they assign to particular health states on a scale where 0 = the value of being dead and 1.0 = the value of being in perfect health. Spouse spillover utility is assigned to a spouse of an individual who is in a particular health state. FINDINGS Mean individual utility ranged from 0.574 [95% confidence interval (CI) = 0.538, 0.611] for active injection opioid misuse to 0.766 for stabilized buprenorphine therapy (95% CI = 0.738, 0.795), with other states in between. Female respondents assigned higher utility to the active prescription misuse and buprenorphine therapy at initiation states than did males (P < 0.05); all other states did not differ by respondent gender. Mean spousal utilities were significantly lower than 1.0 but mostly higher than individual utility, and were similar between male and female respondents. CONCLUSIONS In the opinion of the US public, injection opioid misuse results in worse health-related quality of life than prescription misuse, and methadone therapy results in worse health-related quality of life than buprenorphine therapy. Spouses are negatively affected by their partner's opioid misuse and early treatment.
Collapse
Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeremy W. Bray
- Department of Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Brandon Aden
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bruce R. Schackman
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
11
|
Grosse SD, Chaugule SS, Hay JW. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:267-83. [PMID: 25585817 DOI: 10.1586/14737167.2015.1001372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost-effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost-effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system.
Collapse
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mail Stop E-64, Atlanta, GA 30333, USA
| | | | | |
Collapse
|
12
|
Jackson LJ, Auguste P, Low N, Roberts TE. Valuing the health states associated with Chlamydia trachomatis infections and their sequelae: a systematic review of economic evaluations and primary studies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:116-130. [PMID: 24438725 DOI: 10.1016/j.jval.2013.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Economic evaluations of interventions to prevent and control sexually transmitted infections such as Chlamydia trachomatis are increasingly required to present their outcomes in terms of quality-adjusted life-years using preference-based measurements of relevant health states. The objectives of this study were to critically evaluate how published cost-effectiveness studies have conceptualized and valued health states associated with chlamydia and to examine the primary evidence available to inform health state utility values (HSUVs). METHODS A systematic review was conducted, with searches of six electronic databases up to December 2012. Data on study characteristics, methods, and main results were extracted by using a standard template. RESULTS Nineteen economic evaluations of relevant interventions were included. Individual studies considered different health states and assigned different values and durations. Eleven studies cited the same source for HSUVs. Only five primary studies valued relevant health states. The methods and viewpoints adopted varied, and different values for health states were generated. CONCLUSIONS Limitations in the information available about HSUVs associated with chlamydia and its complications have implications for the robustness of economic evaluations in this area. None of the primary studies could be used without reservation to inform cost-effectiveness analyses in the United Kingdom. Future debate should consider appropriate methods for valuing health states for infectious diseases, because recommended approaches may not be suitable. Unless we adequately tackle the challenges associated with measuring and valuing health-related quality of life for patients with chlamydia and other infectious diseases, evaluating the cost-effectiveness of interventions in this area will remain problematic.
Collapse
Affiliation(s)
- Louise J Jackson
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK
| | - Peter Auguste
- Warwick Evidence, Warwick Medical School, The University of Warwick, Coventry, UK
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tracy E Roberts
- Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, UK.
| |
Collapse
|
13
|
Carer Preferences in Economic Evaluation and Healthcare Decision Making. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:235-9. [DOI: 10.1007/s40271-013-0035-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
14
|
Wittenberg E, Prosser LA. Disutility of illness for caregivers and families: a systematic review of the literature. PHARMACOECONOMICS 2013; 31:489-500. [PMID: 23572441 PMCID: PMC3674134 DOI: 10.1007/s40273-013-0040-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Caring for an ill or disabled family member imposes a well-documented burden on the caregiver. The benefits of a health intervention may be underestimated if "spillover" effects on family members are not captured, resulting in inaccurate conclusions of economic evaluations. OBJECTIVE To provide an estimate of, and to summarize measurement approaches for, the spillover disutility of illness on family members, relatives, and caregivers, through a systematic review of the literature. METHODS The medical (PubMED), psychology (PsycINFO), and economics (EconLit) literatures were searched from inception through February 2012 for published studies measuring spillover disutility of illness on family members and caregivers. Inclusion criteria were (1) studies using preference-based measures of health-related quality of life, and (2) studies reporting spillover disutility, or (3) studies reporting data from which a spillover disutility could be inferred. RESULTS Fifteen studies were included in this review: seven reported estimates of spillover disutility and eight reported data from which disutility could be inferred. Three studies found no disutility associated with spillover, whereas 12 found measurable effects as large as -0.718 (and two found evidence of positive spillover in subsets of their samples). Generic (indirect) utility instruments were primarily used to measure spillover, including the EQ-5D, QWB, and HUI (n = 13), though two studies used modified versions of the time trade-off technique. Illnesses studied included childhood disorders (e.g., spina bifida, congenital malformations), diseases of the elderly (e.g., Alzheimer's disease and dementia), physically disabling conditions (e.g., arthritis, multiple sclerosis), and medical conditions such as cancer and stroke. The persons affected by spillover included parents, grandparents, spouses/partners, other family caregivers, and household members. CONCLUSIONS There is a limited literature on the spillover disutility of illness on family members and caregivers, providing some specific estimates of a generally small, negative effect for particular conditions and individuals. Measurement methods vary across studies and a consensus approach has not yet been reached. Evidence suggests that the inclusion of spillover effects in economic evaluations would increase the relative effectiveness of interventions that address conditions with spillover compared to those without, though such differential benefits may be limited to such specific circumstances.
Collapse
Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard School of Public Health, 718 Huntington Ave, Boston, MA 02115, USA.
| | | |
Collapse
|
15
|
Shabaruddin FH, Chen LC, Elliott RA, Payne K. A systematic review of utility values for chemotherapy-related adverse events. PHARMACOECONOMICS 2013; 31:277-288. [PMID: 23529208 DOI: 10.1007/s40273-013-0033-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Chemotherapy offers cancer patients the potential benefits of improved mortality and morbidity but may cause detrimental outcomes due to adverse drug events (ADEs), some of which requiring time-consuming, resource-intensive and costly clinical management. To appropriately assess chemotherapy agents in an economic evaluation, ADE-related parameters such as the incidence, (dis)utility and cost of ADEs should be reflected within the model parameters. To date, there has been no systematic summary of the existing literature that quantifies the utilities of ADEs due to healthcare interventions in general and chemotherapy treatments in particular. OBJECTIVE This review aimed to summarize the current evidence base of reported utility values for chemotherapy-related ADEs. METHODS A structured electronic search combining terms for utility, utility valuation methods and generic terms for cancer treatment was conducted in MEDLINE and EMBASE in June 2011. Inclusion criteria were: (1) elicitation of utility values for chemotherapy-related ADEs and (2) primary data. Two reviewers identified studies and extracted data independently. Any disagreements were resolved by a third reviewer. RESULTS Eighteen studies met the inclusion criteria from the 853 abstracts initially identified, collectively reporting 218 utility values for chemotherapy-related ADEs. All 18 studies used short descriptions (vignettes) to obtain the utility values, with nine studies presenting the vignettes used in the valuation exercises. Of the 218 utility values, 178 were elicited using standard gamble (SG) or time trade-off (TTO) approaches, while 40 were elicited using visual analogue scales (VAS). There were 169 utility values of specific chemotherapy-related ADEs (with the top ten being anaemia [34 values], nausea and/or vomiting [32 values], neuropathy [21 values], neutropenia [12 values], diarrhoea [12 values], stomatitis [10 values], fatigue [8 values], alopecia [7 values], hand-foot syndrome [5 values] and skin reaction [5 values]) and 49 of non-specific chemotherapy-related adverse events. In most cases, it was difficult to directly compare the utility values as various definitions and study-specific vignettes were used for the ADEs of interest. LIMITATIONS This review was designed to provide an overall description of existing literature reporting utility values for chemotherapy-related ADEs. The findings were not exhaustive and were limited to publications that could be identified using the search strategy employed and those reported in the English language. CONCLUSIONS This review identified wide ranges in the utility values reported for broad categories of specific chemotherapy-related ADEs. There were difficulties in comparing the values directly as various study-specific definitions were used for these ADEs and most studies did not make the vignettes used in the valuation exercises available. It is recommended that a basic minimum requirement be developed for the transparent reporting of study designs eliciting utility values, incorporating key criteria such as reporting how the vignettes were developed and presenting the vignettes used in the valuation tasks as well as valuing and reporting the utility values of the ADE-free base states. It is also recommended, in the future, for studies valuing the utilities of chemotherapy-related ADEs to define the ADEs according to the National Cancer Institute (NCI) definitions for chemotherapy-related ADEs as the use of the same definition across studies would ease the comparison and selection of utility values and make the overall inclusion of adverse events within economic models of chemotherapy agents much more straightforward.
Collapse
Affiliation(s)
- Fatiha H Shabaruddin
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|
16
|
Wittenberg E, Ritter GA, Prosser LA. Evidence of spillover of illness among household members: EQ-5D scores from a US sample. Med Decis Making 2012; 33:235-43. [PMID: 23100461 DOI: 10.1177/0272989x12464434] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVES The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members' health-related quality of life. METHODS Medical Expenditures Panel Survey (MEPS) data from 2000-2003 were analyzed using multivariable regression to identify spillover of household members' chronic conditions onto individuals' health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child). RESULTS Controlling for an individual's own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64-0.79), respiratory (0.85; 0.75-0.97), and musculoskeletal (0.83; 0.75-0.93) conditions among adults and with mental (0.72; 0.62-0.82) and respiratory (0.80; 0.81-0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults' mental (0.79; 0.65-0.97), nervous/sensory system (0.76; 0.61-0.96), and musculoskeletal (0.78; 0.65-0.95) conditions and children's mental conditions (0.64; 0.48-0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members. CONCLUSIONS Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.
Collapse
Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA (EW)
| | - Grant A Ritter
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA(GAR)
| | - Lisa A Prosser
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI (LAP)
| |
Collapse
|