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Scheibler F, Geiger F, Wehkamp K, Danner M, Debrouwere M, Stolz-Klingenberg C, Schuldt-Joswig A, Sommer CG, Kopeleva O, Bünzen C, Wagner-Ullrich C, Koch G, Coors M, Wehking F, Clayman M, Weymayr C, Sundmacher L, Rüffer JU. Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre-post trial. BMJ Evid Based Med 2024; 29:87-95. [PMID: 37890982 PMCID: PMC10982630 DOI: 10.1136/bmjebm-2023-112462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM). DESIGN Pre-post study. SETTING University Hospital Schleswig-Holstein (UKSH), Kiel Campus. PARTICIPANTS Healthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH. INTERVENTIONS The S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate. MAIN OUTCOME MEASURES In this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre-post comparisons were done using t-tests. RESULTS The implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDM showed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges' g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects. CONCLUSIONS The hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.
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Affiliation(s)
- Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Köln, Germany
| | - Friedemann Geiger
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marion Danner
- DARUM Marion Danner und Anne Rummer GbR, Cologne, Germany
| | - Marie Debrouwere
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Constanze Stolz-Klingenberg
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Anja Schuldt-Joswig
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christina Gesine Sommer
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Olga Kopeleva
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
- Department of General Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Claudia Bünzen
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Christine Wagner-Ullrich
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Gerhard Koch
- Department for Orthodontics, University Hospital Schleswig Holstein, Kiel, Germany
| | - Marie Coors
- Department of Health Economics, Technical University of Munich, München, Germany
| | - Felix Wehking
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - Marla Clayman
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Administration, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Christian Weymayr
- Department of Paediatrics I, University Hospital Schleswig-Holstein, Kiel, Germany
- National Competency Center for Shared Decision Making, University Hospital Schleswig Holstein, Kiel, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, München, Germany
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Shah S, Jatar SS, Hsueh J, Gallagher L, Pepin A, Danner M, Zwart A, Ayoob MJ, Yung T, Kumar D, Aghdam N, Leger P, Dawson N, Suy S, Collins SP. Bothersome Hot Flashes Following Neoadjuvant Androgen Deprivation Therapy and Stereotactic Body Radiotherapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e258-e259. [PMID: 37784992 DOI: 10.1016/j.ijrobp.2023.06.1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Androgen deprivation therapy (ADT) may improve cancer control in unfavorable localized prostate cancer treated with stereotactic body radiotherapy (SBRT). ADT is known to cause hormonally related symptoms that resolve with testosterone recovery. Hot flashes are particularly burdensome. This study sought to evaluate the timeline of hot flashes following short-course ADT and SBRT as well as its relationship with testosterone recovery. MATERIALS/METHODS Institutional IRB approval was obtained for this retrospective review of prospectively collected data (IRB#: 2009-510). ADT was initiated three months prior to the start of SBRT. Hot flashes were self-reported via question 13a a healthcare software prior to ADT initiation, the first day of robotic SBRT, and at each follow-up (1, 3, 6, 9, 12, 18, 24 and 36 months). The responses were grouped into three relevant categories (no problem, very small-small problem and moderate-big problem). Scores were transformed to a 0-100 scale with higher scores reflecting less bother. Testosterone levels were measured at each follow-up. RESULTS From 2007 to 2010, 122 localized prostate cancer patients (9 low-, 64 intermediate-, and 49 high-risk according to the D'Amico classification) at a median age of 72 years (range 54.5-88.3) were treated with short course ADT (3-6 months) and SBRT (35-36.25 Gy) at Georgetown University Hospital. Thirty-two percent were black and 27% were obese. 77% of patient received three months of ADT. At baseline, 2% of men experienced hot flashes that were a "moderate to big problem" and that proportion peaked at the start of SBRT (45%) before returning to baseline 9 months post-SBRT with a cumulative incidence of 52.4%. The median baseline healthcare software hot flash score of 94 declined to 50 at the start of SBRT but this returned to baseline by six months post SBRT. These changes were both statistically and clinically significant (MID = 9.5083). Testosterone recovery (> 230 ng/dL) occurred in approximately 70% of patients by 12 months post SBRT. Resolution of hot flashes correlated with testosterone recovery. CONCLUSION Bothersome hot flashes occur in greater than 50% of men treated with neoadjuvant ADT. Resolution of hot flashes occurs in the majority of patients within one year after treatment. Reassurance of the temporary nature of hot flashes may assist in reducing patient anxiety. Measuring testosterone levels at follow-up visits may allow for anticipatory counseling that may limit the associated bother.
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Affiliation(s)
- S Shah
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - S S Jatar
- Georgetown School Of Medicine, Washington, DC
| | - J Hsueh
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - L Gallagher
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - A Pepin
- Department of Radiation Oncology, Abramson Cancer Center, Hospital of University of Pennsylvania, Philadelphia, PA
| | - M Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - A Zwart
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - M J Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - T Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - D Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC
| | - N Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Washington, DC
| | - P Leger
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - N Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - S Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - S P Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
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Jatar SS, Shah S, Hsueh J, Gallagher L, Danner M, Zwart A, Ayoob MJ, Yung T, Kumar D, Leger P, Aghdam N, Dawson N, Suy S, Collins SP. Bothersome Gynecomastia Following Neoadjuvant GnRH Agonists and Stereotactic Body Radiotherapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e238-e239. [PMID: 37784943 DOI: 10.1016/j.ijrobp.2023.06.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Androgen deprivation therapy (ADT) is increasingly utilized in combination with stereotactic body radiotherapy (SBRT) for unfavorable prostate cancer. ADT such as gonadotropin releasing hormone (GnRH) agonists are known to cause hormonal-related side effects such as gynecomastia. The incidence of bothersome breast tenderness and/or enlargement following short course GnRH agonists and SBRT is unknown. This study sought to evaluate the timeline of gynecomastia as well as its relationship with testosterone recovery. MATERIALS/METHODS Gynecomastia was self-reported via question 13b of a healthcare software prior to ADT initiation, the first day of robotic SBRT, and at each follow-up (1, 3, 6, 9, 12, 18, 24 and 36 months). The responses were grouped into three relevant categories (no problem, very small-small problem, and moderate-big problem). Scores were transformed to a 0-100 scale with higher scores reflecting less bother. Testosterone levels were measured at each follow-up. RESULTS From 2007 to 2010, 122 localized prostate cancer patients (9 low-, 64 intermediate-, and 49 high-risk according to the D'Amico classification) at a median age of 72 years (range 54.5-88.3) were treated with short course ADT (3-6 months) and SBRT (35-36.25 Gy) at Georgetown University Hospital. Of the participants, 48% percent were non-white and 48% were overweight. 77% of patients received three months of ADT. At baseline, 2% of men experienced gynecomastia that was a "moderate to big problem" and that proportion peaked at 3 and 12 months post-SBRT (7%) before returning to less than baseline (0%) 24 months post-SBRT with a cumulative incidence of 14.75%. The median baseline healthcare software hot flash score of 98 declined to 90 at 3 months post-SBRT but this returned to baseline by 24 months post SBRT. These changes were both statistically and clinically significant (MID = 6.5). Testosterone recovery (> 230 ng/dL) occurred in approximately 70% of patients by 12 months post SBRT. The development and resolution of gynecomastia fluctuated at various timepoints and did not directly correlate with testosterone recovery. CONCLUSION Bothersome gynecomastia occurs in less than 15% of men treated with neoadjuvant ADT. Resolution of gynecomastia occurs in most patients within two years after treatment. Reassurance of the temporary nature of gynecomastia may assist in reducing patient anxiety. Institutional IRB (IRB#: 2009-510) approval was obtained for retrospective review of prospectively collected data.
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Affiliation(s)
- S S Jatar
- Georgetown School Of Medicine, Washington, DC
| | - S Shah
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - J Hsueh
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - L Gallagher
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - M Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - A Zwart
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - M J Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - T Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - D Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC
| | - P Leger
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - N Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Washington, DC
| | - N Dawson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - S Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - S P Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
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Khan I, Lee Z, Zwart A, Rechter T, Tettey J, Danner M, Ayoob MJ, Yung T, Kumar D, Li H, Suy S, Collins SP. Low Incidence of Late Lymphopenia Following Stereotactic Body Radiotherapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e400. [PMID: 37785339 DOI: 10.1016/j.ijrobp.2023.06.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is increasing in use for the treatment of localized prostate cancer. The utilization of highly conformal photon therapy such as SBRT may increase the whole-body integral dose. Lymphocytes are very radiation sensitive. This dose increase could lead to unintended consequences such as lymphopenia. Prior studies have shown that lymphopenia following radiation therapy may negatively impact long-term outcomes. This study sought to evaluate the incidence and timeline of chronic lymphopenia following prostate SBRT. MATERIALS/METHODS Institutional IRB (IRB#: 2012-1175) approval was obtained. The absolute lymphocyte count was measured 1-2 hours prior to robotic SBRT (35-36.25 Gy in 5 fractions) and at each follow-up (3, 6, 12, 18 and 24 months). Lymphopenia was graded using the CTCAEv.4: Grade 1 (1.0-0.8 k/μl), Grade 2 (0.8-0.5 k/μl), Grade 3 (0.5-0.2 k/μl) and Grade 4 (<0.2 k/μl). Late lymphopenia was defined as lymphopenia occurring 3 or more months post-SBRT. RESULTS From 2019 to 2022, 198 localized prostate cancer patients (23 low-, 148 intermediate-, and 27 high-risk according to the D'Amico classification) at a median age of 73.5 years were treated with SBRT (35-36.25 Gy) at Georgetown University Hospital on a prospective clinical trial. Baseline lymphopenia was uncommon: Grade 1 (3.5%), Grade 2 (1.5%) and Grade 3 (0%). The baseline ALC of 1.9 k/μl decreased to 1.5 k/μl at 3 months post-SBRT and then remained stable for the remainder of the two-year follow-up. Overall, 14.6% of men experienced lymphopenia in the two years following SBRT: Grade 1 (7.6%), Grade 2 (6.6%) and Grade 3 (0.5%). No patient experienced Grade 4 lymphopenia. CONCLUSION Prostate SBRT leads to a low rate of late lymphopenia with the vast majority of toxicities being low grade. The peak incidence occurred at 3 months post-SBRT. Resolution of lymphopenia occurs in most patients within two years after SBRT. Future studies should explore the possible impact on quality of life and cancer control outcomes.
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Affiliation(s)
- I Khan
- Georgetown University School of Medicine, Washington, DC
| | - Z Lee
- Georgetown University Hospital, Washington, DC
| | - A Zwart
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - T Rechter
- Georgetown University Hospital Department of Radiation Medicine, Washington, DC
| | - J Tettey
- University of Maryland College Park School of Public Health, College Park, MD
| | - M Danner
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - M J Ayoob
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - T Yung
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - D Kumar
- Biotechnology Research Institute, North Carolina Central University, Durham, NC
| | - H Li
- Georgetown University Department of Oncology, Washington, DC
| | - S Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - S P Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
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Cantalino J, Pernia M, Obayomi-Davies O, Aghdam N, Danner M, Suy S, Conroy D, Collins S, Salvatore M, Makariou E, Rudra S, Lischalk J, Collins B. Adjuvant Stereotactic Body Radiation Therapy (ASBRT) for Early-Stage Breast Cancer: Symptomatic Fat Necrosis is Associated with Consecutive Daily Treatments. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Conroy D, Sholklapper T, Lawlor M, Cantalino J, Zwart A, Ayoob M, Danner M, Yung T, Collins B, Lei S, Rashid A, Kumar D, Suy S, Aghdam N, Collins S. Correlation between Obesity and Treatment Failure Following Stereotactic Body Radiation Therapy (SBRT) for Clinically Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Repka M, Sholklapper T, Zwart A, Danner M, Ayoob M, Yung T, Lei S, Collins B, Kumar D, Suy S, Hankins R, Kishan A, Collins S. Prognostic Utility of Biopsy-Based PTEN and ERG Status on Biochemical Progression and Overall Survival after SBRT for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Danner M, Debrouwere M, Rummer A, Wehkamp K, Rüffer JU, Geiger F, Wolff R, Weik K, Scheibler F. A scattered landscape: assessment of the evidence base for 71 patient decision aids developed in a hospital setting. BMC Med Inform Decis Mak 2022; 22:44. [PMID: 35177043 PMCID: PMC8855583 DOI: 10.1186/s12911-022-01777-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Recent publications reveal shortcomings in evidence review and summarization methods for patient decision aids. In the large-scale “Share to Care (S2C)” Shared Decision Making (SDM) project at the University Hospital Kiel, Germany, one of 4 SDM interventions was to develop up to 80 decision aids for patients. Best available evidence on the treatments’ impact on patient-relevant outcomes was systematically appraised to feed this information into the decision aids. Aims of this paper were to (1) describe how PtDAs are developed and how S2C evidence reviews for each PtDA are conducted, (2) appraise the quality of the best available evidence identified and (3) identify challenges associated with identified evidence.
Methods The quality of the identified evidence was assessed based on GRADE quality criteria and categorized into high-, moderate-, low-, very low-quality evidence. Evidence appraisal was conducted across all outcomes assessed in an evidence review and for specific groups of outcomes, namely mortality, morbidity, quality of life, and treatment harms. Challenges in evidence interpretation and summarization resulting from the characteristics of decision aids and the type and quality of evidence are identified and discussed. Results Evidence reviews assessed on average 25 systematic reviews/guidelines/studies and took about 3 months to be completed. Despite rigorous review processes, nearly 70% of outcome-specific information derived for decision aids was based on low-quality and mostly on non-directly comparative evidence. Evidence on quality of life and harms was often not provided or not in sufficient form/detail. Challenges in evidence interpretation for use in decision aids resulted from, e.g., a lack of directly comparative evidence or the existence of very heterogeneous evidence for the diverse treatments being compared.
Conclusions Evidence reviews in this project were carefully conducted and summarized. However, the evidence identified for our decision aids was indeed a “scattered landscape” and often poor quality. Facing a high prevalence of low-quality, non-directly comparative evidence for treatment alternatives doesn’t mean it is not necessary to choose an evidence-based approach to inform patients. While there is an urgent need for high quality comparative trials, best available evidence nevertheless has to be appraised and transparently communicated to patients.
Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01777-x.
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Affiliation(s)
- Marion Danner
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Marie Debrouwere
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Anne Rummer
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Kai Wehkamp
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Jens Ulrich Rüffer
- SHARE TO CARE (S2C) GmbH, Cologne, Germany.,TAKEPART Media+Science GmbH, Cologne, Germany
| | - Friedemann Geiger
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,SHARE TO CARE (S2C) GmbH, Cologne, Germany
| | | | | | - Fueloep Scheibler
- SHARE TO CARE (S2C) Team, National Competency Center for Shared Decision Making, University Hospital Schleswig-Holstein (UKSH) - Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,SHARE TO CARE (S2C) GmbH, Cologne, Germany
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Swift SL, Puehler T, Misso K, Lang SH, Forbes C, Kleijnen J, Danner M, Kuhn C, Haneya A, Seoudy H, Cremer J, Frey N, Lutter G, Wolff R, Scheibler F, Wehkamp K, Frank D. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis. BMJ Open 2021; 11:e054222. [PMID: 34873012 PMCID: PMC8650468 DOI: 10.1136/bmjopen-2021-054222] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients undergoing surgery for severe aortic stenosis (SAS) can be treated with either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). The choice of procedure depends on several factors, including the clinical judgement of the heart team and patient preferences, which are captured by actively informing and involving patients in a process of shared decision making (SDM). We synthesised the most up-to-date and accessible evidence on the benefits and risks that may be associated with TAVI versus SAVR to support SDM in this highly personalised decision-making process. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Embase (Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley) were searched from January 2000 to August 2020 with no language restrictions. Reference lists of included studies were searched to identify additional studies. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) that compared TAVI versus SAVR in patients with SAS and reported on all-cause or cardiovascular mortality, length of stay in intensive care unit or hospital, valve durability, rehospitalisation/reintervention, stroke (any stroke or major/disabling stroke), myocardial infarction, major vascular complications, major bleeding, permanent pacemaker (PPM) implantation, new-onset or worsening atrial fibrillation (NOW-AF), endocarditis, acute kidney injury (AKI), recovery time or pain were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers were involved in data extraction and risk of bias (ROB) assessment using the Cochrane tool (one reviewer extracted/assessed the data, and the second reviewer checked it). Dichotomous data were pooled using the Mantel-Haenszel method with random-effects to generate a risk ratio (RR) with 95% CI. Continuous data were pooled using the inverse-variance method with random-effects and expressed as a mean difference (MD) with 95% CI. Heterogeneity was assessed using the I2 statistic. RESULTS 8969 records were retrieved and nine RCTs (61 records) were ultimately included (n=8818 participants). Two RCTs recruited high-risk patients, two RCTs recruited intermediate-risk patients, two RCTs recruited low-risk patients, one RCT recruited high-risk (≥70 years) or any-risk (≥80 years) patients; and two RCTs recruited all-risk or 'operable' patients. While there was no overall change in the risk of dying from any cause (30 day: RR 0.89, 95% CI 0.65 to 1.22; ≤1 year: RR 0.90, 95% CI 0.79 to 1.03; 5 years: RR 1.09, 95% CI 0.98 to 1.22), cardiovascular mortality (30 day: RR 1.03, 95% CI 0.77 to 1.39; ≤1 year: RR 0.90, 95% CI 0.76 to 1.06; 2 years: RR 0.96, 95% CI 0.83 to 1.12), or any type of stroke (30 day: RR 0.83, 95% CI 0.61 to 1.14;≤1 year: RR 0.94, 95% CI 0.72 to 1.23; 5 years: RR 1.07, 95% CI 0.88 to 1.30), the risk of several clinical outcomes was significantly decreased (major bleeding, AKI, NOW-AF) or significantly increased (major vascular complications, PPM implantation) for TAVI vs SAVR. TAVI was associated with a significantly shorter hospital stay vs SAVR (MD -3.08 days, 95% CI -4.86 to -1.29; 4 RCTs, n=2758 participants). Subgroup analysis generally favoured TAVI patients receiving implantation via the transfemoral (TF) route (vs non-TF); receiving a balloon-expandable (vs self-expanding) valve; and those at low-intermediate risk (vs high risk). All RCTs were rated at high ROB, predominantly due to lack of blinding and selective reporting. CONCLUSIONS No overall change in the risk of death from any cause or cardiovascular mortality was identified but 95% CIs were often wide, indicating uncertainty. TAVI may reduce the risk of certain side effects while SAVR may reduce the risk of others. Most long-term (5-year) results are limited to older patients at high surgical risk (ie, early trials), therefore more data are required for low risk populations. Ultimately, neither surgical technique was considered dominant, and these results suggest that every patient with SAS should be individually engaged in SDM to make evidence-based, personalised decisions around their care based on the various benefits and risks associated with each treatment. PROSPERO REGISTRATION NUMBER CRD42019138171.
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Affiliation(s)
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- German Centre for Cardiovascular Research, Kiel, Germany
| | - Kate Misso
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | | | | | - Marion Danner
- National Competency Center for Shared Decision Making, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Christian Kuhn
- German Centre for Cardiovascular Research, Kiel, Germany
- Department of Cardiology and Angiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Hatim Seoudy
- German Centre for Cardiovascular Research, Kiel, Germany
- Department of Cardiology and Angiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- German Centre for Cardiovascular Research, Kiel, Germany
| | | | - Fueloep Scheibler
- National Competency Center for Shared Decision Making, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Kai Wehkamp
- Department of Internal Medicine I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Derk Frank
- German Centre for Cardiovascular Research, Kiel, Germany
- Department of Cardiology and Angiology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Pepin A, Shah S, Pernia M, Lei S, Ayoob M, Danner M, Yung T, Collins B, Suy S, Aghdam N, Collins S. PO-1364 Bleeding Risk after Prostate SBRT in Men on Baseline Anticoagulant/Antiplatelet Therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Koldehoff A, Danner M, Civello D, Rhiem K, Stock S, Müller D. Cost-Effectiveness of Targeted Genetic Testing for Breast and Ovarian Cancer: A Systematic Review. Value Health 2021; 24:303-312. [PMID: 33518037 DOI: 10.1016/j.jval.2020.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/25/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Targeted genetic testing is a tool to identify women at increased risk of gynaecological cancer. OBJECTIVE This systematic review evaluates the results and quality of cost-effectiveness modeling studies that assessed targeted genetic-based screen-and-treat strategies to prevent breast and ovarian cancer. METHODS Using MEDLINE and databases of the Centre for Reviews and Dissemination, we searched for health economic modeling evaluations of targeted genetic-based screen-and-treat strategies to prevent inheritable breast and ovarian cancer (until August 2020). The incremental cost-effectiveness ratios (ICERs) were compared. Methodological variations were addressed by evaluating the model conceptualizations, the modeling techniques, parameter estimation and uncertainty, and transparency and validation of the models. Additionally, the reporting quality of each study was assessed. RESULTS Eighteen studies met our inclusion criteria. From a payer perspective, the ICERs of (1) BRCA screening for high-risk women without cancer ranged from dominating the no test strategy to an ICER of $21 700/quality-adjusted life years (QALY). In studies that evaluated (2) BRCA cascade screening (ie, screening of women with cancer plus their unaffected relatives) compared with no test, the ICERs were between $6500/QALY and $50 200/QALY. Compared with BRCA alone, (3) multigene testing in women without cancer had an ICER of $51 800/QALY (one study), while for (4) multigene-cascade screening the ICERs were $15 600/QALY, $56.500/QALY, and $69 600/QALY for women in the United Kingdom, Norway, and the United States, respectively (2 studies). More recently published studies showed a higher methodological and reporting quality. CONCLUSIONS Targeted BRCA or multiple gene screening is likely to be cost-effective. Methodological variations could be decreased by the development of a reference model, which may serve as a tool for validation of present and future cost-effectiveness models.
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Affiliation(s)
- Andreas Koldehoff
- Department of Anaesthesiology, Ruhr-Universität Bochum (RUB), Bochum, Germany
| | - Marion Danner
- University Hospital Schleswig-Holstein, SHARE TO CARE Team, Department of General Pediatrics, Kiel, Germany
| | - Daniele Civello
- Cologne Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne (AöR), Cologne, Germany
| | - Stephanie Stock
- Cologne Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Dirk Müller
- Cologne Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany.
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12
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Danner M, Geiger F, Wehkamp K, Rueffer JU, Kuch C, Sundmacher L, Skjelbakken T, Rummer A, Novelli A, Debrouwere M, Scheibler F. Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital. BMJ Open 2020; 10:e037575. [PMID: 33039998 PMCID: PMC7549440 DOI: 10.1136/bmjopen-2020-037575] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Shared decision-making (SDM) is not yet widely used when making decisions in German hospitals. Making SDM a reality is a complex task. It involves training healthcare professionals in SDM communication and enabling patients to actively participate in communication, in addition to providing sound, easy to understand information on treatment alternatives in the form of evidence-based patient decision aids (EbPDAs). This project funded by the German Innovation Fund aims at designing, implementing and evaluating a multicomponent, large-scale and integrative SDM programme-called SHARE TO CARE (S2C)-at all clinical departments of a University Hospital Campus in Northern Germany within a 4-year time period. METHODS AND ANALYSIS S2C tackles the aforementioned components of SDM: (1) training physicians in SDM communication, (2) activating and empowering patients, (3) developing EbPDAs in the most common/relevant diseases and (4) training other healthcare professionals in SDM coaching. S2C is designed together with patients and providers. The physicians' training programme entails an online and an in situ training module. The decision coach training is based on a similar but less comprehensive approach. The development of online EbPDAs follows the International Patient Decision Aid Standards and includes written, graphical and video-based information. Validated outcomes of SDM implementation are measured in a preintervention and postintervention evaluation design. Process evaluation accompanies programme implementation. Health economic impact of the intervention is investigated using a propensity-score-matched approach based on potentially preference-sensitive hospital decisions. ETHICS AND DISSEMINATION Ethics committee review approval has been obtained from Medical Ethics Committee of the Medical Faculty of the Christian-Albrechts-University Kiel. Project information and results will be disseminated at conferences, on project-hosted websites at University Hospital Medical Center Schleswig Holstein and by S2C as well as in peer-reviewed and professional journals.
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Affiliation(s)
- Marion Danner
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Friedemann Geiger
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
| | - Kai Wehkamp
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
| | - Jens Ulrich Rueffer
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
- TAKEPART Media & Sciences GmbH, Cologne, Germany
| | - Christine Kuch
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | | | - Tove Skjelbakken
- Universitetet i Tromso Helsevitenskapelige fakultet Helsefak, Tromso, Norway
| | - Anne Rummer
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Anna Novelli
- Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Marie Debrouwere
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Fueloep Scheibler
- SHARE TO CARE Team, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
- SHARE TO CARE, Patientenzentrierte Kommunikation GmbH, Cologne, Germany
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13
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Wang E, Aziz A, Danner M, Yung T, Ayoob M, Lei S, Rashid A, Dritschilo A, Lischalk J, Collins B, Lynch J, Suy S, Aghdam N, Collins S. Patterns of Recurrence Following Stereotactic Body Radiation Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Forsthoefel M, Burlile J, Lane S, Tsou H, Kataria S, Danner M, Yung T, Ayoob M, Lischalk J, Collins B, Suy S, Aghdam N, Collins S. Testosterone Recovery Following Short Course Androgen Deprivation Therapy and Stereotactic Body Radiotherapy Correlates Closely with Improvements in Patient-Reported Hormonal and Sexual Domain Scores. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Müller D, Danner M, Schmutzler R, Engel C, Wassermann K, Stollenwerk B, Stock S, Rhiem K. Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer. Eur J Health Econ 2019; 20:739-750. [PMID: 30790097 DOI: 10.1007/s10198-019-01038-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The 'German Consortium for Hereditary Breast and Ovarian Cancer' (GC-HBOC) offers women with a family history of breast and ovarian cancer genetic counseling. The aim of this modeling study was to evaluate the cost-effectiveness of genetic testing for BRCA 1/2 in women with a high familial risk followed by different preventive interventions (intensified surveillance, risk-reducing bilateral mastectomy, risk-reducing bilateral salpingo-oophorectomy, or both mastectomy and salpingo-oophorectomy) compared to no genetic test. METHODS A Markov model with a lifelong time horizon was developed for a cohort of 35-year-old women with a BRCA 1/2 mutation probability of ≥ 10%. The perspective of the German statutory health insurance (SHI) was adopted. The model included the health states 'well' (women with increased risk), 'breast cancer without metastases', 'breast cancer with metastases', 'ovarian cancer', 'death', and two post (non-metastatic) breast or ovarian cancer states. Outcomes were costs, quality of life years gained (QALYs) and life years gained (LYG). Important data used for the model were obtained from 4380 women enrolled in the GC-HBOC. RESULTS Compared with the no test strategy, genetic testing with subsequent surgical and non-surgical treatment options provided to women with deleterious BRCA 1 or 2 mutations resulted in additional costs of €7256 and additional QALYs of 0,43 (incremental cost-effectiveness ratio of €17,027 per QALY; cost per LYG: €22,318). The results were robust in deterministic and probabilistic sensitivity analyses. CONCLUSION The provision of genetic testing to high-risk women with a BRCA1 and two mutation probability of ≥ 10% based on the individual family cancer history appears to be a cost-effective option for the SHI.
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Affiliation(s)
- Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Kirsten Wassermann
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany
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16
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Aghdam N, Katarian S, Danner M, Ayoob M, Yung T, Lei S, Kumar D, Collins B, Lischalk J, Dritschilo A, Suy S, Lynch J, Collins S. PO-0852 Stereotactic Body Radiation Therapy for Unfavorable Prostate Cancer: Large institutional experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Gutknecht M, Danner M, Schaarschmidt ML, Gross C, Augustin M. Assessing the Importance of Treatment Goals in Patients with Psoriasis: Analytic Hierarchy Process vs. Likert Scales. Patient 2019; 11:425-437. [PMID: 29450833 DOI: 10.1007/s40271-018-0300-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To define treatment benefit, the Patient Benefit Index contains a weighting of patient-relevant treatment goals using the Patient Needs Questionnaire, which includes a 5-point Likert scale ranging from 0 ("not important at all") to 4 ("very important"). These treatment goals have been assigned to five health dimensions. The importance of each dimension can be derived by averaging the importance ratings on the Likert scales of associated treatment goals. OBJECTIVE As the use of a Likert scale does not allow for a relative assessment of importance, the objective of this study was to estimate relative importance weights for health dimensions and associated treatment goals in patients with psoriasis by using the analytic hierarchy process and to compare these weights with the weights resulting from the Patient Needs Questionnaire. Furthermore, patients' judgments on the difficulty of the methods were investigated. METHODS Dimensions of the Patient Benefit Index and their treatment goals were mapped into a hierarchy of criteria and sub-criteria to develop the analytic hierarchy process questionnaire. Adult patients with psoriasis starting a new anti-psoriatic therapy in the outpatient clinic of the Institute for Health Services Research in Dermatology and Nursing at the University Medical Center Hamburg (Germany) were recruited and completed both methods (analytic hierarchy process, Patient Needs Questionnaire). Ratings of treatment goals on the Likert scales (Patient Needs Questionnaire) were summarized within each dimension to assess the importance of the respective health dimension/criterion. Following the analytic hierarchy process approach, consistency in judgments was assessed using a standardized measurement (consistency ratio). RESULTS At the analytic hierarchy process level of criteria, 78 of 140 patients achieved the accepted consistency. Using the analytic hierarchy process, the dimension "improvement of physical functioning" was most important, followed by "improvement of social functioning". Concerning the Patient Needs Questionnaire results, these dimensions were ranked in second and fifth position, whereas "strengthening of confidence in the therapy and in a possible healing" was ranked most important, which was least important in the analytic hierarchy process ranking. In both methods, "improvement of psychological well-being" and "reduction of impairments due to therapy" were equally ranked in positions three and four. In contrast to this, on the level of sub-criteria, predominantly a similar ranking of treatment goals could be observed between the analytic hierarchy process and the Patient Needs Questionnaire. From the patients' point of view, the Likert scales (Patient Needs Questionnaire) were easier to complete than the analytic hierarchy process pairwise comparisons. CONCLUSIONS Patients with psoriasis assign different importance to health dimensions and associated treatment goals. In choosing a method to assess the importance of health dimensions and/or treatment goals, it needs to be considered that resulting importance weights may differ in dependence on the used method. However, in this study, observed discrepancies in importance weights of the health dimensions were most likely caused by the different methodological approaches focusing on treatment goals to assess the importance of health dimensions on the one hand (Patient Needs Questionnaire) or directly assessing health dimensions on the other hand (analytic hierarchy process).
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Affiliation(s)
- Mandy Gutknecht
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology (IGKE), University Hospital of Cologne (AöR), Cologne, Germany
| | - Marthe-Lisa Schaarschmidt
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.,Department of Dermatology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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18
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Seidl A, Danner M, Wagner CJ, Sandmann FG, Sroczynski G, Stürzlinger H, Zsifkovits J, Schwalm A, Lhachimi SK, Siebert U, Gerber-Grote A. Estimation of Input Costs for a Markov Model in a German Health Economic Evaluation of Newer Antidepressants. MDM Policy Pract 2018; 3:2381468317751923. [PMID: 30288435 PMCID: PMC6132834 DOI: 10.1177/2381468317751923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/13/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Estimating input costs for Markov models in health
economic evaluations requires health state–specific costing. This is a challenge
in mental illnesses such as depression, as interventions are not clearly related
to health states. We present a hybrid approach to health state–specific cost
estimation for a German health economic evaluation of antidepressants.
Methods: Costs were determined from the perspective of the
community of persons insured by statutory health insurance (“SHI insuree
perspective”) and included costs for outpatient care, inpatient care, drugs, and
psychotherapy. In an additional step, costs for rehabilitation and productivity
losses were calculated from the societal perspective. We collected resource use
data in a stepwise hierarchical approach using SHI claims data, where available,
followed by data from clinical guidelines and expert surveys. Bottom-up and
top-down costing approaches were combined. Results: Depending on
the drug strategy and health state, the average input costs varied per patient
per 8-week Markov cycle. The highest costs occurred for agomelatine in the
health state first-line treatment (FT) (“FT relapse”) with €506 from the SHI
insuree perspective and €724 from the societal perspective. From both
perspectives, the lowest costs (excluding placebo) were €55 for selective
serotonin reuptake inhibitors in the health state “FT remission.”
Conclusion: To estimate costs in health economic evaluations of
treatments for depression, it can be necessary to link different data sources
and costing approaches systematically to meet the requirements of the
decision-analytic model. As this can increase complexity, the corresponding
calculations should be presented transparently. The approach presented could
provide useful input for future models.
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Affiliation(s)
- Astrid Seidl
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Marion Danner
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Christoph J Wagner
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Frank G Sandmann
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Gaby Sroczynski
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Heidi Stürzlinger
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Johannes Zsifkovits
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Anja Schwalm
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Stefan K Lhachimi
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Uwe Siebert
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
| | - Andreas Gerber-Grote
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany (A Seidl, A Schwalm).,Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany (MD, CJW).,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (FGS).,Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Tirol, Austria (GS, US).,Gesundheit Österreich GmbH, Vienna, Austria (HS, JZ).,Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany (SKL).,Institute for Public Health and Nursing, Health Sciences Bremen, University of Bremen, Bremen, Germany (SKL).,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland (AG)
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Gutknecht M, Schaarschmidt ML, Danner M, Otten M, Augustin M. How to weight patient-relevant treatment goals for assessing treatment benefit in psoriasis: preference elicitation methods vs. rating scales. Arch Dermatol Res 2018; 310:567-577. [PMID: 29934781 DOI: 10.1007/s00403-018-1846-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
In psoriasis, several patient-relevant treatment goals must be met to be able to consider a treatment beneficial. To assess treatment benefit, the validated questionnaire Patient Benefit Index (PBI) can be used. Its global score summarizes the degree of patient-relevant treatment goals achieved after treatment, weighted by their individual importance on rating scales. These treatment goals have empirically been assigned to five dimensions. While the weighting procedure of the PBI provides information about the importance patients attach to treatment goals on a rating scale from 0 to 4, methods of preference elicitation provide information on how patients would trade off certain treatment goals against each other. However, since the treatment goals defined in the PBI often overlap conceptually, the dimensions of the PBI might be more suitable for exploration in preference elicitation methods. We used an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to generate preference-based importance weights for the PBI dimensions, and compared these weights to those derived from the rating scales. We were further interested in the effect of importance weights on the calculation of the PBI score. A total of 120 patients with psoriasis completed a questionnaire at baseline, including AHP, DCE and the rating scales, and at follow-up, regarding the attainment of treatment goals, to calculate the PBI score. In contrast to the results derived from the average rating scores, use of AHP and DCE resulted in both similar importance weights and rankings of dimensions. Presumably, patients rated treatment goals differently than the respective dimension they belong to. However, the differently calculated importance weights led to similar values of the PBI score. Our findings nevertheless provide clear evidence that, regardless of the method used, the importance of treatment goals differs between psoriasis patients, and this should be reflected in treatment decisions.
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Affiliation(s)
- Mandy Gutknecht
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
| | - Marthe-Lisa Schaarschmidt
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.,Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology (IGKE), University Hospital of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Marina Otten
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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20
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Müller D, Danner M, Rhiem K, Stollenwerk B, Engel C, Rasche L, Borsi L, Schmutzler R, Stock S. Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation. Eur J Health Econ 2018; 19:341-353. [PMID: 28382503 DOI: 10.1007/s10198-017-0887-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/14/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation. METHODS A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed. RESULTS With costs of €29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 € per QALY, the probability of the intervention being cost-effective was 80%. CONCLUSIONS From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.
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Affiliation(s)
- Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, The University Hospital of Cologne (AöR), Kerpener Straße 34, 50931, Cologne, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Linda Rasche
- Department of Controlling, The University Hospital of Cologne (AöR), Kerpener Straße 62, 50937, Cologne, Germany
| | - Lisa Borsi
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, The University Hospital of Cologne (AöR), Kerpener Straße 34, 50931, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany
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Cheung K, Evers S, De Vries H, Levy P, Pokhrel S, Jones T, Danner M, Wentlandt J, Knufinke L, Mayer S, Hiligsmann M. Most important barriers and facilitators of HTA usage in decision-making in Europe. Expert Rev Pharmacoecon Outcomes Res 2018; 18:297-304. [DOI: 10.1080/14737167.2018.1421459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K.L. Cheung
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - S.M.A.A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - H. De Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - P. Levy
- Department of Economics, Paris Dauphine University, Paris, France
| | - S. Pokhrel
- Health Economics Research Group, Brunel University, London, UK
| | - T. Jones
- Health Economics Research Group, Brunel University, London, UK
| | - M. Danner
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - J. Wentlandt
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - L. Knufinke
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - S. Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - M. Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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22
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Vennedey V, Derman SH, Hiligsmann M, Civello D, Schwalm A, Seidl A, Scheibler F, Stock S, Noack MJ, Danner M. Patients' preferences in periodontal disease treatment elicited alongside an IQWiG benefit assessment: a feasibility study. Patient Prefer Adherence 2018; 12:2437-2447. [PMID: 30510407 PMCID: PMC6248230 DOI: 10.2147/ppa.s176067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE The German Institute for Quality and Efficiency in Health Care (IQWiG) previously tested two preference elicitation methods in pilot projects and regarded them as generally feasible for prioritizing outcome-specific results of benefit assessment. The present study aimed to investigate the feasibility of completing a discrete choice experiment (DCE) within 3 months and to determine the relative importance of attributes of periodontal disease and its treatment. PATIENTS AND METHODS This preference elicitation was conducted alongside the IQWiG benefit assessment of systematic treatments of periodontal diseases. Attributes were defined based on the benefit assessment, literature review, and patients' and periodontologists' interviews. The DCE survey was completed by patients with a history of periodontal disease. Preferences were elicited for the attributes "tooth loss within next 10 years", "own costs for treatment, follow-up visits, re-treatment", "complaints and symptoms", and "frequency of follow-up visits". Patients completed a self-administered questionnaire including 12 choice tasks. Data were analyzed using a random parameters logit model. The relative attribute importance was calculated based on level ranges. RESULTS Within 3 months, survey development, data collection among 267 patients, data analysis, and provision of a study report could be completed. The analysis showed that tooth loss (score 0.73) was the most important attribute in patients' decisions, followed by complaints and symptoms (0.22), frequency of follow-up visits (0.02), and costs (0.03) (relative importance scores summing up to 1). CONCLUSION A preference analysis performing a DCE can be generally feasible within 3 months; however, a good research infrastructure and access to patients is required. Outcomes used in benefit assessments might need to be adapted to be used in preference analyses.
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Affiliation(s)
- Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), Cologne, Germany,
| | - Sonja Hm Derman
- Department of Operative Dentistry and Periodontology, University Hospital Cologne (AöR), Cologne, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Daniele Civello
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), Cologne, Germany,
| | - Anja Schwalm
- Department of Health Care and Health Economics, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Astrid Seidl
- Department of Health Care and Health Economics, Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Fülöp Scheibler
- Department of Paediatrics, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), Cologne, Germany,
| | - Michael J Noack
- Department of Operative Dentistry and Periodontology, University Hospital Cologne (AöR), Cologne, Germany
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne (AöR), Cologne, Germany,
- Department of Paediatrics, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
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Gutknecht M, Schaarschmidt ML, Danner M, Blome C, Augustin M. Measuring the importance of health domains in psoriasis - discrete choice experiment versus rating scales. Patient Prefer Adherence 2018; 12:363-373. [PMID: 29588575 PMCID: PMC5858654 DOI: 10.2147/ppa.s152509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psoriasis affects different aspects of health-related quality of life (eg, physical, psychological, and social impairments); these health domains can be of different importance for patients. The importance of domains can be measured with the Patient Benefit Index (PBI). This questionnaire weights the achievement of treatment goals by Likert scales (0, "not important at all" to 4, "very important") using the Patient Needs Questionnaire (PNQ). Treatment goals assessed with the PBI have been assigned to five health domains; the importance of each domain can be calculated as the average importance of the respective treatment goals. In this study, the PBI approach of deriving importance weights is contrasted to a discrete choice experiment (DCE), in order to determine the importance of health domains in psoriasis, and to find if the resulting weights will differ when derived from these two methods. METHODS Adult patients with psoriasis completed both questionnaires (PNQ, DCE). The PBI domains were used as attributes in the DCE with the levels "did not help at all", "helped moderately", and "helped a lot". RESULTS Using DCE, "improving physical functioning" was the most important health domain, followed by "improving psychological well-being". Using PNQ, these domains were ranked in position two and three following "strengthening confidence in the therapy and in a possible healing". The latter was least important using DCE. The only agreement of ranking was shown in "reducing impairments due to therapy" (position four). "Improving social functioning" was ranked in position three (DCE) and five (PNQ). CONCLUSION Health domains have different importance to patients with psoriasis. Using PNQ or DCE to determine the importance of domains results in markedly different rankings; both approaches can thus not be considered equivalent. However, in this study, importance was assessed at the domain level in DCE and at the single item level in PNQ, which may have added to the differences.
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Affiliation(s)
- Mandy Gutknecht
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Correspondence: Mandy Gutknecht, German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistr 52, D-20246 Hamburg, Germany, Tel +49 40 741 052 129, Fax +49 40 741 040 160, Email
| | - Marthe-Lisa Schaarschmidt
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology (IGKE), University Hospital of Cologne, Cologne, Germany
| | - Christine Blome
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Aghdam N, Smith C, Johnson C, Danner M, Ayoob M, Yung T, Lei S, Collins B, Dritschilo A, Suy S, Lynch J, Collins S. Predictors of Decreased Mobility Following Stereotactic Body Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Collins S, Danner M, Hung M, Ayoob M, Yung T, Lei S, Collins B, Dritschilo A, Suy S. Utilization of Patient-Reported Outcomes to Guide Symptom Management During Stereotactic Body Radiation Therapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bien DR, Danner M, Vennedey V, Civello D, Evers SM, Hiligsmann M. Patients' Preferences for Outcome, Process and Cost Attributes in Cancer Treatment: A Systematic Review of Discrete Choice Experiments. Patient 2017; 10:553-565. [PMID: 28364387 PMCID: PMC5605613 DOI: 10.1007/s40271-017-0235-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION As several studies have been conducted to elicit patients' preferences for cancer treatment, it is important to provide an overview and synthesis of these studies. This study aimed to systematically review discrete choice experiments (DCEs) about patients' preferences for cancer treatment and assessed the relative importance of outcome, process and cost attributes. METHODS A systematic literature review was conducted using PubMed and EMBASE to identify all DCEs investigating patients' preferences for cancer treatment between January 2010 and April 2016. Data were extracted using a predefined extraction sheet, and a reporting quality assessment was applied to all studies. Attributes were classified into outcome, process and cost attributes, and their relative importance was assessed. RESULTS A total of 28 DCEs were identified. More than half of the studies (56%) received an aggregate score lower than 4 on the PREFS (Purpose, Respondents, Explanation, Findings, Significance) 5-point scale. Most attributes were related to outcome (70%), followed by process (25%) and cost (5%). Outcome attributes were most often significant (81%), followed by process (73%) and cost (67%). The relative importance of outcome attributes was ranked highest in 82% of the cases where it was included, followed by cost (43%) and process (12%). CONCLUSION This systematic review suggests that attributes related to cancer treatment outcomes are the most important for patients. Process and cost attributes were less often included in studies but were still (but less) important to patients in most studies. Clinicians and decision makers should be aware that attribute importance might be influenced by level selection for that attribute.
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Affiliation(s)
- Daniela R Bien
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marion Danner
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Daniele Civello
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Silvia M Evers
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, PO Box 6161, 6200 MD, Maastricht, The Netherlands.
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Paydar I, Pepin A, Aghdam N, Yung T, Bullock E, Lei S, Danner M, Satinsky A, Harter K, Suy S, Dritschilo A, Lynch J, Collins S. Supplemental IMRT May Increase the Risk of Rectal Bleeding in Prostate Cancer Patients Treated with Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Danner M, Vennedey V, Hiligsmann M, Fauser S, Gross C, Stock S. Comparing Analytic Hierarchy Process and Discrete-Choice Experiment to Elicit Patient Preferences for Treatment Characteristics in Age-Related Macular Degeneration. Value Health 2017; 20:1166-1173. [PMID: 28964450 DOI: 10.1016/j.jval.2017.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/22/2017] [Accepted: 04/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In this study, we conducted an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to elicit the preferences of patients with age-related macular degeneration using identical attributes and levels. OBJECTIVES To compare preference-based weights for age-related macular degeneration treatment attributes and levels generated by two elicitation methods. The properties of both methods were assessed, including ease of instrument use. METHODS A DCE and an AHP experiment were designed on the basis of five attributes. Preference-based weights were generated using the matrix multiplication method for attributes and levels in AHP and a mixed multinomial logit model for levels in the DCE. Attribute importance was further compared using coefficient (DCE) and weight (AHP) level ranges. The questionnaire difficulty was rated on a qualitative scale. Patients were asked to think aloud while providing their judgments. RESULTS AHP and DCE generated similar results regarding levels, stressing a preference for visual improvement, frequent monitoring, on-demand and less frequent injection schemes, approved drugs, and mild side effects. Attribute weights derived on the basis of level ranges led to a ranking that was opposite to the AHP directly calculated attribute weights. For example, visual function ranked first in the AHP and last on the basis of level ranges. CONCLUSIONS The results across the methods were similar, with one exception: the directly measured AHP attribute weights were different from the level-based interpretation of attribute importance in both DCE and AHP. The dependence/independence of attribute importance on level ranges in DCE and AHP, respectively, should be taken into account when choosing a method to support decision making.
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Affiliation(s)
- Marion Danner
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany.
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI School for Primary Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Sascha Fauser
- Center for Ophthalmology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Christian Gross
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany
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Danner M, Vennedey V, Hiligsmann M, Fauser S, Stock S. Focus Groups in Elderly Ophthalmologic Patients: Setting the Stage for Quantitative Preference Elicitation. Patient 2016; 9:47-57. [PMID: 25726011 DOI: 10.1007/s40271-015-0122-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Patients suffering from age-related macular degeneration (AMD) are rarely actively involved in decision-making, despite facing preference-sensitive treatment decisions. This paper presents a qualitative study to prepare quantitative preference elicitation in AMD patients. The aims of this study were (1) to gain familiarity with and learn about the special requirements of the AMD patient population for quantitative data collection; and (2) to select/refine patient-relevant treatment attributes and levels, and gain insights into preference structures. METHODS Semi-structured focus group interviews were performed. An interview guide including preselected categories in the form of seven potentially patient-relevant treatment attributes was followed. To identify the most patient-relevant treatment attributes, a ranking exercise was performed. Deductive content analyses were done by two independent reviewers for each attribute to derive subcategories (potential levels of attributes) and depict preference trends. RESULTS The focus group interviews included 21 patients. The interviews revealed that quantitative preference surveys in this population will have to be interviewer assisted to make the survey feasible for patients. The five most patient-relevant attributes were the effect on visual function [ranking score (RS): 139], injection frequency (RS: 101), approval status (RS: 83), side effects (RS: 79), and monitoring frequency (RS: 76). Attribute and level refinement was based on patients' statements. Preference trends and dependencies between attributes informed the quantitative instrument design. CONCLUSION This study suggests that qualitative research is a very helpful step to prepare the design and administration of quantitative preference elicitation instruments. It especially facilitated familiarization with the target population and its preferences, and it supported attribute/level refinement.
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Affiliation(s)
- Marion Danner
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Gleueler Straße 176-178, 50935, Cologne, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI School for Primary Care and Public Health, Maastricht University, Maastricht, The Netherlands
| | - Sascha Fauser
- Center for Ophthalmology, Cologne University Hospital, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Gleueler Straße 176-178, 50935, Cologne, Germany
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Vennedey V, Danner M, Evers SMAA, Fauser S, Stock S, Dirksen CD, Hiligsmann M. Using qualitative research to facilitate the interpretation of quantitative results from a discrete choice experiment: insights from a survey in elderly ophthalmologic patients. Patient Prefer Adherence 2016; 10:993-1002. [PMID: 27350743 PMCID: PMC4902149 DOI: 10.2147/ppa.s101584] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in industrialized countries. Currently, mainly three treatment options are available, which are all intravitreal injections, but differ with regard to the frequency of injections needed, their approval status, and cost. This study aims to estimate patients' preferences for characteristics of treatment options for neovascular AMD. METHODS An interviewer-assisted discrete choice experiment was conducted among patients suffering from AMD treated with intravitreal injections. A Bayesian efficient design was used for the development of 12 choice tasks. In each task patients indicated their preference for one out of two treatment scenarios described by the attributes: side effects, approval status, effect on visual function, injection and monitoring frequency. While answering the choice tasks, patients were asked to think aloud and explain the reasons for choosing or rejecting specific characteristics. Quantitative data were analyzed with a mixed multinomial logit model. RESULTS Eighty-six patients completed the questionnaire. Patients significantly preferred treatments that improve visual function, are approved, are administered in a pro re nata regimen (as needed), and are accompanied by bimonthly monitoring. Patients significantly disliked less frequent monitoring visits (every 4 months) and explained this was due to fear of deterioration being left unnoticed, and in turn experiencing disease deterioration. Significant preference heterogeneity was found for all levels except for bimonthly monitoring visits and severe, rare eye-related side effects. Patients gave clear explanations of their individual preferences during the interviews. CONCLUSION Significant preference trends were discernible for the overall sample, despite the preference heterogeneity for most treatment characteristics. Patients like to be monitored and treated regularly, but not too frequently or infrequently. The results of our qualitative research facilitated the interpretation of the quantitative data collected in this study.
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Affiliation(s)
- Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
- Correspondence: Vera Vennedey, Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany, Tel +49 221 4679 133, Fax +49 221 4302 304, Email
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Silvia MAA Evers
- Department of Health Services Research, School for Primary Care and Public Health (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Sascha Fauser
- Department of Vitreo-Retinal Surgery, Center of Ophthalmology, Cologne University Hospital, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, University Hospital Maastricht, Maastricht, the Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, School for Primary Care and Public Health (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Schaarschmidt W, Hagmann H, Roth B, Cingoez T, Karumanchi A, Wenger J, Lucchesi KJ, Tamez H, Lindner T, Fridmann A, Thome U, Kribs A, Danner M, Hamacher S, Mallmann P, Stepan H, Benzing T, Thadhani R. Removal of soluble Fms-like tyrosine kinase (sFlt-1) by plasma-specific apheresis: pilot study in women with very preterm preeclampsia. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Müller D, Danner M, Stock S, Rhiem K, Schmutzler R, Stollenwerk B. Economic modeling of risk-adapted screen-and-treat strategies in women at high-risk for breast or ovarian cancer. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schaarschmidt W, Thadhani R, Hagmann H, Roth B, Kisner T, Karumanchi SA, Wenger J, Lucchesi KJ, Hector T, Lindner T, Fridman A, Thome U, Kribs A, Danner M, Mallmann P, Stepan H, Benzing T. Removal of Soluble Fms-like Tyrosine Kinase (sFlt-1) by Plasma-Specific Apheresis: A Pilot Study in Women with Severe Preterm Preeclampsia. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1548707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Stollenwerk B, Lhachimi SK, Briggs A, Fenwick E, Caro JJ, Siebert U, Danner M, Gerber-Grote A. Communicating the parameter uncertainty in the IQWiG efficiency frontier to decision-makers. Health Econ 2015; 24:481-490. [PMID: 24590819 PMCID: PMC4489337 DOI: 10.1002/hec.3041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 01/03/2014] [Accepted: 01/19/2014] [Indexed: 05/30/2023]
Abstract
The Institute for Quality and Efficiency in Health Care (IQWiG) developed-in a consultation process with an international expert panel-the efficiency frontier (EF) approach to satisfy a range of legal requirements for economic evaluation in Germany's statutory health insurance system. The EF approach is distinctly different from other health economic approaches. Here, we evaluate established tools for assessing and communicating parameter uncertainty in terms of their applicability to the EF approach. Among these are tools that perform the following: (i) graphically display overall uncertainty within the IQWiG EF (scatter plots, confidence bands, and contour plots) and (ii) communicate the uncertainty around the reimbursable price. We found that, within the EF approach, most established plots were not always easy to interpret. Hence, we propose the use of price reimbursement acceptability curves-a modification of the well-known cost-effectiveness acceptability curves. Furthermore, it emerges that the net monetary benefit allows an intuitive interpretation of parameter uncertainty within the EF approach. This research closes a gap for handling uncertainty in the economic evaluation approach of the IQWiG methods when using the EF. However, the precise consequences of uncertainty when determining prices are yet to be defined.
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Affiliation(s)
- Björn Stollenwerk
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care ManagementNeuherberg, Germany
| | - Stefan K Lhachimi
- IQWiG, Institute for Quality and Efficiency in Health Care, Department of Health EconomicsCologne, Germany
- Cooperative Research Group for Evidence Based Public Health, Leibniz Institute for Prevention Research and EpidemiologyBremen, Germany
- Institute for Public Health and Nursing Research, University of BremenBremen, Germany
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of GlasgowGlasgow, Scotland, UK
| | - Elisabeth Fenwick
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of GlasgowGlasgow, Scotland, UK
| | - Jaime J Caro
- McGill University, Department of Epidemiology, Biostatistics and Occupational Health, Division of General Internal MedicineMontreal, Quebec, Canada
- United BioSource CorporationLexington, MA, USA
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, EWZ ITyrol, Austria
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical SchoolBoston, MA, USA
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public HealthBoston, MA, USA
- Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL Center for Personalized Cancer MedicineInnsbruck, Austria
| | - Marion Danner
- Institute for Health Economics and Clinical Epidemiology, University of ColgoneCologne, Germany
| | - Andreas Gerber-Grote
- IQWiG, Institute for Quality and Efficiency in Health Care, Department of Health EconomicsCologne, Germany
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Araujo JV, Davidenko N, Danner M, Cameron RE, Best SM. Novel porous scaffolds of pH responsive chitosan/carrageenan-based polyelectrolyte complexes for tissue engineering. J Biomed Mater Res A 2014; 102:4415-26. [PMID: 24677767 DOI: 10.1002/jbm.a.35128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 12/26/2022]
Abstract
Polyelectrolyte complexes (PECs) represent promising materials for drug delivery and tissue engineering applications. These substances are obtained in aqueous medium without the need for crosslinking agents. PECs can be produced through the combination of oppositely charged medical grade polymers, which include the stimuli responsive ones. In this work, three-dimensional porous scaffolds were produced through the lyophilization of pH sensitive PECs made of chitosan (CS) and carrageenan (CRG). CS:CRG molar ratios of 1:1 (CSCRG1), 2:1 (CSCRG2), and 3:1 (CSCRG3) were used. The chemical compositions of the PECs, as well as their influence in the final structure of the scaffolds were meticulously studied. In addition, the pH responsiveness of the PECs in a range including the physiological pH values of 7.4 (simulating normal physiological conditions) and 4.5 (simulating inflammatory response) was assessed. Results showed that the PECs produced were stable at pH values of 7.4 and under but dissolved as the pH increased to nonphysiological values of 9 and 11. However, after dissolution, the PEC could be reprecipitated by decreasing the pH to values close to 4.5. The scaffolds obtained presented large and interconnected pores, being equally sensitive to changes in the pH. CSCRG1 scaffolds appeared to have higher hydrophilicity and therefore higher water absorption capacity. The increase in the CS:CRG molar ratios improved the scaffold mechanical properties, with CSCRG3 presenting the higher compressive modulus under wet conditions. Overall, the PEC scaffolds appear promising for tissue engineering related applications that require the use of pH responsive materials stable at physiological conditions.
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Affiliation(s)
- J V Araujo
- Department of Materials Science & Metallurgy, Cambridge Centre for Medical Materials, University of Cambridge, Cambridge, CB3 0FS, United Kingdom
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Sroczynski G, Lhachimi S, Esteban E, Danner M, Sandmann F, Stürzlinger H, Conrads-Frank A, Zsifkovits J, Rosian I, Schnell-Inderst P, Siebert U, Gerber-Grote A. Die 1. Kosten-Nutzen-Bewertung des IQWiG - Ergebnisse und Methodische Aspekte am Beispiel der Antidepressiva Bewertung. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Danner M. Die Eigenverantwortung chronisch kranker und behinderter Menschen. AKTUEL RHEUMATOL 2013. [DOI: 10.1055/s-0033-1349145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Danner
- BAG SELBSTHILFE, Geschäftsführung, Düsseldorf
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Hummel MJ, Volz F, van Manen JG, Danner M, Dintsios CM, IJzerman MJ, Gerber A. Using the Analytic Hierarchy Process to Elicit Patient Preferences. The Patient: Patient-Centered Outcomes Research 2012. [DOI: 10.2165/11635240-000000000-00000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Schwalm A, Danner M, Seidl A, Volz F, Dintsios CM, Gerber A. [IQWiG's methods for the cost-benefit assessment : Comparison with an international reference scenario]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:615-22. [PMID: 20449550 DOI: 10.1007/s00103-010-1067-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Standardization of international health economic guidelines has been repeatedly requested. In this context, an international reference case was proposed, which constitutes an agreed approach for the key elements of health economic evaluation including study perspective, comparators, source of effectiveness data, role of modeling, main (economic) outcome, source of utilities, characterizing uncertainty. It is, however, questionable whether such a reference scenario can reasonably be applied across all health care systems. Our analysis pursues the question to which degree the Institute for Quality and Efficiency in Health Care's (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) "General methods for evaluating the relation between cost and benefit" comply with the key elements of the reference case. In case of divergences, they will be described and discussed in light of the German social legislation and in consideration of current scientific evidence. In conclusion, the analysis revealed that IQWiG complied with the reference case in almost all aspects. Differences were found only with respect to the choice of main (economic) outcome and the source of utilities. These differences seem justified and well explained in the context of the German social legislation as well as in view of the weaknesses of the quality-adjusted life year (QALY) concept.
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Affiliation(s)
- A Schwalm
- Ressort Gesundheitsökonomie, Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Köln.
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Danner M, Bartel C, Hoffmann W, Siering U, Rüther A. Identifizierung evidenzbasierter Versorgungsstandards: Leitliniensynopse am Beispiel der Depression. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Laus C, Danner M, Rüttimann S. [Epigastric pain and abnormal ECG]. Praxis (Bern 1994) 2005; 94:307-310. [PMID: 15779613 DOI: 10.1024/0369-8394.94.8.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report on a 50-year old man who presented with upper abdominal pain and new T-wave inversions in the anterior leads of the electrocardiogramm. Since the patient additionally had cardiovascular risk factors (positive family history, smoking, hypercholesterinemia and hypertension) he was initially thought to have an acute coronary syndrome. Moreover, he had elevated serum levels of amylase and lipase, and together with typical findings of abdominal ultrasound he was diagnosed with acute pancreatitis responsible for the patient's pain. The ECG changes persisted during the hospital stay, but had fully normalised three weeks later. Further cardiologic evaluation yielded normal results. Thus, the ECG-abnormalities could be attributed to the acute pancreatitis, which can cause ECG-pathologies mimicking an acute coronary syndrome in up to 30%. Knowledge of there findings is important in order to prevent wrong therapeutic decisions.
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Affiliation(s)
- Ch Laus
- Abteilung Innere Medizin, Kantonsspital Schaffhausen
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Abstract
OBJECTIVE Depression has been related to a higher risk of developing coronary heart disease, but the mechanism that accounts for this association is unclear. Because atherosclerosis is an inflammatory process, depression could increase the risk of coronary heart disease by inducing or promoting inflammation. The objective of the present study was to investigate the association between history of major depressive episode and presence of low-grade systemic inflammation as measured by serum C-reactive protein (CRP). METHODS We analyzed data from the Third National Health and Nutrition Examination Survey, a representative sample of the US population from 1988 to 1994. Participants included a total of 6149 individuals aged 17 to 39 years who were free of cardiovascular diseases and chronic inflammatory conditions. The main predictor variable of interest was lifetime history of a major depressive episode as assessed by means of the Diagnostic Interview Schedule. The main outcome variable was the presence or absence of an elevated CRP level (> or =22 mg/dl). RESULTS Among men, history of a major depressive episode was associated with elevated CRP, particularly for recent episodes (up to 6 months before assessment). In multivariate analyses, men with a history of major depressive episode had 2.77 times higher odds of elevated CRP compared with never-depressed men (95% confidence interval, 1.43-5.26). The adjusted odds ratio was 3.81, 3.98, 1.51, and 1.52 for men who had their last major depressive episode less than 1 month before, 1 to 6 months before, 7 to 12 months before, and more than 12 months before assessment, respectively (p for trend =.004). In women, a comparable association between depression and CRP was quite weak and not significant. CONCLUSIONS A recent history of major depressive episode is strongly associated with elevated CRP in men aged 17 to 39. In this group, low-grade systemic inflammation could represent a mechanism linking depression to cardiovascular risk.
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Affiliation(s)
- Marion Danner
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30306, USA
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Troche CJ, Tacke J, Hinzpeter B, Danner M, Lauterbach KW. Cost-effectiveness of primary and secondary prevention in cardiovascular diseases. Eur Heart J 1998; 19 Suppl C:C59-65. [PMID: 9597427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED INTRODUCTION, AIMS, AND METHODS: Industrial countries' societies are challenged to counter the increasing costs of health care. The preponderance of cardiovascular diseases in middle-aged people demands new strategies to reduce the extremely high rates of early deaths and increased morbidity and thus to avert considerable costs. Prevention programmes are appropriate means to combine therapeutic needs with health economic goals. A review of techniques of economic evaluation is given, from which a critical appraisal of cost-effectiveness analyses in primary and secondary prevention with HMG-CoA reductase inhibitors in coronary heart disease follows. Our own analysis of cost-effectiveness of primary prevention based on the clinical results of the WOSCOP study is also presented. RESULTS AND CONCLUSIONS Long-term treatment with HMG-CoA reductase inhibitors is effective (30% mortality reduction), safe and tolerable. With a cost-effectiveness ratio of DM15,000-25,000/life-year saved ($9000-15,000) it can be recommended for secondary prevention. The application of statins in primary prevention has also proved to be clinically effective. But with a cost-effectiveness ratio of DM330,000/life-year saved ($195,000) they cannot be generally advocated in patients with hypercholesterolaemia. However, the treatment has to be considered for high risk patients. Aspirin prevention seems to be an alternative in patients without additional risk factors.
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Affiliation(s)
- C J Troche
- Institute for Health Economics, Medicine, and Society, University of Cologne, Germany
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Danner M, Langwieder K. [Critical analysis of German accident statistics]. Versicherungsmedizin 1994; 46:77-8. [PMID: 8053099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Bertram R, Geßner W, Müller D, Danner M. Charakterisierung von Al(III)-Spezies in basischen Aluminiumchlorid-Flockungsmitteln mittels Ferronreaktion bzw.27Al-Kernresonanzspektroskopie Characterization of Al(III) Species in Basic Aluminium Chloride Flocculants by Means of Ferron Method and27 Al Nuclear Magnetic Resonance. ACTA ACUST UNITED AC 1994. [DOI: 10.1002/aheh.19940220604] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Temperature-sensitive folding (tsf) and global-tsf-suppressor (su) point mutations affect the folding yields of the trimeric, thermostable phage P22 tailspike endorhamnosidase at elevated temperature, both in vivo and in vitro, but they have little effect on function and stability of the native folded protein. To delineate the mechanism by which these mutations modify the partitioning between productive folding and off-pathway aggregation, the kinetics of refolding after dilution from acid-urea solutions and the thermal stability of folding intermediates were analyzed. The study included five tsf mutations of varying severity, the two known su mutations, and four tsf/su double mutants. At low temperature (10 degrees C), subunit-folding rates, measured as an increase in fluorescence, were similar for wild-type and mutants. At 25 degrees C, however, tsf mutations reduced the rate of subunit folding. The su mutations increased this rate, when present in the tsf-mutant background, but had no effect in the wild-type background. Conversely, tsf mutations accelerated, and su mutations retarded the irreversible off-pathway reaction, as revealed by temperature down-shifts after varied times during refolding at high temperature (40 degrees C). The kinetic results are consistent with tsf mutations destabilizing and su mutations stabilizing an essential subunit folding intermediate. In accordance with this interpretation, tsf mutations decreased, and su mutations increased the temperature resistance of folding intermediates, as disclosed by temperature up-shifts during refolding at 25 degrees C. The stabilizing and destabilizing effects were most pronounced early during refolding. However, they were not limited to subunit-folding intermediates and were also observable during thermal unfolding of the native protein.
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Affiliation(s)
- M Danner
- Institut für Biophysik und Physikalische Biochemie, Universität Regensburg, Germany
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Mitraki A, Danner M, King J, Seckler R. Temperature-sensitive mutations and second-site suppressor substitutions affect folding of the P22 tailspike protein in vitro. J Biol Chem 1993; 268:20071-5. [PMID: 8376364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
One of the central problems in protein folding is how amino acid sequences within polypeptide chains direct polypeptide chain folding and avoid off-pathway aggregation both in intracellular environments and in the test tube. The tailspike protein of phage P22 is a model system for which genetic analysis has permitted mutational dissection of the role of amino acid positions in the polypeptide chain in directing its in vivo folding. Two classes of mutations that affect intracellular folding and aggregation have been characterized; temperature-sensitive folding (tsf) mutants and second-site suppressors of tsf mutants. Here we report the effects of these mutations on the in vitro refolding and aggregation pathway of the purified proteins. The tsf mutations reduced refolding yields at high temperature and increased aggregation, while second-site suppressors enhanced refolding and inhibited aggregation in the test tube. For both types of mutations, the strength of the effects observed in vitro correlated with their in vivo phenotypes. The results confirm that the mutations act intrinsically on the folding pathway of the tailspike polypeptide and not through accessory proteins.
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Affiliation(s)
- A Mitraki
- Department of Biology, Massachusetts Institute of Technology, Cambridge 02139
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Mitraki A, Danner M, King J, Seckler R. Temperature-sensitive mutations and second-site suppressor substitutions affect folding of the P22 tailspike protein in vitro. J Biol Chem 1993. [DOI: 10.1016/s0021-9258(20)80695-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Danner M, Fuchs A, Miller S, Seckler R. Folding and assembly of phage P22 tailspike endorhamnosidase lacking the N-terminal, head-binding domain. Eur J Biochem 1993; 215:653-61. [PMID: 8354271 DOI: 10.1111/j.1432-1033.1993.tb18076.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Tryptic digestion of a thermal unfolding intermediate of the phage P22 tailspike endorhamnosidase produces an N-terminally shortened protein fragment comprising amino-acid residues 108-666 [Chen, B.-L. & King, J. (1991) Biochemistry 30, 6260-6269]. In the present work, the 60-kDa C-terminal fragment was purified to homogeneity from the tryptic digest by gel-fitration chromatography. As in the case for the whole tailspike protein (72 kDa), the purified fragment was found to remain stably folded as a highly soluble, SDS-resistant, enzymatically active trimer. However, its unfolding in the presence of guanidinium chloride was accelerated at least 10-fold compared to the complete, native tailspike protein. Shortened tailspike trimers reconstituted spontaneously and with high yield after diluting a solution containing acid-urea-unfolded fragment polypeptides with neutral buffer. Upon recombinant expression of the 60-kDa polypeptide in Escherichia coli, it also assembled efficiently and formed SDS-resistant trimers. The refolding and assembly pathway of the N-terminally shortened tailspike paralleled that of the complete protein with slightly, but significantly, accelerated folding reactions, at both the subunit and the trimer levels. As found for the complete tailspike protein, yields of refolding and assembly of the 60-kDa fragments into SDS-resistant trimers decreased with increasing temperature. The refolding yield of fragments derived from a temperature-sensitive mutant (Gly244-->Arg) tailspike protein was affected in similar fashion as shown for the whole protein. We conclude that the N-terminal domain (residues 1-107) is dispensable for folding and assembly of the P22 tailspike endorhamnosidase both in vitro and in vivo.
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Affiliation(s)
- M Danner
- Universität Regensburg, Institut für Biophysik und Physikalische Biochemie, Germany
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Brunschier R, Danner M, Seckler R. Interactions of phage P22 tailspike protein with GroE molecular chaperones during refolding in vitro. J Biol Chem 1993; 268:2767-72. [PMID: 8094077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Because efficient folding in vivo and reconstitution in vitro of phage P22 tailspike protein is temperature-sensitive, and because a chaperone function of the GroE proteins for tailspike folding in vivo has been suggested by genetic observations, the interactions of purified Escherichia coli GroE proteins with phage P22 tailspikes during refolding in vitro were investigated. At elevated temperature (> 30 degrees C), in the absence of ATP, GroEL effectively trapped refolding tailspike protein and prevented reconstitution. Tailspike protein was released from GroEL by addition of ATP around 35 degrees C or without added ATP upon cooling to 25 degrees C, and native tailspike trimers were formed. In accordance with the cold release, tailspike reconstitution at < or = 25 degrees C was unaffected by GroE. No formation of native tailspike trimers was observed, when refolding was initiated at 42 degrees C in the presence of the GroE proteins and ATP or when tailspike protein was dissociated from a preformed complex with the chaperone by addition of ATP at 42 degrees C. In contrast to other GroE ligands, the tailspike polypeptide was bound by and released from GroE in similar states of folding, and the presence of GroES in addition to GroEL had no effect on reconstitution yields at any temperature. Thus, the GroE proteins may exhibit widely differing interactions even with proteins showing similarly temperature-sensitive yields of folding.
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Affiliation(s)
- R Brunschier
- Universität Regensburg, Institut für Biophysik und Physikalische Biochemie, Germany
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