scholarly journals Estimating Cost-Effectiveness Using Alternative Preference-Based Scores and Within-Trial Methods: Exploring the Dynamics of the Quality-Adjusted Life-Year Using the EQ-5D 5-Level Version and Recovering Quality of Life Utility Index

2022 ◽  
Author(s):  
Matthew Franklin ◽  
Rachael Maree Hunter ◽  
Angel Enrique ◽  
Jorge Palacios ◽  
Derek Richards
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Utility Index ◽  
Quality Adjusted Life

scholarly journals Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

2008 ◽  
Vol 15 (3) ◽  
pp. 159-165 ◽  
Author(s):  
MCY Tan ◽  
NT Ayas ◽  
A Mulgrew ◽  
L Cortes ◽  
JM FitzGerald ◽  
...  
Keyword(s):  
Quality Of Life ◽  
British Columbia ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Third Party ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
The Cost ◽  
Quality Adjusted Life

BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH) is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs). Continuous positive airway pressure (CPAP), which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.OBJECTIVE: To assess the cost-effectiveness of CPAP therapy versus no treatment for OSAH patients who are drivers.METHODS: A Markov decision analytical model with a five-year time horizon was used. The study population consisted of male and female patients, between 30 and 59 years of age, who were newly diagnosed with moderate to severe OSAH. The model evaluated the cost-effectiveness of CPAP therapy in reducing rates of MVCs and improving quality of life. Utility values were obtained from previously published studies. Rates of MVCs under the CPAP and no CPAP scenarios were calculated from Insurance Corporation of British Columbia data and a systematic review of published studies. MVCs, equipment and physician costs were obtained from the British Columbia Medical Association, published cost-of-illness studies and the price lists of established vendors of CPAP equipment in British Columbia. Findings were examined from the perspectives of a third-party payer and society.RESULTS: From the third-party payer perspective, CPAP therapy was more effective but more costly than no CPAP (incremental cost-effectiveness ratio [ICER] of $3,626 per quality-adjusted life year). From the societal perspective, the ICER was similar ($2,979 per quality-adjusted life year). The ICER was most dependent on preference elicitation method used to obtain utility values, varying almost sixfold under alternative assumptions from the base-case analysis.CONCLUSION: After considering costs and impact on quality of life, as well as the risk of MVCs in individuals with OSAH, CPAP therapy for OSAH patients is a highly efficient use of health care resources. Provincial governments who do not provide funding for CPAP therapy should reconsider.

scholarly journals The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

2017 ◽  
Vol 31 (4) ◽  
pp. 306-322 ◽  
Author(s):  
Anne B Wichmann ◽  
Eddy MM Adang ◽  
Peep FM Stalmeier ◽  
Sinta Kristanti ◽  
Lieve Van den Block ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Integrative Review ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Pros And Cons ◽  
Quality Adjusted Life

Background: In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care. Aim: To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year’s value for palliative care. Design: The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped. Data sources: A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years. Findings: Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied. Conclusion: The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to—in addition to the EQ-5D— make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.

scholarly journals Acceptability and Feasibility of a Mindfulness Intervention Delivered via Videoconferencing for People With Parkinson’s

2021 ◽  
pp. 089198872098890
Author(s):  
Angeliki Bogosian ◽  
Catherine S. Hurt ◽  
John V. Hindle ◽  
Lance M. McCracken ◽  
Debora A. Vasconcelos e Sa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Qualitative Interviews ◽  
Quality Adjusted Life Year ◽  
Secondary Outcome ◽  
Structured Interviews ◽  
Potential Cost ◽  
Mindfulness Intervention ◽  
Related Quality

Mindfulness-based group therapy is a rapidly growing psychological approach that can potentially help people adjust to chronic illness and manage unpleasant symptoms. Emerging evidence suggests that mindfulness-based interventions may benefit people with Parkinson’s. The objective of the paper is to examine the appropriateness, feasibility, and potential cost-effectiveness of an online mindfulness intervention, designed to reduce anxiety and depression for people with Parkinson’s. We conducted a feasibility randomized control trial and qualitative interviews. Anxiety, depression, pain, insomnia, fatigue, impact on daily activities and health-related quality of life were measured at baseline, 4, 8, and 20 weeks. Semi-structured interviews were conducted at the end of the intervention. Participants were randomized to the Skype delivered mindfulness group (n = 30) or wait-list (n = 30). Participants in the mindfulness group were also given a mindfulness manual and a CD with mindfulness meditations. The intervention did not show any significant effects in the primary or secondary outcome measures. However, there was a significant increase in the quality of life measure. The incremental cost-effectiveness ratio was estimated to be £27,107 per Quality-Adjusted Life Year gained. Also, the qualitative study showed that mindfulness is a suitable and acceptable intervention. It appears feasible to run a trial delivering mindfulness through Skype, and people with Parkinson’s found the sessions acceptable and helpful.

Quality of Life and Resource Allocation

1988 ◽  
Vol 23 ◽  
pp. 33-55 ◽  
Author(s):  
Michael Lockwood
Keyword(s):  
Quality Of Life ◽  
Resource Allocation ◽  
Quality Adjusted Life Year ◽  
Medical Resources ◽  
Medical Vocabulary ◽  
Quality Adjusted Life

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted life year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene.

scholarly journals Value of Life Year and Cost-Effectiveness Thresholds: The Case of Poland

2021 ◽  
Vol 8 (55) ◽  
pp. 256-268
Author(s):  
Olimpia Markiewicz
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
Quality Adjusted Life Year ◽  
Value Of Life ◽  
Stated Preferences ◽  
Medical Treatments ◽  
Health Quality ◽  
Two Populations

Abstract Objective The objective of this article is to examine how people value two different attributes of Value of Life Year (VOLY): life expectancy and the quality of life. The results of the first VOLY estimations conducted in Poland are discussed and compared with Polish cost-effectiveness thresholds for medical treatments in the period 2008–2020. Methodology The Discrete Choice Experiment (DCE) method was used to value two attributes of VOLY: increase in life expectancy and improvement in the quality of life. Main findings The VOLY research was conducted in two populations: general and dialysis. Depending on their current health status, people value increased life expectancy and improvement in health quality differently. In light of these results, the VOLY should be differentiated. Also in the Quality Adjusted Life Year (QALY) indicator, the weights of the attributes of length and quality of life should be varied according to different states of health. A uniform cost-effectiveness threshold is not justified from the perspective of stated preferences. Cost-effectiveness thresholds based on demand-side values should be differentiated. Current Polish cost-effectiveness thresholds are overestimated compared to valuations based on stated preferences. Contributions The article presents the first estimations of two attributes of VOLY: life expectancy and the quality of life, carried out in Poland.

Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

2002 ◽  
Vol 22 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Karin Sennfält ◽  
Martin Magnusson ◽  
Per Carlsson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Peritoneal Dialysis ◽  
Kidney Failure ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Age Group ◽  
The Cost ◽  
Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

Economic Evaluation of A Support Program for Caregivers of Demented Elderly

1991 ◽  
Vol 7 (2) ◽  
pp. 209-219 ◽  
Author(s):  
Michael F. Drummond ◽  
E. Ann Mohide ◽  
Michelle Tew ◽  
David L. Streiner ◽  
Dorothy M. Pringle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Evaluation ◽  
Statistical Significance ◽  
Quality Adjusted Life Year ◽  
Support Program ◽  
Caregiver Support ◽  
Health Care Interventions ◽  
Caregiver Quality ◽  
Quality Adjusted Life

AbstractAn economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.

scholarly journals Modern aspects of the study of the quality of life in children with cystic fibrosis

2019 ◽  
Vol 19 (1) ◽  
pp. 43-48
Author(s):  
M. S. Samsonova ◽  
O. I. Simonova ◽  
Irina V. Vinyarskaya
Keyword(s):  
Quality Of Life ◽  
Cystic Fibrosis ◽  
Pharmacoeconomic Analysis ◽  
Quality Adjusted Life Year ◽  
Therapeutic Approaches ◽  
Health Related ◽  
The One ◽  
Practice Methods ◽  
Quality Adjusted Life

There is presented a review of recent data on the changes in quality of life (QL) in children suffering from cystic fibrosis (CF). The recurrence of acute pulmonary infections was shown to significantly reduce health-related QL. In this aggressive treatment of exacerbations ofpulmonary infection leads to a significant improvement in QL, and to gain in the life expectancy ofpatients with CF. Used in clinical practice methods demonstrate the effectiveness in the short term period, but their impact on health-related QL has not yet been studied. The use of the concept of Quality adjusted life year (QALY) in conjunction with the pharmacoeconomic analysis is the one out of promising directions, which allows in the comparative plan to determine the ratio between cost and effectiveness, safety and QL in alternative schemes of treatment of the disease. The use of the QALY index in the analysis of the CF will allow to execute the cumulative determination as the ratio of "cost-effectiveness", and the influence of the conducted therapy on health-related QL ofpatients, which is an inherent component of the evaluation of the estimation of usefulness of specific therapeutic approaches.

scholarly journals Infliximab for the treatment of ulcerative colitis

2009 ◽  
Vol 13 (Suppl 3) ◽  
pp. 7-12
Author(s):  
C Hyde ◽  
S Bryan ◽  
A Juarez-Garcia ◽  
L Andronis ◽  
A Fry-Smith
Keyword(s):  
Quality Of Life ◽  
Ulcerative Colitis ◽  
Cost Effectiveness ◽  
Evidence Review Group ◽  
Clinical Effectiveness ◽  
Quality Adjusted Life Year ◽  
Single Technology Appraisal ◽  
Nice Guidance ◽  
Related Quality

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of infliximab for moderately to severely active ulcerative colitis (UC) based upon a review of the manufacturer’s submission to the National Institute for Health and Clinical Excellent (NICE) as part of the single technology appraisal (STA) process. The submission indicated that the efficacy of infliximab (5 mg/kg) had been demonstrated in terms of higher response rates and a sustained response in health-related quality of life. For the cost-effectiveness analysis, the manufacturer built a Markov model to compare infliximab with standard care. It estimated the incremental cost per quality-adjusted life-year (QALY) gained was between £25,044 and £33,866 depending on the strategy used. The ERG report generally agreed with the evidence on effectiveness of infliximab for subacute exacerbations of UC. However, there were several areas of uncertainty, of which the interpretation of the importance of the quality of life changes in the subacute situation and the assessment of the adequacy of the evidence of effectiveness of infliximab in the acute hospital-based situation were considered pre-eminent by the ERG. This challenged the estimates of cost-effectiveness offered and suggested that there should be a separate assessment of infliximab for acute exacerbations of moderately to severely active UC. The summary of the NICE guidance issued in April 2008 as a result of the STA states that: infliximab is not recommended for the treatment of subacute manifestations of moderately to severely active UC.

Measuring the Value of Prescription Drugs

2021 ◽  
pp. 62-92
Author(s):  
Neumann Peter J. ◽  
Cohen Joshua T. ◽  
Ollendorf Daniel A
Keyword(s):  
Cost Effectiveness ◽  
Prescription Drugs ◽  
Quality Adjusted Life Year ◽  
Costs And Benefits ◽  
Purchasing Decisions ◽  
A Value ◽  
Near Term ◽  
Productive Output ◽  
Quality Adjusted Life

This chapter recounts the evolution of methods to put a value on health benefits, a step crucial to appropriately pricing drugs. Early efforts valued life based on a worker’s productive output. “Willingness-to-pay” methods use surveys and examine real-world purchasing decisions to value life beyond productivity considerations. Cost-effectiveness analysis sidesteps explicitly pricing life by instead measuring an intervention’s cost per unit of health gained. A common currency for benefits called the quality-adjusted life year (QALY) facilitates cost-effectiveness ratio comparisons across diseases. Although controversial, the QALY packs information about longevity and quality of life, making it popular. Next, this chapter explains that economists down-weight (“discount”) future costs and benefits as less important than near term impacts. Finally, it explores the question of perspective—that is, whether an analysis should, for example, reflect only costs and benefits pertinent to health system payers or whether it should take a broader, “societal” perspective.

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