scholarly journals DEEP Study: Modeling Outcomes and Costs of Persistent Orofacial Pain

2021 ◽  
pp. 238008442110638
Author(s):  
J. Durham ◽  
M. Breckons ◽  
L. Vale ◽  
J. Shen
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Service ◽  
Markov Model ◽  
Life Course ◽  
Orofacial Pain ◽  
Care Pathways ◽  
Perfect Health ◽  
Life Years

Persistent orofacial pain (POFP) affects patients’ daily lives and can lead to significant costs for them and/or the health service provider. This partial economic evaluation examined costs and utilities experienced by individuals with POFP over a 24-mo period and used these data to populate the life course Markov model used to estimate costs and quality-adjusted life years (QALYs) from pain onset over an individual’s life course while receiving usual health care. A total of 202 people receiving care for POFP were followed for 24 mo. Data were collected every 6 mo on pain-related disability (Graded Chronic Pain Scale dichotomized to low [0–IIa] or high [IIb–IV] pain-related disability states), health service utilization, and health-related quality of life measured by QALYs derived from the EQ-5D-5L. Unbalanced regressions were used to demonstrate how costs and QALYs varied according to participant characteristics with the results used to parameterize a Markov model. This probabilistic Markov model was used to estimate the outcomes for a cohort of POFP patients from age 25 y until death as determined by age- and sex-specific mortality rates. Across all time points, complete data were available from 129 participants. A high pain-related disability state led to significantly increased health care cost (£221; 95% confidence interval [CI], 87–355; P < 0.01) and a significant decrease in quality of life (mean difference, –0.08; 95% CI, –0.11 to −0.05; P < 0.0001) over a 24-mo period. The Markov model estimated that the average cost was £27,317 (95% CI, 26,558–28,046) and the average lifetime QALYs were 17.54 (95% CI, 17.38–17.71). The modeling suggests that a cohort of POFP patients from age 25 y would only accrue 18 QALYs per person before death. POFP therefore exerts a considerable impact on health, and it is likely more effective care (pathways) could realize substantial gains in terms of both treatment outcomes and health care utilization. Knowledge of Transfer Statement: Despite a substantial number of consultations, individuals experiencing the care pathways in this study continued to have far from perfect health over their life course. The modeling suggests they would only experience 18 y in “perfect health.” There is considerable scope to improve current care/outcomes and patient experience.

scholarly journals Analysis of the Situation of Unmet Health Care Need Among Extremely Rare Disease of Gaucher

2020 ◽  
Author(s):  
Xinye Qi ◽  
Jiao Xu ◽  
Linghan Shan ◽  
Ye Li ◽  
Yu Cui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Health Care ◽  
Health Service ◽  
Health Service Utilization ◽  
Health Related Quality ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract BackgroundThe diagnosis and health care of patients with rare diseases present a tremendous challenge worldwide. This study estimated the health service utilization, cost of illness, and patients with Gaucher disease (GD)’s/caregivers’ health-related quality of life in China.MethodAn online retrospective survey of patients with GD and their caregivers was conducted during May-June 2018. Socio-demographic, health service utilization, disease-related expenses, social support, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the Short Form Health Survey (SF-36) were investigated. Using self-reported information, we estimated the annual cost of illness, including direct medical, direct non-medical, and indirect medical costs. ResultsForty patients and their 49 caregivers were surveyed. The patients’ onset age of GD was 9.3±10.9; their disease course was 3.5±3.1 years. 21 (42.9%) patients had ≥2 caregivers, but 35 (71.4%) caregivers reported have no experience as a caregiver. 79.6% caregivers have stopped working, and 87.8% changed weekly working schedule. Before final diagnosis, patients visited 3.9±3.1 (max=20) hospitals and took 1.2±1.7 (max=6.6) years for confirmed diagnosis. On average, 5.0±9.6 misdiagnoses occurred, and the per-patient diagnoses cost was USD ($) 7,576. After GD confirmation, 8 (16.3%) patients received no treatment, 40 (81.6%) received pharmacotherapy, 10 (20.4%) received surgery, 38 (77.6%) received outpatient service (8.8±9.1 times/annually), and 37 (77.5%) received inpatient service (4.0±3.5 times/annually). Annual per-patient cost was USD ($) 49,925 (95% confidence interval: 29,178, 70,672). Average direct medical cost was $41,816, including pharmaceutical ($29,908), inpatient ($7,451), and outpatient ($1,838). Productivity loss per-caregiver was $1,980, and their Zarit Burden Inventory score was moderate-severe (48.6±19.6). Both patients/caregivers reported lower social support (32.4±7.4, 34.9±7.6), two times higher PSQI (7.9±2.9, 8.7±3.6), and half lower SF-36 (41.3±18.6, 46.5±19.3) than those reported for healthy Chinese individuals.ConclusionThis study finds out that fill the unmet need for extremely rare diseases is very challenging. The high misdiagnosis rate, together with delayed diagnosis, substantial costs, and deteriorated health-related quality of life of GD patients as well as their heavy care burden, calls for extreme attention from policymakers in China. Further efforts of government and society are urgently demanded, including pharmaceutical reimbursement, screening newborns, developing precise diagnostic tools, and training doctors.

scholarly journals Profiling bone and joint problems and health service use in an Australian regional population: The Port Lincoln Health Study

2013 ◽  
Vol 37 (4) ◽  
pp. 504 ◽  
Author(s):  
Clarabelle Pham ◽  
Tiffany K. Gill ◽  
Elizabeth Hoon ◽  
Muhammad Aziz Rahman ◽  
Deirdre Whitford ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Health Service ◽  
Health Professionals ◽  
Allied Health ◽  
Computer Assisted ◽  
Care Pathways ◽  
Allied Health Professionals ◽  
Regional Population

Objectives To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns. Methods In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP. Results Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists. Conclusions GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently. What is known about the topic? As a highly prevalent group of conditions that are likely to impact on health-related quality of life and are a common cause of severe long-term disability, musculoskeletal conditions place a significant burden on individuals and the health system. However, far less is known about access and usage of musculoskeletal-related health services and programs in Australia. What does this paper add? As a result of analysing the characteristics of the overall BJP population, as well as phenotypes within it, a greater understanding of patterns of health service interactions, care pathways and opportunities for targeted improvements in delivery of care may be identified. The results emphasise that participants with BJP utilised the services of a narrow range of providers, which may have workforce implications for these sectors. The funding models for physiotherapists and chiropractors in Australia involve a mix of private and fees for service, which limits access to those who have private health insurance or can pay directly for these services. What are the implications for practitioners? These analyses indicate the importance of linking allied health professionals with general practice to manage BJP more efficiently. Alternative and appropriate care pathways need to be more strongly developed and identified for effective management of these conditions rather than relying on a traditional range of practitioners. Alternatively, greater ease of access to allied health practitioners may enable more effective treatment and improved quality of life for those with BJP. There is an urgent need to develop an effective population-based model of integrated care for BJP within regional Australia.

scholarly journals HOW TO ALLOCATE SCARCE HEALTH RESOURCES WITHOUT DISCRIMINATING AGAINST PEOPLE WITH DISABILITIES

2016 ◽  
Vol 33 (2) ◽  
pp. 161-186 ◽  
Author(s):  
Tyler M. John ◽  
Joseph Millum ◽  
David Wasserman
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Resources ◽  
People With Disabilities ◽  
Quality Adjusted Life Years ◽  
Disabled People ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Quality Adjusted Life

Abstract:One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the 'QALY trap': we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination.

scholarly journals Is administration of proton pump inhibitors in functional dyspepsia worth the risk of developing gastric cancer: a Markov model to bridge the gap between scientific evidence and clinical practice

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e031091
Author(s):  
Efrat Broide ◽  
Adi Eindor-Abarbanel ◽  
Haim Shirin ◽  
Vered Richter ◽  
Shay Matalon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Markov Model ◽  
Functional Dyspepsia ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Model Parameters ◽  
Decision Analysis Model ◽  
Life Years

ObjectiveTo formulate a decision analysis model based on recently published data that addresses the dilemma, whether improvement in quality of life rationalises continued proton pump inhibitors (PPI) use despite the risk of gastric cancer (GC) in patients with functional dyspepsia (FD).DesignA Markov model consisting of an initial decision regarding treatment with PPI (denoting it by PPI strategy) or any other treatment without PPI (denoting it by placebo strategy) was designed.Data sourcesData from prospective cross-sectional studies indicating risk stratification for GC after the use of PPI, combined with a Markov model that comprised the following states: Live, GC stages 1–4, Death.Outcome measuresThe primary outputs included quality-adjusted life years (QALYs) and life expectancy (LE). The improvement in utility in FD without PPI as compared with PPI use was tested (PPI vs placebo strategies). Sensitivity analyses were performed to evaluate the robustness of the model and address uncertainty in the estimation of model parameters.SettingWe considered only patients whose symptoms were relieved with PPIs and thus, had a better quality of life compared with patients who did not receive PPIs.ResultsThe base case model showed that PPIs compared with placebo decreased LE by 58.4 days with a gain of 2.1 QALY. If utility (quality of life of patients with FD using PPI compared with patients with FD without PPI) improved by more than 0.8%, PPI use is considered better than placebo. Older patients benefited less from PPI treatment than did younger patients.ConclusionTo bridge the gap between evidence and decision making, we found that even a small improvement in the QALY justified continuing PPI treatment.

Potential Societal Savings from Reduced Sodium Consumption in the U.S. Adult Population

2009 ◽  
Vol 24 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Kartika Polar ◽  
Roland Sturm
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Costs ◽  
Sodium Intake ◽  
Population Level ◽  
Dietary Sodium ◽  
Life Years ◽  
Care Costs ◽  
Sodium Consumption

Purpose. Policies that address the food environment at the population level may help prevent chronic disease, but their value to society is still uncertain. Dietary sodium is linked to increased prevalence of hypertension, a primary risk factor for cardiovascular and renal diseases. This study calculates the potential societal savings of reducing hypertension and related cardiovascular disease via a reduction in population-level sodium intake. On average, U. S. adults consume almost twice the recommended maximum of dietary sodium, most of it from processed foods. Design. This study modeled sodium-reduction scenarios by using a cross-sectional simulation approach. The model used population-level data on blood pressure, antihypertensive medication use, and sodium intake from the National Health and Nutrition Examination Survey (1999–2004). This data was then combined with parameters from the literature on sodium effects, disease outcomes, costs, and quality of life to yield model outcomes. Measures. This study calculated the following outcome measures: hypertension prevalence, direct health care costs, and quality-adjusted life years for noninstitutionalized U.S. adults. Analysis. The simulation was conducted with STATA 9.2 and Microsoft Excel. Survey weights were used to calculate population averages. Results. Reducing average population sodium intake to 2300 mg per day, the recommended maximum for adults, may reduce cases of hypertension by 11 million, save $18 billion health care dollars, and gain 312,000 QALYs that are worth $32 billion annually. Greater reductions in population sodium consumption bring even greater savings to society. Conclusions. Large benefits to society may result from efforts to lower sodium consumption on a population level by modest amounts over time. Although savings in direct health care costs are likely to be quite high, they could easily be matched or exceeded by the value of quality-of-life improvements.

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