Value of life and time: A survivorship perspective.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18298-e18298
Author(s):  
Jennifer M. Hinkel ◽  
Daniel B. Sexton ◽  
Justine Egan-Kunicki
Keyword(s):  
Online Survey ◽  
Full Range ◽  
Health Utility ◽  
Hematologic Malignancies ◽  
Quality Adjusted Life Year ◽  
Value Of Life ◽  
Health States ◽  
Convenience Sample ◽  
Potential Health ◽  
Life Years

e18298 Background: Common tools to quantify value of life years after a cancer diagnosis include the Quality Adjusted Life Year (QALY). This measure is partly based on health utility states derived from Quality of Life (QoL) survey instruments such as the EQ-5D. Research has identified shortcomings in applying the QALY, including the potential for underestimating value. QoL surveys may fail to capture the full range of potential health states, or the values derived may fail to reflect patient perspectives of value. Methods: An online survey was piloted with a convenience sample of cancer survivors via two US survivor Facebook groups over two weeks in Jan. 2017 to explore these themes. Results: 116 complete responses were analyzed (of 123 respondents). Original diagnoses included solid tumors and hematologic malignancies, and respondents were between one and 32 years post-diagnosis (PoD). Most (101, 87%) had completed active treatment. A majority (85, 73%) rated PoD years as having more value than years pre-diagnosis (PreD). 83% (98) indicated that they felt their time is more valuable since their diagnosis. While the majority of respondents (57%) assigned a lower value to the 12 months immediately following diagnosis compared to the value of a PreD year, a majority (55%) also valued the most recent twelve months to have equal or greater value than a PreD year. Many assigned higher valuations to PoD years even when simultaneously reporting limitations in Activities of Daily Living (ADLs). Conclusions: Comparing survivor valuations of PoD life years to valuations derived by utility state instruments has not been heavily researched. This survey generates additional hypotheses. First, assuming PoD years hold lower value than PreD years may underestimate value compared to a survivor’s view. Second, QoL instruments may not be capturing positive changes in PoD years, some of which have been documented in psychology research, such as Post-Traumatic Growth or increased feeling of meaningfulness. Further investigation is imperative to ensure that value determinations have a solid evidentiary basis and reflect patient-centered viewpoints, particularly as the “value debate” influences patient access to care.

Incorporating Mortality in Health Utility Measures

2020 ◽  
Vol 40 (7) ◽  
pp. 862-872
Author(s):  
Barry Dewitt ◽  
George W. Torrance
Keyword(s):  
Health Utility Index ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
The State ◽  
Multidimensional Space ◽  
Health States ◽  
Utility Systems ◽  
Design Choice ◽  
Scale Properties ◽  
Utility Measures

The creation of multiattribute health utility systems requires design choices that have profound effects on the utility model, many of which have been documented and studied in the literature. Here we describe one design choice that has, to the best of our knowledge, been unrecognized and therefore ignored. It can emerge in any multiattribute decision analysis in which one or more essential outcomes cannot be described in terms of the multiattribute space. In health applications, the state of being dead is such an outcome. When the remaining health is conceptualized as a multidimensional space, determining the utility of the state of being dead requires using the interval-scale properties of cardinal utility, combined with elicited utilities for the state of being dead and the all-worst state, to produce a utility function in which the state of being dead has a utility of 0 and full health has a utility of 1 (i.e., the quality-adjusted life-year scale). Although previously unrecognized, there are two approaches to accomplish that step, and they produce different results in almost all cases. As a corollary, the choice of approach determines the proportion of states rated as worse than dead by the system. For example, in the Health Utility Index 3 (HUI3), the method used classifies 78% of the 972,000 unique health states in the classification system as worse than dead, and that proportion increases to 85% when the HUI3 is recalculated using the alternative approach. Studies of populations with significant morbidity are the most likely to be sensitive to the design choice. Those who design utility measures should be aware that they are using a researcher degree of freedom when they decide how to scale the state of being dead.

scholarly journals EQ-5D-5L and SF-6Dv2 utility scores in people living with chronic low back pain: a survey from Quebec

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e035722
Author(s):  
Thomas G Poder ◽  
Liang Wang ◽  
Nathalie Carrier
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Online Survey ◽  
Short Form ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
Low Back ◽  
Five Dimensions ◽  
Utility Scores

ObjectiveTo describe how chronic low back pain (CLBP) impacts on utility scores and which patients’ characteristics most affect these scores in the province of Quebec.SettingsProvince of Quebec, Canada.Participants569 adult patients with CLBP.Methods and outcomesAn online survey on low back pain was conducted between October 2018 and January 2019. The EuroQol Five Dimensions (EQ-5D-5L) and the Short Form Six Dimensions version 2 (SF-6Dv2) are two generic preference-based measures used to evaluate health-related quality of life (HRQoL) and provide quality-adjusted life-year utility values.ResultsThe number of subjects who agreed to participate was 610, but 41 were excluded because 8 had low back pain for less than 3 months and 33 did not start the survey. A total of 569 subjects were analysed, but only 410 completed the survey up to the EQ-5D-5L or SF-6Dv2 sections. Median (range) of EQ-5D-5L was 0.622 (−0.072 to 0.905), and mean (range) of SF-6Dv2 and EQ-Visual Analogue Scale was 0.561 (0.301–0.829) and 51.0 (0–100), respectively. In all multivariate models, health or life satisfaction increased the health utility score, while pain reduced it. Co-occurring health problems were present for a majority (68%) of participants, mainly fatigue/insomnia (57.4%), musculoskeletal disorder (56.2%) and mental disorder (44%).ConclusionThis study provided utility scores with EQ-5D-5L and SF-6Dv2 in patients with CLBP in Quebec, and results were similar to other studies conducted in different settings. These values were well below those reported in the Quebec general population and highlight the association between CLBP and HRQoL.

scholarly journals Parental Perceptions and Exposure to Advertising of Toddler Milk: A Pilot Study with Latino Parents

2021 ◽  
Vol 18 (2) ◽  
pp. 528
Author(s):  
Emily W. Duffy ◽  
Lindsey S. Taillie ◽  
Ana Paula C. Richter ◽  
Isabella C. A. Higgins ◽  
Jennifer L. Harris ◽  
...  
Keyword(s):  
Online Survey ◽  
Public Health Problem ◽  
Spanish Language ◽  
Latino Parents ◽  
Convenience Sample ◽  
Potential Health ◽  
Added Sugar ◽  
Fortified Milk ◽  
The Us ◽  
Almost All

Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12–36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents’ experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential “health halo” effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.

The impact of midlevel providers on productivity in outpatient oncology clinics at National Comprehensive Cancer Network (NCCN) institutions

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6628-6628
Author(s):  
J. M. Hinkel ◽  
J. L. Vandergrift ◽  
S. J. Perkel ◽  
M. B. Waldinger MHSA ◽  
W. Levy PA-C ◽  
...  
Keyword(s):  
Online Survey ◽  
Surgical Oncology ◽  
Hematologic Malignancies ◽  
Convenience Sample ◽  
Cancer Centers ◽  
Productivity Data ◽  
Primary Specialty ◽  
Physician Extenders ◽  
The Impact

6628 Background: An ASCO workforce study has predicted an oncologist shortage by 2020. Increased reliance on mid-level providers (PA/NPs) has been proposed to ameliorate the physician shortage. However, no methods currently exist to assess the impact of PA/NPs as physician extenders in an oncology setting. Obtaining productivity data is challenging due to variations in PA/NP utilization and billing. NCCN developed a survey to evaluate the use of PA/NPs in cancer centers and to pilot test PA/NP productivity metrics in outpatient oncology clinics. Methods: An online survey instrument was developed in consultation with oncologists, executive administrators, and PA/NP leaders at NCCN institutions. It included questions on work characteristics, allocation of time and labor, and productivity. PA/NP outpatient clinic productivity was measured as the average number of new and follow-up patients seen per half-day clinic (patients per clinic, PPC). A convenience sample was obtained through 15 NCCN institutions that distributed the survey through their own internal PA/NP e-mail lists. Results: A total of 206 PA/NPs completed the survey. A greater proportion of respondents were NPs (54%) than PAs (46%). Most responding PA/NPs listed their primary specialty as medical oncology (MO, 34%), followed by hematologic malignancies/BMT (HM/BMT, 28%) and surgical oncology (SO, 23%). The highest reported productivity was observed for SO specialists (mean = 8.7 PPC, SD = 3.5), followed by MO (mean = 7.6, SD = 4.3), and HM/BMT (mean = 6.1, SD = 2.8). Within the SO and HM/BMT specialties, little difference was observed between NP and PA productivity. Among MO specialists, NPs reported seeing more follow-up patients per clinic (mean = 7.2, SD = 4.3) than PAs (mean = 5.5, SD = 2.7, p = 0.04). In most cases, productivity was unrelated to seniority. However, more experienced HM/BMT NPs were more productive with new patients (rs = 0.46, p = 0.03). Conclusions: Mid-level providers have a measurable impact on productivity in outpatient oncology clinics. Refining productivity metrics for PAs/NPs will help inform workforce projections and staffing decisions for oncology practices/specialists and cancer centers, especially in the face of future physician shortages. No significant financial relationships to disclose.

scholarly journals Developing a cerebral palsy-specific preference-based measure for a six-dimensional classification system (CP-6D): protocol for a valuation study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029325
Author(s):  
Mina Bahrampour ◽  
Richard Norman ◽  
Joshua Byrnes ◽  
Martin Downes ◽  
Paul A Scuffham
Keyword(s):  
Quality Of Life ◽  
Cerebral Palsy ◽  
Classification System ◽  
Online Survey ◽  
Cost Utility ◽  
Health States ◽  
Human Research Ethics ◽  
Dimensional Classification ◽  
Life Years

IntroductionCerebral palsy (CP) is a lifelong condition. The CP quality of life (CPQOL) instrument is a frequently used disease-specific instrument to assess health-related quality of life (HRQoL) in people with CP, but it cannot be used to generate quality-adjusted life years (QALY) which are the basis of cost utility analysis (CUA). Generic utility instruments (such as the EQ-5D or SF-6D) that are used to value HRQOL may be insensitive to small but important health changes in children with CP. This study aims to generate a preference-based scoring algorithm for the CP six dimensions (CP-6D), a classification system developed from the CPQOL.Methods and analysisA discrete choice experiment with duration (DCEtto) will be administrated to value health states described by the CP-6D classification system. These health states will be presented to members of Australian general population and parents of children with CP via an online survey. Conditional logit regression will be used to produce the utility algorithm for CP-6D.Ethics and disseminationThe Griffith University Human Research Ethics Committee approved for the study (reference HREC/number 2018/913). The developed algorithm can be applied to previous and future economic evaluation of interventions and treatments targeting people with CP which have used either the CPQOL or CP-6D.

scholarly journals Shared Decision Making during the COVID-19 Pandemic

2021 ◽  
pp. 0272989X2110041
Author(s):  
Anja K. Köther ◽  
Katharina U. Siebenhaar ◽  
Georg W. Alpers
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Online Survey ◽  
Health Care Systems ◽  
Shared Decision ◽  
Patient Centered ◽  
Convenience Sample ◽  
Potential Health ◽  
Care Systems

Objective The COVID-19 pandemic pushed some of the most well-developed health care systems to their limits. In many cases, this has challenged patient-centered care. We set out to examine individuals’ attitudes toward shared decision making (SDM) and to identify predictors of participation preference during the pandemic. Methods We conducted an online survey with a large convenience sample ( N = 1061). Our main measures of interest were participants’ generic and COVID-19–related participation preference as well as their acceptance and distress regarding a triage vignette. We also assessed anxiety, e-health literacy, and aspects of participants’ health. We conducted group comparisons and multiple linear regression analyses on participation preference as well as triage acceptance. Results In generic decision making, most participants expressed a strong need for information and a moderate participation preference. In the hypothetical case of COVID-19 infection, most preferred physician-led decisions. Generic participation preference was the strongest predictor of COVID-19–related participation preference, followed by age, education, and anxiety. Furthermore, both higher generic and COVID-19–related participation preferences predicted lower triage acceptance. Conclusion Our findings demonstrate potential health care recipients’ attitudes toward SDM during a severe health care crisis and emphasize that participation preference varies according to the context.

Quality-adjusted life years assessment using cabozantinib for patients with advanced hepatocellular carcinoma (aHCC) in the CELESTIAL trial.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 207-207 ◽  
Author(s):  
Ghassan K. Abou-Alfa ◽  
Patrick Mollon ◽  
Tim Meyer ◽  
Ann-Lii Cheng ◽  
Anthony B. El-Khoueiry ◽  
...  
Keyword(s):  
Minimal Important Difference ◽  
Health Utility ◽  
Advanced Hepatocellular Carcinoma ◽  
Life Questionnaire ◽  
Quality Adjusted Life Years ◽  
Small Reduction ◽  
Health States ◽  
Life Years ◽  
The Difference ◽  
Quality Adjusted Life

207 Background: In patients previously treated for aHCC, cabozantinib (cabo) led to longer overall survival and progression-free survival vs placebo (pbo) in the randomized, phase 3 CELESTIAL trial (NCT01908426; N = 707). CELESTIAL was stopped early for benefit at the second interim analysis. This post hoc analysis estimated the incremental quality-adjusted life years (QALYs) accrued in CELESTIAL. Methods: Health utility was elicited at each study visit using the EQ-5D-5L quality of life questionnaire. (completed by 82–100% of patients overall). UK crosswalk tariffs were applied for health states. Cumulative QALYs by patient were calculated by linear interpolation; for patients who were censored (31% of patients; including 9% within 100 days of randomization), the last observed utility value was carried forward to study end. The difference in restricted mean QALYs was calculated using generalized linear models, accounting for baseline utility, and with 0.06–0.08 QALYs considered the minimal important difference. Results: At day 50 after randomization (acute treatment phase), cabo was associated with a small reduction in mean total QALYs vs pbo (difference −0.003; 95% CI −0.005 to −0.002; p ≤ 0.001; n = 601 [cabo, n = 389; pbo, n = 212]). At day 100, there was a numerical benefit in mean total QALYs for cabo (difference +0.007; 95% CI −0.001 to 0.015; p = 0.103; n = 627 [cabo, n = 410; pbo, n = 217]), and at day 150 the difference was +0.032 QALYs (95% CI 0.017 to 0.047; p ≤ 0.001; n = 629 [cabo, n = 412; pbo, n = 217]) in favor of cabo. Over the entire follow-up, patients randomized to cabo accrued a mean of +0.092 (95% CI 0.016 to 0.169; p = 0.018; n = 700 [cabo, n = 465; pbo, n = 235]) additional QALYs compared with those receiving pbo. Using alternative Devlin weights for health states, the mean accrued QALYs with cabo was +0.115 vs pbo (95% CI 0.032 to 0.198; p = 0.007). Conclusions: Cabo was associated with an initial, small reduction in health utility. However, with continued treatment, health utility increased and at the end of the study there was a clinically and statistically significant benefit in mean QALYs in favor of cabo. Clinical trial information: NCT01908426.

scholarly journals Sexual health practices of 16 to 19 year olds in New Zealand: an exploratory study

2020 ◽  
Vol 12 (1) ◽  
pp. 64 ◽  
Author(s):  
Sonja J. Ellis ◽  
Robyn Aitken
Keyword(s):  
New Zealand ◽  
Young People ◽  
Sexual Health ◽  
Online Survey ◽  
Full Range ◽  
Sexual Practices ◽  
Health Practices ◽  
Age Group ◽  
Convenience Sample ◽  
Sexual Behaviours

ABSTRACT INTRODUCTIONNew Zealand sexual health surveillance data suggest that young people aged 15–19 years are at considerable risk of contracting sexually transmitted infections. Although there is an established body of international research around sexual behaviours and sexual health practices among teenagers, there is a dearth of local research focusing on this age group. AIMThe aim of this study was to explore the sexual repertoires and sexual health practices among teenagers in New Zealand with a view to better understanding levels of risk in this age group. METHODSThis study comprised a cross-sectional online survey designed to ask questions about sexual behaviours. A convenience sample of young people (n=52) aged 16–19 years living in New Zealand completed the survey. RESULTSMost participants (71.2%) were sexually active, reporting engagement in a range of sexual practices. The most commonly reported sexual behaviours were penis-in-vagina sex (86.5%) and oral sex with a person-with-a-penis (81.1%). Infrequent and inconsistent use of barrier protection across all types of sexual behaviour was also reported. DISCUSSIONThe findings of this study highlight the importance of ensuring that young people have access to sexual health education that routinely includes health information and advice addressing the full range of sexual practices, regardless of the identity classifications they may use, or that may be attributed to them.

scholarly journals Cost‐Effectiveness of Combination Therapy for Patients With Systemic Sclerosis–Related Pulmonary Arterial Hypertension

2021 ◽  
Author(s):  
An Tran‐Duy ◽  
Kathleen Morrisroe ◽  
Philip Clarke ◽  
Wendy Stevens ◽  
Susanna Proudman ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Pulmonary Arterial Hypertension ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Cost Effective ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
Life Years ◽  
Pulmonary Arterial ◽  
Quality Adjusted Life

Background To evaluate the cost‐effectiveness of combination pulmonary arterial hypertension specific therapy in systemic sclerosis–related PAH. Methods and Results Health outcomes and costs were captured through data linkage. Health utility was derived from Medical Outcomes Study Short Form‐36 scores. A probabilistic discrete‐time model was developed to simulate lifetime changes in costs and health utility. Mortality was predicted using a Gompertz parametric survival model. For both treatment arms, the simulations were started using the same cohort of 10 000 patients. Probabilistic sensitivity analysis was performed using the Monte Carlo simulation with 1000 sets of sampled parameter values. Of 143 patients with systemic sclerosis–related pulmonary arterial hypertension, 89 were on monotherapy and 54 on combination therapy. Mean simulated costs per patient per year in monotherapy and combination therapy groups were AU$23 411 (US$16 080) and AU$29 129 (US$19 982), respectively. Mean life years and quality‐adjusted life years from pulmonary arterial hypertension diagnosis to death of patients receiving monotherapy were 7.1 and 3.0, respectively, and of those receiving combination therapy were 9.2 and 3.9, respectively. Incremental costs per life year and quality‐adjusted life year gained of combination therapy compared with monotherapy were AU$47 989 (US$32 920) and AU$113 823 (US$78 082), respectively. At a willingness‐to‐pay threshold of AU$102 000 (US$69 972) per life year gained, and of AU$177 222 (US$121 574) per quality‐adjusted life year gained, the probability of combination therapy being cost‐effective was 0.95. Conclusions The incremental cost per quality‐adjusted life year gained of combination therapy compared with monotherapy was substantial in the base case analysis. Given the fatal prognosis of systemic sclerosis–related pulmonary arterial hypertension and the incremental cost per life year of AU$47 989 (US$32 920), combination therapy could be considered cost‐effective in systemic sclerosis–related pulmonary arterial hypertension.

scholarly journals Incorporating Patients’ Values and Preferences Into Decision Making About Transplantation of HCV-Naïve Recipients With Kidneys From HCV-Viremic Donors: A Feasibility Study

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110565
Author(s):  
Mark H. Eckman ◽  
Adeboye A. Adejare ◽  
Heather Duncan ◽  
E. Steve Woodle ◽  
Charuhas V. Thakar ◽  
...  
Keyword(s):  
Decision Making ◽  
Hemodialysis Patients ◽  
Patient Specific ◽  
Health State ◽  
Net Benefit ◽  
Health States ◽  
Convenience Sample ◽  
Mean Values ◽  
Life Years ◽  
Dialysis Vintage

Introduction. While use of (hepatitis C virus) HCV-viremic kidneys may result in net benefit for the average end-stage kidney disease (ESKD) patient awaiting transplantation, patients may have different values for ESKD-related health states. Thus, the best decision for any individual may be different depending on the balance of these factors. Our objective was to explore the feasibility of sampling health utilities from hemodialysis patients in order to perform patient-specific decision analyses considering various transplantation strategies. Study Design. We assessed utilities on a convenience sample of hemodialysis patients for health states including hemodialysis, and transplantation with either an HCV-uninfected kidney or an HCV-viremic kidney. We performed patient-specific decision analyses using each patient’s age, race, gender, dialysis vintage, and utilities. We used a Markov state transition model considering strategies of continuing hemodialysis, transplantation with an HCV-unexposed kidney, and transplantation with an HCV-viremic kidney and HCV treatment. We interviewed 63 ESKD patients from four dialysis centers (Dialysis Clinic Inc., DCI) in the Cincinnati metropolitan area. Results. Utilities for ESKD-related health states varied widely from patient to patient. Mean values were highest for -transplantation with an HCV-uninfected kidney (0.89, SD: 0.18), and were 0.825 (SD: 0.231) and 0.755 (SD: 0.282), respectively, for hemodialysis and transplantation with an HCV-viremic kidney. Patient-specific decision analyses indicated 37 (59%) of the 63 ESKD patients in the cohort would have a net gain in quality-adjusted life years from transplantation of an HCV-viremic kidney, while 26 would have a net loss. Conclusions. It is feasible to gather dialysis patients’ health state utilities and perform personalized decision analyses. This approach could be used in the future to guide shared decision-making discussions about transplantation strategies for ESKD patients.

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