Understanding the influence of physical resources and social supports on primary food providers’ snack food provision: a discrete choice experiment

Background Snack eating occasions contribute approximately a third of children’s energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers’ snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position. Methods Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute. Results Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (− 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight − 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds. Conclusions Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers’ snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity. Trial registration Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280

Quality of Life and Eligibility for Specific Financial Assistance for Medical Expenses: A Cross-Sectional Web-Based Survey among Patients with Inflammatory Bowel Disease in Japan

Specific financial assistance for people with rare and intractable diseases is part of Japan’s public health system. This survey aimed to clarify the relationship between eligibility for this specific financial assistance and quality of life (QOL) among individuals with inflammatory bowel disease (IBD) in Japan. A nationwide, web-based survey was conducted in Japan among 300 people with IBD. Questionnaire items covered socioeconomic characteristics and QOL, assessed with the five-dimension, five-level EuroQol (EQ-5D-5L). The percentage of respondents who were ineligible for specific financial assistance was 11.0% among those with Crohn’s disease (CD) and 34.0% among those with ulcerative colitis (UC). For those with CD, the median EQ-5D-5L utility weight did not differ significantly between the non-assistance and assistance groups (p = 0.2222). For those with UC, the median EQ-5D-5L utility weight was significantly higher in the non-assistance group than in the assistance group (p = 0.0034). The present study demonstrated that the revision of the law on intractable and rare diseases has not had a negative influence on the QOL of patients with IBD in Japan. Based on our findings, further research on patient-reported outcomes among individuals with IBD may be necessary to inform health policy makers.

Inclusion of health-related quality-of-life data in oncology drug reimbursement submissions in Canada: A review of submissions to the pan-Canadian Oncology Drug Review.

94 Background: For health technologies, and cancer treatments specifically, economic evaluation is often used to assess the value of new treatments. The preferred approach to economic evaluation is often cost-utility analysis (CUA). In CUA, incremental costs and benefits of a new treatment and a standard of care are calculated with benefits quantified using the quality-adjusted life-year (QALY); the QALY attempts to account for the quantity and quality of life (using a utility weight). The utility weight often comes from a generic, preference-based measure of health-related quality of life (HRQoL), such as the 5-dimension EuroQol measure (EQ-5D). Many submissions for reimbursement by manufacturers, and indeed many clinical trials, still do not include HRQoL data which may result in lower quality submissions and thus, sub-optimal decisions. Methods: We reviewed submissions to the pan-Canadian Oncology Drug Review (pCODR), the body charged with making reimbursement recommendations in Canada. We reviewed submissions from those first recorded (August 2012) to the present (June 2018). Only submissions that were completed (status listed as 'Notification to Implement Issued') were included. Upon completion, three documents are produced by pCODR: the final recommendation from the pCODR Expert Review Committee, the final clinical guidance report, and the final economic guidance report. All three documents were searched for how HRQoL was incorporated into the economic evaluation. Results: In total, 135 submissions were made to pCODR over the period. Of these, 107 (79.3%) had been completed and met the criteria for inclusion. In most studies, the incremental gain in QALYs from the new technology was small (in 2017 submissions the mean QALY gain was 1.1 QALYs). In addition, few studies reported an original measure of HRQoL, with most citing previously completed studies of variable relevance and quality. Conclusions: Our results indicate that manufacturers should improve the collection of HRQoL data of patients alongside clinical trials. This would enhance the focus on patients and improve decision-making around reimbursement of treatments.

A Hybrid Fuzzy DEMATEL-VIKOR Method for Product Concept Evaluation

The product concept evaluation plays a very important role in product development. It can be considered as multi-criteria decision making (MCDM) problem. In a MCDM problem, a decision maker has to choose the best alternative that satisfies the evaluation criteria among a set of candidate solutions. This paper introduces a compromise MCDM evaluation model which combines fuzzy DEMATEL and VIKOR methods. The criteria weights are determined based on separate cause-effect assessment of a group of experts using the fuzzy DEMATEL approach. The resulting criteria weights are applied to the decision analysis where the fuzzy VIKOR approach is adopted which determines a compromise solution by using utility weight.

Quality-Adjusted Survival (Q-TWiST) Analysis of Patients with Relapsed or Refractory Chronic Lymphocytic Leukaemia Treated with Rituximab Plus Fludarabine and Cyclophosphamide (R-FC) Versus FC Alone.

Abstract 1368 Poster Board I-390 Background: Results from the REACH randomised trial showed that patients with relapsed or refractory CLL who received rituximab in combination with fludarabine-cyclophosphamide (R-FC) remained in progression free ten months (median) longer than patients receiving FC alone (30.6 vs. 20.6 months). Comparison of the amount of time a patient can expect before relapse without debilitating toxicities is a valuable aid in choosing between treatments. Objective: To evaluate whether relapsed or refractory CLL patients treated with the combination of R-FC would experience longer time in a better health state compared with patients on FC alone. Methods: The Q-TWiST was based on 25.3 months median follow-up data from the REACH trial (Robak et al., 2008) where 276 patients were treated with R-FC and 276 patients with FC alone. Because of shorter follow up time in the FC arm, the data was truncated at 52.53 months; the longest follow up in the shortest PFS curve of the comparator to exclude follow-up time bias in favor of R-FC. Patients with event times greater than 52.53 months were censored at the truncation point. The area under survival curves was partitioned into health states: (1) Relapse (REL) - area between overall and progression free survival curves; (2) Toxicity (TOX) - time period with all treatment-related adverse events from start of study treatment to up to 28 days following last dose and/or progression; and (3) Time without disease symptoms or treatment toxicity (TWiST), defined as the area between the PFS and TOX curves. Utility weights were applied to each health state to reflect the quality of life value relative to time in TWiST. Each utility weight ranged from 0 to 1, where 0 represents a state as bad as death, 1 represents a state as good as TWiST. For example, a utility weight of 0·5 for REL would indicate that 2 month of time after relapse is valued the same as 1 month in the TWiST state. Mean differences and 95% confidence intervals (CI) were calculated for each health state. Results: R-FC patients gained a mean of 6.38 months TWiST (95% CI, 3.92-8.93, p<0.0001), spent a mean of 4.82 months less time in relapse (95% CI, 1.40-8.43 p<0.0009) compared with patients treated with FC, without a significant increase in the burden of toxicity (mean difference 0.06 months (95% CI, 0.39-0.50, p=0.404). With utility coefficients of 1.0 for all health states, the unadjusted mean difference in survival between R-FC and FC was 1.50 months (95% CI, 0.84-3.69, p=0.401). Using the utility of 0.618 for REL derived by Hancock et al. (2002), an assumed utility of 0.618 for TOX, and a utility of 1.0 for TWiST, R-FC patients experienced a mean of 3.45 months longer quality-adjusted survival compared with FC (95% CI, 1.69-5.14, p<0.0001). The key driver for these results is the substantial (40.9%) reduction in the time spent in the relapsed health state due to the addition of rituximab to FC. The threshold analyses showed that, all utility combinations for TOX and REL (0.1-0.9) with a TWiST utility of 1 resulted in a statistically significant (p<0.002) gain in Q-TWiST for R-FC patients. A second sensitivity analysis was conducted using 0.80 for TWiST and varying the REL and TOX utilities from 0.1 to 0.9. Each of these utility combinations resulted in a significant Q-TWiST outcome for R-FC relative to FC (p ≤0.039). For utilities TOX and REL combinations greater than 0.6 there was a trend towards significance. However, such combinations are clinical extremes and unlikely to present in clinical practice. Conclusion: The result of the Q-TWiST analysis on the REACH study data showed that, relapsed or refractory CLL patients receiving R-FC, spend less time with disease symptoms with no significant increase in treatment toxicity compared with patients who received FC alone. Disclosures: Robak: F Hoffmann-La Roche: Honoraria. Oertel: Hoffmann La Roche Ltd.: Employment, Equity Ownership. Carr: F.Hoffmann-La Roche Ltd.: Employment.