The monetary value of a quality-adjusted life-year (QALY) is frequently used to assess the benefits of health interventions and inform funding decisions. However, there is little consensus on methods ...for the estimation of this monetary value. In this study, we use life satisfaction as an indicator of ‘experienced utility’, and estimate the dollar equivalent value of a QALY using a fixed effect model with instrumental variable estimators. Using a nationally-representative longitudinal survey including 28,347 individuals followed during 2002–2015 in Australia, we estimate that individual's willingness to pay for one QALY is approximately A$42,000-A$67,000, and the willingness to pay for not having a long-term condition approximately A$2000 per year. As the estimates are derived using population-level data and a wellbeing measurement of life satisfaction, the approach has the advantage of being socially inclusive and recognizes the significant meaning of people's subjective valuations of health. The method could be particularly useful for nations where QALY thresholds are not yet validated or established.
•The value of a QALY is used to inform funding decisions of health interventions.•There is little consensus on methods for the estimation of this value.•We estimated the value of a QALY using a wellbeing measurement of life satisfaction.•We used population representative data and a fixed effect model with instruments.
This multicenter trial comparing nasal high-flow therapy with CPAP as primary support for preterm infants with respiratory distress showed a significantly higher treatment-failure rate with high-flow ...therapy.
In 2014, there were more than 380,000 preterm births (i.e., births at a gestational age of <37 weeks) in the United States, accounting for approximately 10% of all births that year.
1
Preterm infants have a risk of the respiratory distress syndrome. The introduction of endotracheal ventilation has improved the survival rate among preterm infants but is associated with an increased risk of complications such as bronchopulmonary dysplasia.
2
Clinicians aim to use noninvasive respiratory support to minimize the risk of such complications. The most widely used noninvasive approach, nasal continuous positive airway pressure (CPAP), has been shown to be an effective . . .
BackgroundIt is a public heath priority to understand why many children with mental health problems fail to access mental health services. This study aims to quantify under-recognition of children’s ...mental health problems by parents across income quintiles.MethodsWe estimated under-recognition with parent-reported mental health problems and the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative Australian data set for children aged 4–15 years with 24 269 person-wave observations.ResultsUnder-recognition was the highest in the lowest income quintile, with 11.5% of children from the lowest income quintile families who scored in the clinical range on the SDQ perceived by parents as having no mental health problems. For the highest income quintile this was 2.4%. In terms of gender and age, under-recognition was greater for boys and younger children.ConclusionsParent’s mental health literacy, especially for low-income families, warrants prioritised attention from researchers, clinicians and policymakers.
Providing equitable care is an objective of many national healthcare systems. Using the birth cohort of the nationally representative Longitudinal Study of Australian Children linked with the ...Medicare Benefits Scheme billing data who were recruited in 2004 at ages 0–1 years and assessed biennially for six waves, we assessed the distribution of out-of-hospital government Medicare spending by household income. 4853 children followed over 11 years were included in the study. Distributions of major spending components including general practitioner and specialist care were assessed using concentration indices. Trends in the inequalities as children grow were investigated. The results showed that after controlling for health care needs, total government Medicare spending over 0–11 years of age favoured the rich (concentration index 0.041). The Medicare spending for general practitioner care was equal (concentration index 0.005) while for specialist care and diagnostics and imaging were ‘pro-rich’ (concentration index 0.108 and 0.088 respectively). Children from poorer families were most disadvantaged when aged 0–1 years in specialist spending, and the disparity lessened as children approached adolescence. Our findings suggest that income-related inequalities exist in government Medicare spending particularly in the first few years of life. As early years of life are a critical window in childhood development and building block for future health, the results warrant further investigation and attention from policy makers.
•Medicare GP spending for children was neutral regarding income.•Children from lower income families received less specialist care spending.•Income-related inequality in specialist spending was most profound early in life.•The disparity lessened as children approached adolescence.
There is increasing interest in the validation of pediatric preference-based health-related quality of life measurement instruments. It is critical that children with various degrees of ...health-related quality of life (HRQoL) impact are included in validation studies. To inform patient sample selection for validation studies from a pragmatic perspective, this study explored HRQoL impairments between known-groups and HRQoL changes over time across 27 common chronic child health conditions and identified conditions with the largest impact on HRQoL.
The health dimensions of two common preference-based HRQoL measures, the EQ-5D-Y and CHU9D, were constructed using Pediatric Quality of Life Inventory items that overlap conceptually. Data was from the Longitudinal Study of Australian Children, a nationally representative sample with over 10,000 children at baseline. Seven waves of data were included for the analysis, with child age ranging from 2 to18 years. Impacts to specific health dimensions and overall HRQoL between those having a specific condition versus not were compared using linear mixed effects models. HRQoL changes over time were obtained by calculating the HRQoL differences between two consecutive time points, grouped by "Improved" and "Worsened" health status. Comparison among various health conditions and different age groups (2-4 years, 5-12 years and 13-18 years) were made.
Conditions with the largest statistically significant total HRQoL impairments of having a specific condition compared with not having the condition were recurrent chest pain, autism, epilepsy, anxiety/depression, irritable bowel, recurrent back pain, recurrent abdominal pain, and attention deficit hyperactivity disorder (ADHD) for the total sample (2-18 years). Conditions with largest HRQoL improvement over time were anxiety/depression, ADHD, autism, bone/joint/muscle problem, recurrent abdominal pain, recurrent pain in other part, frequent headache, diarrhea and day-wetting. The dimensions included in EQ-5D-Y and CHU9D can generally reflect HRQoL differences and changes. The HRQoL impacts to specific health dimensions differed by condition in the expected direction. The conditions with largest HRQoL impacts differed by age group.
The conditions with largest HRQoL impact were identified. This information is likely to be valuable for recruiting patient samples when validating pediatric preference-based HRQoL instruments pragmatically.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To identify and describe distinct developmental trajectories of health-related quality of life (HRQoL) in a national level Australian population sample, overall and separately for boys and girls.
...Data were from the Longitudinal Study of Australian Children (LSAC). Participants were children aged 4-5 years recruited in 2004 and followed through to age 16-17 years in 2016, and their caregivers. Group-based trajectory modelling was used to identify groups of children that follow qualitatively distinct developmental trajectories of HRQoL.
Three distinct trajectories were identified for the total sample: (1) high-stable (52.2% of children); (2) middle-stable (38.0%); and (3) low-declining (9.8%). These trajectories differed for boys, who saw increasing HRQoL in the highest trajectory group; a middle-stable trajectory; and declining and rebounding HRQoL in the lowest trajectory group. In contrast, girls saw no increasing or rebounding trajectories; approximately half of girls had high-stable HRQoL and the remaining half had either steadily or rapidly declining HRQoL from age 4-5 to 16-17 years.
Our results highlight the importance of considering the distinct trajectories for girls and boys and not relying on population mean levels of HRQoL for decision-making. The presence of developmentally distinct trajectories of HRQoL, and differences in the trajectories faced by boys and girls, should be considered when assessing the effectiveness of treatments and interventions impacting upon HRQoL throughout childhood and adolescence. Failure to account for these pre-existing trajectories may over- or under-estimate treatment effects.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
To assess the associations between adherence to 24-hour movement behaviors guidelines and child general health and functional status measured by health-related quality of life.
Methods
The ...Longitudinal Study of Australian Children (2004–2016) a nationally representative sample with data available for children aged 2–15 years was used. Physical activity time, recreational screen time, and sleep time were calculated from time use diaries and classified as ‘meeting guidelines’ or ‘not’ based on the age-specific 24-h movement guidelines. Child general health and functional status were measured using the multidimensional Pediatric Quality of Life Inventory (PedsQL). Associations between meeting guidelines and PedsQL were assessed using linear mixed effects models.
Results
8919 children were included. Each additional guideline met was associated with a 0.52 (95% confidence interval CI 0.39–0.65) increase in PedsQL total score. Compared with meeting no guidelines, the effect of meeting physical activity guidelines alone (
β
= 0.93, 95% CI 0.42–1.44) was larger compared to meeting screen (
β
= 0.66, 95% CI 0.06–1.27) or sleep time (
β
= 0.47, 95% CI 0.04–0.89) guidelines alone. The highest increment was observed in meeting both screen time and physical activity guidelines (
β
= 1.89, 95% CI 1.36–2.43). Associations were stronger in children from lower-income families (
β
for meeting all versus none = 2.88, 95% CI 1.77–3.99) and children aged 14–15 years (
β
= 4.44, 95% CI 2.49–6.40).
Conclusions
The integration of screen time and physical activity guidelines is associated with the highest PedsQL improvement. The association between guidelines adherence and PedsQL appears stronger for adolescents and those from low-income families.
Background
The inclusion of future medical costs in cost-effectiveness analyses remains a controversial issue. The impact of capturing future medical costs is likely to be particularly important in ...patients with cancer where costly lifelong medical care is necessary. The lack of clear, definitive pharmacoeconomic guidelines can limit comparability and has implications for decision making.
Objective
The aim of this study was to demonstrate the impact of incorporating future medical costs through an applied example using original data from a clinical study evaluating the cost effectiveness of a sepsis intervention in cancer patients.
Methods
A decision analytic model was used to capture quality-adjusted life-years (QALYs) and lifetime costs of cancer patients from an Australian healthcare system perspective over a lifetime horizon. The evaluation considered three scenarios: (1) intervention-related costs (no future medical cost), (2) lifetime cancer costs and (3) all future healthcare costs. Inputs to the model included patient-level data from the clinical study, relative risk of death due to sepsis, cancer mortality and future medical costs sourced from published literature. All costs are expressed in 2017 Australian dollars and discounted at 5%. To further assess the impact of future costs on cancer heterogeneity, variation in survival and lifetime costs between cancer types and the implications for cost-effectiveness analysis were explored.
Results
The inclusion of future medical costs increased incremental cost-effectiveness ratios (ICERs) resulting in a shift from the intervention being a dominant strategy (cheaper and more effective) to an ICER of $7526/QALY. Across different cancer types, longer life expectancies did not necessarily result in greater lifetime healthcare costs. Incremental costs differed across cancers depending on the respective costs of managing cancer and survivorship, thus resulting in variations in ICERs.
Conclusions
There is scope for including costs beyond intervention costs in economic evaluations. The inclusion of future medical costs can result in markedly different cost-effectiveness results, leading to higher ICERs in a cancer population, with possible implications for funding decisions.
Abstract Background The number and age demographic of the future Fontan population is unknown. Methods Population projections were calculated probabilistically using microsimulation. Mortality hazard ...rates for each Fontan recipient were calculated from survivorship of 1353 Fontan recipients in the Australia and New Zealand Fontan Registry, based on Fontan type, age at Fontan, gender and morphology. Projected rates of new Fontan procedures were generated from historical rates of Fontan procedures per population births. Results At the end of 2014, the living Fontan population of Australia and New Zealand was 1265 people from an Australian and New Zealand regional population of 28 million (4.5 per 100,000 population). Of those, 165 (13%) received an atrio-pulmonary (AP) procedure, 262 (21%) a lateral tunnel (LT) procedure and 838 (66%) an extra-cardiac conduit (ECC) procedure. This population is expected to grow to 1917 (95% CI: 1846: 1986) by 2025 (5.8 per 100,000 population), with 149 (8%) AP procedures, 254 (13%) LT procedures, and 1514 (79%) ECC procedures. By 2045, the living Fontan population is expected to reach 2986 (95% CI: 2877: 3085; 7.2 per 100,000 population). The average age of the Fontan population is expected to increase from 18 years in 2014 to 23 years (95% CI: 22–23) by 2025, and 31 years (95% CI: 30–31) by 2045. Conclusion The Australian and New Zealand population of patients alive after a Fontan procedure will double over the next 20 years increasing the demand for heart-failure services and cardiac transplantation. Greater consideration for the needs of this mostly adult Fontan population will be necessary.
Background Cancer patients are at significant risk of developing sepsis due to underlying malignancy and necessary treatments. Little is known about the economic burden of sepsis in this high-risk ...population. We estimate the short- and long-term healthcare costs of care of cancer patients with and without sepsis using individual-level linked-administrative data. Methods We conducted a population-based matched cohort study of cancer patients aged greater than or equal to18, diagnosed between 2010 and 2017. Cases were identified if diagnosed with sepsis during the study period, and were matched 1:1 by age, sex, cancer type and other variables to controls without sepsis. Mean costs (2018 Canadian dollars) for patients with and without sepsis up to 5 years were estimated adjusted using survival probabilities at partitioned intervals. We estimated excess cost associated with sepsis presented as a cost difference between the two cohorts. Haematological and solid cancers were analysed separately. Results 77,483 cancer patients with sepsis were identified and matched. 64.3% of the cohort were aged greater than or equal to65, 46.3% female and 17.8% with haematological malignancies. Among solid tumour patients, the excess cost of care among patients who developed sepsis was $29,081 (95%CI, $28,404-$29,757) in the first year, rising to $60,714 (95%CI, $59,729-$61,698) over 5 years. This was higher for haematology patients; $46,154 (95%CI, $45,505-$46,804) in year 1, increasing to $75,931 (95%CI, $74,895-$76,968). Conclusions Sepsis imposes substantial economic burden and can result in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to deploy targeted strategies to alleviate this burden.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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