Dutch Tariff for the Five-Level Version of EQ-5D M. Versteegh, Matthijs, PhD; M. Vermeulen, Karin, PhD; M. A. A. Evers, Silvia, PhD ...
Value in health,
06/2016, Letnik:
19, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Abstract Background In 2009, a new version of the EuroQol five-dimensional questionnaire (EQ-5D) was introduced with five rather than three answer levels per dimension. This instrument is known as ...the EQ-5D-5L. To make the EQ-5D-5L suitable for use in economic evaluations, societal values need to be attached to all 3125 health states. Objectives To derive a Dutch tariff for the EQ-5D-5L. Methods Health state values were elicited during face-to-face interviews in a general population sample stratified for age, sex, and education, using composite time trade-off (cTTO) and a discrete choice experiment (DCE). Data were modeled using ordinary least squares and tobit regression (for cTTO) and a multinomial conditional logit model (for DCE). Model performance was evaluated on the basis of internal consistency, parsimony, goodness of fit, handling of left-censored values, and theoretical considerations. Results A representative sample (N = 1003) of the Dutch population participated in the valuation study. Data of 979 and 992 respondents were included in the analysis of the cTTO and the DCE, respectively. The cTTO data were left-censored at −1. The tobit model was considered the preferred model for the tariff on the basis of its handling of the censored nature of the data, which was confirmed through comparison with the DCE data. The predicted values for the EQ-5D-5L ranged from −0.446 to 1. Conclusions This study established a Dutch tariff for the EQ-5D-5L on the basis of cTTO. The values represent the preferences of the Dutch population. The tariff can be used to estimate the impact of health care interventions on quality of life, for example, in context of economic evaluations.
To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome ...(LRS) in general practice.
A pragmatic randomized controlled trial. Results were analyzed using mixed models.
Primary care.
Patients (N=50) in the acute phase of LRS.
One epidural injection containing 80mg of triamcinolone in normal saline.
Back pain at 4 weeks after the start of the treatment.
Both groups experienced a significant increase in quality of life in (especially) the physical domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. The intervention group scored significantly better than the control group at certain time points in the physical domain. The differences were small. The cost-utility analysis showed that with a negligible loss of utility (3d in perfect health), societal costs (193,354 euros per quality-adjusted life year lost) would be saved because of more productivity in the intervention group.
Although the beneficial effects of SESIs are small and the natural course of LRS is predominantly favorable, we think decision makers can consider implementing SESIs in daily practice with the purpose of saving resources. Caution must be taken, and further research should be directed at identifying patient subgroups who might benefit from SESIs, with additional focus on (costs of) complications and adverse effects.
Adherence to medication is a favourable with regard to survival after kidney, heart and liver transplantation. Little is known about adherence to medication in lung transplant recipients. To ...determine the prevalence of adherence and identify risk factors of non-adherence (NA) we evaluated adherence to tacrolimus in adult lung transplant recipients who were at least 1 year after transplantation.
Tacrolimus intake was prospectively monitored using the Medication Event Monitoring System (MEMS). Recipients qualified as adherent if a timing-adherence score of ≥ 80% was reached. Patients' characteristics and possible risk factors for NA were collected using the Karnofsky Performance Index, Self-Care Agency ASA Scale, State-Trait Anxiety Inventory, Zung Self-Rating Depression Scale, and the Long-Term Medication Behavior Self-Efficacy Scale.
Ninety-one recipients used MEMS for a median of 95 days (range 50 to 124 days) and were included. They showed a median timing-adherence score of 98.1% (range 31.2% to 100%). A timing-adherence score of ≥ 80% was seen in 92.3% of the recipients. Multiple logistic regression showed an association of lower timing-adherence scores with younger age and lower ability of self-care.
Adherence to immunosuppressive therapy was very high in lung transplant recipients. Only 7.7% of the recipients were non-adherent. Younger recipients and recipients with lower ability of self-care appeared to be at risk for NA. Follow-up of clinical data is needed to determine whether NA is associated with poorer outcome, specifically bronchiolitis obliterans syndrome.
Currently, the goal of lung transplantation is not only to improve survival but also includes improvement of health-related quality of life (HRQL). Limited knowledge is available about the value of ...HRQL before lung transplantation with regard to predicting survival after lung transplantation. To maximize the benefits of transplantation, it is essential to gain knowledge about variables that predict both length and quality of survival. In this study we sought to determine whether HRQL before transplantation predicts survival after lung transplantation.
For each of the 200 lung transplant recipients included in this study, the HRQL questionnaire completed at the date closest to the transplant date was selected. Measures included were: the Nottingham Health Profile (NHP); State-Trait Anxiety Inventory (STAI); Self-Rating Depression Scale (SDS)-Zung; Karnofsky Performance Scale; and Index of Well-Being (IWB). Cox regression models were used to determine whether pre-transplant scores predicted post-transplant survival.
Survival rates at 1, 3 and 5 years were 85%, 73% and 69%, respectively. Mean scores on all pre-transplant HRQL measures were unfavorable compared with reference values for the general population. No significant predictors for survival after lung transplantation were found.
Results suggest that scores on the various HRQL measures before transplantation did not predict survival after lung transplantation. The present results do not support the usefulness of pre-transplant HRQL measures for the selection of lung transplant candidates or their urgency for transplantation.
Lung transplantation has proven to be an effective treatment option for patients with end-stage lung disease with profound effects on both survival and health-related quality of life (HRQL). ...Generally, studies have reported improved HRQL after lung transplantation. When assessing HRQL, physical, psychologic or social dimensions are usually included. However, it is unclear what predicts outcome, to what extent, and whether there are differences in predictors between dimensions of HRQL. Knowledge about these predictors may be useful when making choices regarding therapy. The research question in the present study was: What are the predicting variables of physical and psychologic dimensions of HRQL, and do they differ?
Results from studies of the physical dimension (the Nottingham Health Profile's energy and mobility scales) and the psychologic dimension (Zung depression and STAI anxiety scores) from 140 transplanted patients with a maximum follow-up of almost 10 years were assessed using mixed-model analysis. For both dimensions, the following variables were tested for their predictive value: age; gender; diagnosis; year of transplantation; time on the waiting list; type of transplantation; bronchiolitis obliterans syndrome; and pre-transplant HRQL scores.
With regard to the physical dimension after lung transplantation, presence of bronchiolitis obliterans syndrome (BOS), age and pre-transplant scores on the measure under study were significant predictors for both energy and mobility. For mobility, gender appeared to be an additional predictor. With regard to the psychologic dimension after lung transplantation, BOS was a predictor for both anxiety and depression. Pre-transplant depression was an additional predictor for post-transplant depression, and age was an additional predictor for anxiety.
Several variables were identified that predicted HRQL after lung transplantation. These variables differed between the physical and psychologic dimensions. The presence of BOS was a predictor for both dimensions. The present findings may be helpful when choosing or developing interventions aimed at improving HRQL after lung transplantation.
Summary Background ABCA7 was identified as a risk gene for Alzheimer's disease in genome-wide association studies (GWAS). It was one of the genes most strongly associated with risk of Alzheimer's ...disease in a Belgian cohort. Using targeted resequencing, we investigated ABCA7 in this cohort with the aim to directly detect rare and common variations in this gene associated with Alzheimer's disease pathogenesis. Methods We did massive parallel resequencing of ABCA7 after HaloPlex target enrichment of the exons, introns, and regulatory regions in 772 unrelated patients with Alzheimer's disease (mean age at onset 74·6 years SD 8·9) recruited at two memory clinics in Flanders, Belgium, and 757 geographically matched community-dwelling controls (mean age at inclusion 73·9 years 8·0). After bioinformatic processing, common variants were analysed with conditional logistic regression and rare variant association analysis was done in Variant Association Tools. To explore an observed founder effect, additional unrelated patients with Alzheimer's disease (n=183, mean age at onset 78·8 years SD 6·0) and control individuals (n=265, mean age at inclusion 56·9 years 10·8) from the same cohort who had not been included in massive parallel resequencing because of insufficient biosamples were screened for the ABCA7 frameshift mutation Glu709fs with Sanger sequencing. The effect of loss-of-function mutations on ABCA7 expression was investigated with quantitative real-time PCR in post-mortem brains of patients (n=3) and control individuals (n=4); nonsense mediated mRNA decay was investigated in lymphoblast cell lines from three predicted loss-of-function mutation carriers from the cohort of 772 patients with Alzheimer's disease. Findings An intronic low-frequency variant rs78117248 (minor allele frequency 3·8% in 58 patients with Alzheimer's disease and in controls 1·8% in 28 controls) showed strongest association with Alzheimer's disease (odds ratio 2·07, 95% CI 1·31–3·27; p=0·0016), and remained significant after conditioning for the GWAS top single nucleotide polymorphisms rs3764650, rs4147929, and rs3752246 (2·00, 1·22–3·26; p=0·006). We identified an increased frequency of predicted loss-of-function mutations in the patients compared with the controls (relative risk 4·03, 95% CI 1·75–9·29; p=0·0002). One frameshift mutation (Glu709fs) showed a founder effect in the study population, and was found to segregate with disease in a family with autosomal dominant inheritance of Alzheimer's disease. Expression of ABCA7 was reduced in the two carriers of loss-of-function mutations found only in patients with Alzheimer's disease (Glu709fs and Trp1214*) compared with four non-carrier controls (relative expression 0·45, 95% CI 0·25–0·84; p=0·002) and in lymphoblast cell lines from three carriers of Glu709fs compared with those from two non-carrier controls. Interpretation We propose that a low-frequency variant can explain the association between ABCA7 and Alzheimer's disease, and the evidence of loss-of-function mutations in this risk gene suggests that partial loss-of-function of ABCA7 could be a potential pathogenetic mechanism of Alzheimer's disease. Funding Belgian Science Policy Office Interuniversity Attraction Poles program P7/16, Alzheimer Research Foundation, King Baudouin Foundation AB Fund, Methusalem Excellence Program initiative of the Flemish Government, Flanders Impulse Program on Networks for Dementia Research, Research Foundation Flanders, Agency for Innovation by Science and Technology Flanders, University of Antwerp Research Fund, and European Union's Seventh Framework Programme for Research, Technological development and Demonstration (AgedBrainSYSBIO).
PDF
