Value in health regional issues最新文献

Objective

Methods

Results

Conclusions

Objective

Methods

Results

Conclusion

Objective

We aimed to assess physical and psychosomatic manifestations of patients with long COVID and their association with a decreased patient’s quality of life (QOL) or different times elapsed since the COVID-19 diagnosis.

Methods

This is a cross-sectional study. We retrospectively collected the clinical characteristics of adult patients who had tested positive for SARS-CoV-2 and had symptoms at least as early as 4 weeks after COVID-19 in México City between April 2020 and February 2021. A total of 179 were included. They answered questions to define chronic symptoms. The Sniffin’ Sticks Screening 12 test olfactory evaluation was performed. The diminish of QOL was defined by ≥10 points in the EuroQol visual analog scale between pre- and post-COVID-19, and each dimension of EQ-5D-5L test was evaluated. Chi-square test, Fisher’s exact test, Student t test, Wilcoxon rank-sum, and signed-rank test were used as required. A backward stepwise logistic regression analysis determined the factors associated with a decrease in QOL. All analyses were performed using R software version 3.6.3 (R Foundation).

Results

In the multivariable analysis, post-COVID-19 pain/discomfort (adjusted odds ratio [aOR] 2.5 [1.66-9.68]; P = .01), anxiety/depression (aOR 13 [1.44-17.23]; P = .03), and persistence of ≥3 symptoms (aOR 2.6 [0.96-7.47]; P = .05) remained statistically significant associated with decreased QOL.

Conclusions

Patients with long COVID-19 have decreased QOL mainly associated with pain/discomfort, anxiety/depression, and ≥3 persistent symptoms. Our findings enhanced the notion of a strong psychosomatic factors involved with long COVID-19. Therefore, these patients might benefit from neuropsychological rehabilitation, although the effect of such interventions should be evaluated.

Objectives

Herpes zoster (HZ) substantially affects patients’ health-related quality of life (HRQoL), both in the acute phase and also in those developing postherpetic neuralgia (PHN). Building upon a previous qualitative concept elicitation study in Canada, we adopted a similar approach to further understand the patient experience of HZ/PHN in Argentina and impact on quality of life and qualitatively validate the previously published conceptual model for Argentina.

Methods

(1) Comprehensive literature review of HZ impact on HRQoL in Latin America. (2) Qualitative concept elicitation interviews with participants aged ≥50 years with acute HZ or PHN. Verbatim interview transcripts underwent thematic and content analysis related to symptoms and impacts.

Results

Studies from the literature (n = 6) identified 5 dimensions of HZ impact on HRQoL: pain management, disease management, family life, work, and emotional impact. A total of 10 participants were interviewed (5 acute HZ and 5 with PHN) with a mean age of 68.5 years (range 50-77 years) and 60% female. All participants reported rash and pain (some reporting a migratory element), fatigue (7 of 10), and itchiness (4 of 10). HRQoL domains most commonly affected were activities of daily living (9 of 10), emotional functioning (8 of 10), physical functioning (8 of 10), and sleep (7 of 10). Emergent themes on disease management included the need for greater public disease awareness/education, participants with PHN seeking alternative/traditional medical therapies.

Conclusions

This study qualitatively validates the previously reported HRQoL conceptual framework. HZ symptoms, especially acute and chronic pain, substantially impair various aspects of HRQoL, prompting some participants to seek out alternative medical treatments.

Objectives

This study aimed to estimate the annual healthcare burden of heart failure (HF) with reduced ejection fraction (<40%) in Singapore.

Methods

Retrospective longitudinal descriptive cohort study was conducted using a linked national administrative data set (Singapore Cardiovascular Longitudinal Outcomes Database). In Singapore, during 2011, there were a total of 3267 HF-related hospital admissions. Among these, 1631 patients (49.9%), who had an ejection fraction of less than 40%, were followed up for 9 years. The primary outcomes were annual healthcare costs related to hospital admissions and outpatient visits.

Results

There was a consistent decline in HF-related hospital admissions over the years, and the average per-hospital admission cost and average cost per day for HF varied over the 9 years. The average all-cause per-patient admission cost remained stable annually, ranging between S$16 000 and S$18 800. In the final year of life, there was a significant increase in both all-cause and HF-related hospital admission costs (by 24% and 54% from the previous year, respectively), and this rise in costs reflected increased frequency of admissions and longer hospital stays. There was an upward trend in the cost of outpatient visits as the patients neared death.

Conclusions

Hospital-based HF care imposes a significant financial impact on Singapore’s healthcare system. This suggests a need for cost-efficient management strategies to reduce the reliance on hospital-based treatment, thus mitigating economic pressures on the healthcare system.

Objective

This study aimed to determine the direct and indirect costs of sickle cell disease (SCD) in Saudi Arabia.

Methods

Data were collected from 217 participants aged ≥18 years in the eastern region of Saudi Arabia, using a prevalence-based cost-of-illness approach. The Institute for Medical Technology Assessment Medical Consumption Questionnaire and Institute for Medical Technology Assessment Productivity Cost Questionnaire were used to assess costs. A multistage process was used, encompassing patient data collection over 3 months, cost calculation from clinic visits and drug prices, and extrapolation for annual estimates.

Results

The study revealed substantial societal costs of SCD, with an average per-patient cost of SAR181 899 (US$48 506), covering healthcare and productivity losses. Healthcare costs, including hospitalization, informal care, and medication, averaged SAR80 306 (US$21 415). In addition, productivity costs, including unpaid work and presenteeism, averaged SAR101 594 (US$27 092). Obtaining higher levels of education, such as a diploma and BSc degree or higher, has been found to significantly decrease the costs associated with SCD (P = .016, P = .001). Furthermore, when comparing different employment statuses, students (B = −0.301, P = .058) were found to have marginally lower SCD costs, suggesting that their expenses were lower than those of individuals in other employment categories. The predictive model used in this study explained 11.2% of the variation in costs.

Conclusion

Our study highlights a significant economic burden of SCD in Saudi Arabia and highlights the need for targeted strategies to alleviate financial challenges and improve patient well-being.

Objectives

This study evaluated the treatment preferences among patients and caregivers for moderate or severe hemophilia A in Taiwan.

Methods

This cross-sectional study used a discrete choice experiment approach to assess treatment preferences among patients with hemophilia A and their caregivers. Respondents chose between 2 hypothetical treatments defined by 7 attributes including no bleeding episode, treated events of joint bleeding, long-term safety, type of treatment and risk of thromboembolic events, administration frequency, consumption route, and monitoring dosing options. Preference weights and relative importance (RI) of attributes were estimated using a hierarchical Bayesian logistic regression model.

Results

A total of 51 eligible respondents completed the discrete choice experiment (patients, 76.5%; caregivers, 23.5%). Most patients (70.6%) had severe hemophilia and 43.1% received prophylactic treatment for >10 years. Respondents valued “type of treatment and risk of thromboembolic events” as the most important factor (RI 26.2%; 95% CI 20.9-31.5) followed by “consumption route” (RI 25.8%; 95% CI 20.7-30.9) and “administration frequency” (RI 15.2%; 95% CI 12.0-18.4). “Monitoring dosing options” was the least important attribute (RI 6.3%; 95% CI 5.2-7.4). Respondents had 63% possibility to choose a treatment profile that has factor VIII product compared with nonfactor product.

Conclusions

Patients and caregivers valued “type of treatment and risk of thromboembolic events” as the most important driver in choosing a treatment for moderate or severe hemophilia A. This study provides important insights into patients’ preferences and informs clinicians to consider patients’ choices when prescribing a treatment.

Objectives

This study aimed to produce Sri Lankan population norms of utility values, EuroQol visual analog scale scores, and reported problems in each domain of the EQ-5D-5L, as well as a disutility catalog, based on a representative set of Sri Lankan preferences.

Methods

Data from a nationally representative sample of 6415 adults from the Sri Lanka Health and Ageing Study in 2018 to 2019 were used. Sri Lankan preferences were applied to EQ-5D-5L scores to produce utility values. Descriptive statistics were produced for responses by EQ-5D-5L dimension, mean utility values, and EuroQol visual analog scale scores, disaggregated by demographic and disease group. Multivariable logistic regression assessed associations with problems in each dimension, and demographic and chronic diseases. Robust ordinary least squares and tobit regressions were performed to estimate the marginal disutility of demographic covariates and disease conditions.

Results

The mean utility value for the overall population was 0.867. Utility values decreased with age and increased with increasing education and richer socioeconomic quintiles. Males had higher utility values than females (0.89 vs 0.84; P < .001). Utility values declined by 0.007 with each year increase in age (P < .001) and statistically significant differences (P < .05) in utility were found by ethnicity, socioeconomic quintile, and disease conditions such as stroke, diabetes, cancer, depression, and musculoskeletal conditions, using a tobit regression.

Conclusions

This study provides the first nationally representative set of population norms based on a local value set for key demographic groups and selected chronic disease conditions for Sri Lanka. It also provides a catalog that can be easily used to calculate quality-adjusted life-years for cost-utility analysis when modeling public health interventions.