Value in Health最新文献

Objectives: The EQ Health and Wellbeing (EQ-HWB-9) is a preference-weighted instrument with an interim value set for assessing health and wellbeing in patients, social care users and carers. This study evaluated the experimental (2022) version's psychometric properties and compared it with established measures in a UK general population sample.

Methods: Data were drawn from a large cross-sectional survey of the UK general population (n = 11,383). Ceiling/floor effects were assessed at item (>50% extreme responses) and instrument (>15% at min/max score) levels. Convergent validity was assessed using Spearman correlations between EQ-HWB-9 items and conceptually similar items from the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), ICEpop CAPability measure for Adults (ICECAP-A), Health Utilities Index Mark 3 (HUI3), Office for National Statistics Four Personal Wellbeing Questions (ONS-4) and SIPHER-7. Pearson correlations were used for utility scores. Known-group validity was assessed using effect sizes to examine differences by mental wellbeing, disability, life satisfaction, caregiving status, self-reported health, and age. Agreement with comparator instruments was assessed using Bland-Altman plots and Lin's concordance correlation coefficient (CCC).

Results: Potential ceiling effects were noted for EQ-HWB-9 mobility and activity items, but not at the instrument level. Strong correlations (rs≥0.5, p<.001) with measures hypothesised a priori to assess related constructs (SWEMWBS, ICECAP-A, HUI3, ONS-4 and SIPHER-7) supported convergent validity. The EQ-HWB-9 effectively distinguished between relevant population subgroups (effect sizes≥0.8). Agreement with HUI3 utilities was higher (CCC >0.75) than other comparators.

Conclusions: The EQ-HWB-9 shows strong psychometric performance and is supported for use in UK health and wellbeing assessments.

Objectives: The EARLY TAVR trial demonstrated improved clinical outcomes for patients with asymptomatic severe aortic stenosis (aSAS) treated with transcatheter aortic valve replacement (eTAVR) compared with clinical surveillance (CS). The cost effectiveness of an eTAVR strategy for patients with aSAS in the United States (US) is unknown.

Methods: A Markov model with 30-day cycles was developed from the US healthcare payor perspective to estimate the cost-effectiveness of eTAVR vs. CS over a lifetime horizon. Inputs for population characteristics and health outcomes were derived from the EARLY TAVR trial. Costs were derived from US Medicare reimbursement rates. Probabilistic and deterministic sensitivity analyses were performed to evaluate the effect of parameter uncertainty on model output.

Results: When compared to CS, eTAVR was associated with 0.21 additional life years (LY) and 0.24 additional quality-adjusted life years (QALYs) over a lifetime due to more time spent in the alive and well health state with eTAVR. Lifetime costs were estimated to be $8,812 lower, due primarily to reductions in costs associated with the AVR procedure, stroke, and heart failure hospitalizations. Accordingly, eTAVR was projected to be economically dominant over CS. In probabilistic sensitivity analysis, a large majority of iterations (95.9%) produced cost-effective results ($100,000 threshold) for eTAVR versus CS, with most simulations (90.3%) showing dominance, confirming the robustness of the base case results. These findings were consistent over a variety of scenario analyses.

Conclusions: An eTAVR strategy for the treatment of aSAS may be a cost-saving approach for US healthcare payors, when compared to CS.

Objectives: To examine whether: (1) reasoning for distributional preferences depends on the domain of inequality; (2) reasoning for distributional preferences is affected by cause of inequality; (3) participants provide and explain responses that violate "monotonicity" (the welfare economics principle that, other things being equal, social welfare improves when at least one person is better-off); and (4) the above vary across the digital divide.

Methods: We used mixed-methods to collect qualitative and quantitative data, via online discussion groups with a survey (11 groups, n = 53) and telephone interviews (n = 15) with digital minority individuals. Participants considered scenarios comparing equal and unequal health and wellbeing outcomes for an imaginary island. Well-being was framed as "equivalent income" (described to participants as household spending money, with other life aspects being good).

Results: Distributional preferences varied by domain and cause of inequality but not digital status. Health inequality caused by financial inequality was widely unaccepted. Some preferred equal distributions, even when violating "monotonicity," citing fairness and social cohesion.

Conclusions: Recruiting across the digital divide and using mixed-methods enriches inequality aversion research, enhancing the inclusivity and legitimacy of DCEA.